The government wants community pharmacists to prescribe.
Following comments from health minister Baroness Gillian Merron confirming that pharmacist prescribing will form part of negotiations for the 2026–27 Community Pharmacy Contractual Framework (CPCF), policymakers appear increasingly committed to expanding the clinical role of pharmacy.
That ambition is understandable.
But before government asks community pharmacy to take on new clinical responsibilities, it must confront a fundamental reality: the sector it is relying on is already under significant financial strain.
Clinical
IPCN supports the appropriate expansion of clinical services delivered through community pharmacy.
There is a strong case for doing so. Community pharmacies are among the most accessible healthcare settings in the country. Around 90% of people in England live within a 20-minute walk of a pharmacy, according to NHS data. Pharmacists already provide medicines optimisation, clinical advice and urgent care support to millions of patients every week.
Read more: NHSE to ‘consult’ with CPE on national prescribing service
Recent services show what can be achieved when the right model is in place. Pharmacy First, for example, demonstrates how community pharmacies can safely manage common clinical conditions in the community while helping to reduce pressure on general practice and urgent care services.
Independent prescribing has the potential to build on that progress.
With all newly qualified pharmacists registering as independent prescribers from 2026, the profession will soon have a workforce capable of delivering a much broader range of clinical services. Properly implemented, pharmacist prescribing could significantly improve access to treatment and allow pharmacists to practise at the full extent of their clinical training.
But this opportunity comes with an important condition:
Structural underfunding within the Community Pharmacy Contractual Framework must be addressed first.
Absorbed
Community pharmacy has absorbed increasing clinical responsibilities over several years while operating within a funding framework that many contractors say no longer reflects the real cost of delivering services.
At the same time, more than 1,000 pharmacies have closed in England since 2017, according to NHS Business Services Authority data.
Read more: RPS calls for ‘clearer’ regulation of private prescribing
The economic review commissioned by Community Pharmacy England estimated that the sector faces a funding gap of at least £1.9bn annually, highlighting the scale of the structural pressure within the current contract.
The sector is therefore being asked to expand clinically while the financial foundations of the network remain fragile.
If pharmacist prescribing is introduced without addressing this underlying funding gap, there is a real risk that the policy could place further strain on pharmacy businesses rather than strengthening the network.
That would undermine the very system policymakers are hoping to expand.
Read more: Independent prescribing training: which costs are covered?
Independent prescribing requires infrastructure. Pharmacies must have appropriate consultation facilities, interoperable IT systems and clear governance frameworks.
Workforce training, supervision arrangements and indemnity provisions must also be in place before prescribing can be delivered safely at scale.
All of this requires investment.
Advanced
One possible model already exists. Pharmacy First was introduced with dedicated funding rather than being financed by cutting other pharmacy services. If independent prescribing is to succeed, it should follow a similar approach: ringfenced funding that supports the clinical infrastructure required to deliver the service safely.
Independent prescribing must also be understood as a different level of clinical intervention compared with Patient Group Direction (PGD) services.
Read more: What pressures do new independent prescribers face?
PGDs allow pharmacists to supply medicines within clearly defined clinical pathways. These services are designed to manage common conditions efficiently and safely within tightly specified protocols.
Independent prescribing, however, involves a fundamentally different level of clinical responsibility.
An independent prescriber must take full clinical accountability for the assessment, diagnosis and prescribing decision. This requires structured consultations, clinical judgement, documentation and appropriate governance oversight.
In practice, this places the pharmacist much closer to the responsibilities carried by advanced clinical practitioners.
For that reason, independent prescribing should not be commissioned or reimbursed at levels comparable to PGD-based services.
Doing so would fail to recognise the additional clinical expertise, time and professional accountability required to deliver prescribing safely.
If policymakers treat independent prescribing as simply another minor pharmacy service, the system risks undervaluing the very clinical capability it is seeking to expand.
Structural risk
There is also a long-term structural risk that must be considered.
Once a funding benchmark for prescribing services is established, it becomes extremely difficult for community pharmacy to renegotiate that level in future. If the initial reimbursement is set too low, the sector may find itself locked into an unsustainable funding model for years.
Getting the financial framework right from the start is therefore essential.
Read more: Independent prescribing one of new England pharmacy chief’s main priorities
There is also a patient safety dimension that must not be overlooked.
If government moves ahead with prescribing services while the underlying contractual framework remains underfunded, pharmacies may struggle to invest in the consultation facilities, workforce capacity and governance systems needed for safe prescribing practice.
The danger is not that pharmacists lack the clinical ability to prescribe. They clearly do.
The risk is that the system in which they are asked to prescribe may not be adequately resourced to support them.
This is why the sequence of policy decisions matters.
Stabilising the contractual framework should come first. Expanding services should follow.
Weaken
Negotiations on the next CPCF are already underway, and the government faces significant financial pressures across the NHS. It is reasonable to ask whether there is any realistic prospect of additional funding being made available this year.
But the alternative must also be considered.
If the structural issues within the contract remain unresolved, further pharmacy closures and reduced capacity become increasingly likely. That outcome would weaken one of the NHS’s most accessible healthcare networks at precisely the moment policymakers are hoping to expand its clinical role.
Read more: Govt commences negotiations on 2026/27 funding contract
In that context, investment in community pharmacy should be viewed not simply as an additional cost but as a way to protect and strengthen a critical part of the primary care system.
Independent prescribing could represent one of the most significant developments in community pharmacy in decades.
But it must be introduced in the right way.
If government wants community pharmacy to play a greater clinical role within the NHS, it must first ensure the sector has the stable financial foundations needed to support that expansion safely and sustainably.
Tas Bhatti is an Independent Pharmacy Contractor and IP and a board member of IPCN.