Greater scrutiny of independent prescribing by pharmacists, nurses and other allied health professionals is needed, particularly from September when there will be an influx of pharmacist qualified to do so, a report from the Nuffield Trust has suggested.
Its review of implementation challenges in independent prescribing concluded there is ‘significant scope to improve the monitoring of workforce activity and prescribing practice’, which would provide ‘greater assurance that independent prescribing is working well’ and support wider use of prescribing skills.
Independent prescribers will play an important role in shifting care from hospitals into community settings and in managing the growing population of people with long-term conditions, the report said.
There are already nearly 100,000 independent prescribers in the UK, representing almost a quarter of the prescribing workforce, the Nuffield Trust calculated.
Pharmacists have the greatest proportion of their workforce qualified as independent prescribers at 33% (22,770 pharmacists), and higher percentages are seen in Scotland (48%) and Wales (44%). The profession is also the fastest-growing group of independent prescribers.
Indeed, fully-qualified graduates of the Master of Pharmacy (MPharm) degree can act as independent prescribers at the point of registration from September 2026, meaning several thousand more pharmacist independent prescribers are expected to join the register each year thereafter.
Over the last four years, over 4,000 students enrolled each year on the MPharm degree, the Nuffield Trust noted.
Independent prescribing supervision and CPD
With this new cohort of prescribing pharmacists, there will be a need for ‘robust supervision’ and continuing professional development, the report said.
But it highlighted that ‘the number of active prescribers will increase more slowly than the number who are qualified to prescribe, because there are not enough opportunities for newly qualified pharmacists to work in roles where they will use their prescribing skills’.
A shortage of designated prescribing practitioners is a ‘significant barrier’ and will be a particular a challenge for pharmacists working in the community, the report added.
Overall, the Nuffield Trust raised concerns that current arrangements for funding, supervision and regulation ‘may not be fit for purpose’ as the independent workforce expands.
It found the training pipeline is fragile, funding to cover both training and the clinical oversight required for trainees is not assured and there is high competition for training places.
Integration of independent prescribing across settings will need to be part of the upcoming NHS 10 year workforce plan and funding for designated prescribing practitioners in the community will need to be addressed, it concluded.
Potential for missed opportunities
Commenting on the report, Nuffield Trust deputy director of research Sarah Scobie said: ‘We have an ageing population which is now living with more health issues, and the Government hopes its ambitions to shift more care closer to home will tackle some of the problems this poses.
‘The NHS will need to harness the full potential of its fast-growing prescribing workforce to realise this change, but we have identified some worrying barriers.’
She called for the NHS workforce plan to clearly set out the role prescribers will play within neighbourhood teams based on local population needs.
‘Better monitoring of independent prescribing practice in all settings will also be crucial. Without this, the opportunities presented by the incoming wave of new pharmacist prescribers will sadly be missed.’
