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'The push for independent prescribing must not just be a tick box exercise’

Many pharmacists will know about the universal rollout for independent prescribers (IPs) in 2026. But is full implementation feasible, asks Danny Bartlett

We all know there are increasing numbers of pharmacists moving to primary care positions from hospital and community pharmacy settings.

So it is hard to envisage both a defined role and stable workforce in the community sector when discussing the impending avalanche of IPs qualifying from the point of registration in summer 2026.

Having moved from community pharmacy into primary care myself, I can see huge potential in collaborative working with community pharmacists.

The additional upskilling of IPs can definitely help share the chronic disease burden of an increasingly ageing population.

It can perhaps prevent the back and forth that currently exists in many pharmacy-GP surgery relationships when queries or suggested medication changes arise.

Read more: ‘From community pharmacy to primary care – why I made the move’

One overriding worry from my standpoint is competence in prescribing and actually improving the education and learning of key prescribing skills to new prescribers. I have this worry both from an initial undergraduate training level, all the way through to qualification and progressing once a recognised prescriber.

A pharmacist currently training to be a prescriber needs 90 hours of supervised practice by a designated prescribing practitioner (DPP) to qualify, along with an extensive portfolio of evidence and reflections on their journey to becoming one.

Read more: Wales: Pharmacies lose ‘up to’ 20% of prescribers to GP practices each year

This is a huge time constraint not only on the pharmacist, but also on the DPP.

If all community pharmacists need this allocation of time, it needs to be accounted for in their workforce planning and quality supervision with someone in the field they hope to practice in.

All too often, a DPP is allocated without full knowledge or expectation of the work entailed.

It is vital to incorporate the clinical skills needed in this relationship, plus valuable experience in prescribing and decision making skills.

It cannot simply be seen as a tick box exercise.

As a senior lecturer, I believe it is our responsibility to change and improve the undergraduate degree to embody key skills needed for prescribing such as shared decision making, limitations of practice and prescribing safety.

Read more: Will independent prescriber changes leave trainee pharmacists behind?

One other big concern, assuming that a newly qualified prescriber has had good and meaningful tuition and supervision, is how they will they integrate their new knowledge into positive clinical impacts without duplication on the other side in general practice.

This can only work if pharmacists in primary care have a fully open GP IT system where records can be accessed.

This should include blood results, consultation history, hospital discharges and full medication access – not just access to the summary care record.

Indeed, many community pharmacies share premises with practices and have open access to these records.

But this is not true for all, and if the ultimate goal is for all pharmacists to be IPs, then all pharmacies, irrelevant of location, should have read and write access to these systems to avoid duplication.

This is no easy feat as accessing this system means training, auditing and strict information governance.

I can’t foresee how a chronic disease clinic – for example, a blood pressure clinic in a more remote community pharmacy – can function without full access to the surgery system to communicate medication changes in real time rather than an administrative time delay.

Read more: A day in the life of a PCN pharmacist: challenging clinical work

Moving from community pharmacy to primary care was a decision I took to improve clinically and get better access to a wider multidisciplinary team.

As well as managing a team of pharmacists and technicians, this allows me constant and consistent access to GPs, care co-ordinators, physios, nurses, social prescribers and health and wellbeing coaches in a timely manner.

At the moment, there seems to be a disconnect between primary care colleagues and pharmacies located perhaps a mile or two away from their nearest surgery, meaning this collaboration breaks down and is lost.

My suggestion would be to integrate community pharmacists with general practice and perhaps a routine half-day or day clinic in practice not only for their 90-hour DPP supervision time, but ongoing post-qualification.

This could be done remotely from the pharmacy or, indeed, in the practice.

However, joined up working like this would mean both the practice and primary care network (PCN) goals for patients are aligned with community pharmacy projects and clinics.

Read more: Underappreciated and lonely: the other side of the PCN pharmacist role

Running a blood pressure clinic once a week from a location that is perhaps more remote than directly next to a practice may help with patient access to services.

Many pharmacies already run ambulatory blood pressure services and liaise with practices regarding these results.

However, running independent clinics while being able to code into the practice systems and change medications independently within a pharmacist’s prescribing scope would close the loop entirely and prevent a back and forth.

Of course, all of this means that the essential dispensing and checking work of community pharmacies would need to be maintained.

This is not only an essential part of the community pharmacy model, but is vital in maintaining patient confidence and continuity of care in the supply of their medications

With comprehensive accuracy checking pharmacy technician frameworks, as well as the emergence of an increasing hub-dispensary model, perhaps this could help relieve the strain on pharmacists who are entering this new world of independent prescribing and want to make more of a clinical impact.

 

Danny Bartlett is a lead pharmacist at a PCN in West Sussex and a senior lecturer in medicines use

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