Preparing for pharmacist independent prescribing at scale

Abstract

From 2026, nearly all new pharmacy registrants in the UK will register as independent prescribers (IPs), which follows on from a 2024 government manifesto commitment to introduce a community pharmacy prescribing service in England.

This perspective article builds on findings from previous research and has been written as information for policymakers, commissioners and educators to support the successful roll out of pharmacist independent prescribing (PIP), particularly within the community pharmacy sector^​1​.

In total, 22 semi-structured interviews have identified work already underway and have identified three priority areas for further action. First, newly qualified prescribers need to start using the competencies that underpin prescribing, which may include writing prescriptions, with support, immediately after qualifying. Also, ongoing support is critical and a shared responsibility between prescribers, employers and commissioners should be built into commissioning frameworks. Finally, increased experiential learning should be built into all undergraduate and post-graduate training programmes.

Challenges identified included: delayed prescribing start, support gaps, placement challenges, governance variability, risk culture, liability confusion and performance oversight.

Conclusion: Community pharmacy can become a frontline prescribing service in England if education, support, governance and culture are aligned and resourced. Immediate next steps could include planned transition from patient group directions (PGDs) to commissioned IP services, prioritised commissioning of support hubs and funding of simulation/placement capacity. 

Key words: prescribing, pharmacist, support, experiential learning, roll out, community pharmacy, liability, scope of practice, scrutiny, risk, multidisciplinary, revalidation, performance management

Introduction

Pharmacist prescribing was introduced in the UK in 2003, albeit in a restricted way^​2​. From 1 May 2006, pharmacist independent prescribing (PIP) was introduced, allowing appropriately trained and accredited pharmacists to prescribe any licensed medicine for any medical condition within their competence, except for controlled drugs, which was enabled in 2012^​3,4​.

Another major change was enacted in 2021 when the General Pharmaceutical Council (GPhC) incorporated prescribing into its ‘Standards for the initial education and training of pharmacists’^​5​. As a consequence of this change, nearly all new pharmacy registrants in the UK from 2026 onwards will also be qualified as independent prescribers (IPs) on registration with the GPhC or Pharmaceutical Society of Northern Ireland (PSNI).

GPhC data indicate that there were 19,615 pharmacist independent prescribers in England on the GPhC register as of 30 September 2025, out of a total of 56,981 pharmacists (34.4%)^​6​. In its 2024 election manifesto, the Labour Party committed to introduce a community pharmacy prescribing service in England, and, as a result, it is highly likely that we will see new clinical services and professional practice utilising the prescribing expertise of pharmacists being commissioned in some form in England within the next few years^​7​.

Several countries have started to introduce PIP, using a variety of implementation models, which present a number of opportunities^​8–10​. Meanwhile, Scotland and Wales have both had community pharmacy prescribing services for several years. While many of these opportunities have so far been focused on secondary care, a tipping point appears to have been reached whereby patients will soon be able to benefit from PIP at scale in community pharmacy in England. The feasibility of this has been demonstrated by the NHS England ‘Independent prescribing in community pharmacy pathfinder programme’, which has recently been positively evaluated^​11​. Patients in the UK have also been shown to be positive towards a pharmacist prescribing model^​12​.

Previous research has identified ten central enablers to the successful rollout of PIP in England (see Box 1)^​1​. Some of these themes and recommendations are already being implemented, at least to a certain extent, such as building experiential learning into undergraduate programmes of study. Although the implementation of experiential learning is outlined within the GPhC ‘Standards for the initial education and training of pharmacists’, the length of the academic year and paucity of funding limits the extent that this can be undertaken^​5​. Other areas are yet to be fully addressed, such as ongoing support being built into commissioning frameworks, newly qualified prescribers to start prescribing with support immediately after qualifying and a performance management framework being in place for pharmacist prescribers.

Work in Scotland has also identified that widespread implementation of PIP is hindered by a lack of shared understanding, inconsistent role structures and limited strategic alignment across the whole system^​13​. Research from other professions, including medicine and nursing, also confirm the importance of experiential learning^{​14–17​}.

Current work by NHS England, in the form of its pathfinder programme, has five areas of focus: clinical, governance, people, digital and funding. An evaluation of the programme was published in January 2026^​11​. It is anticipated that a governance framework and supporting resources will be developed as a result of the outcomes. Further details are expected from NHS England once a response to the evaluation has been prepared.

This is a fast-changing environment that involves many players. While various stakeholders — such as the National Pharmacy Association (NPA) and NHS Education for Scotland (NES) — are looking to put the support and infrastructure in place to enable these advances in practice, there are still many gaps as identified in previous research (see Box)^​1​.

This perspective article summarises the findings from a further scoping exercise that looked deeper into these research findings, aiming to prioritise the key themes and provide advice on how recommendations might be addressed in a way that is co-operative, UK and sector wide and in synergy with the NHS England pathfinder programme (see Figure). Findings indicated that success will depend less on legislative change and more on how systems, training and culture adapt to support confident, safe prescribing at scale.

As NHS England accelerates its 2026 vision for a fully integrated, prescribing-enabled pharmacy workforce, strategic enablers across education, practice and governance are needed. Drawing on stakeholder insights, the scoping exercise identified priority actions to support safe, confident and sustainable prescribing practice — particularly in community and primary care settings.

Methods

A total of 22 semi-structured qualitative interviews were conducted with a range of stakeholders, resulting in 354 pages of transcript. Stakeholder representatives came from:

• The Royal Pharmaceutical Society (RPS), now the Royal College of Pharmacy (RCPharm);
• Several higher education institutions in England, Scotland, Wales and Northern Ireland;
• The Company Chemists’ Association;
• The Independent Pharmacies Association;
• The NPA;
• NHS England;
• NES;
• Postgraduate pharmacy deans;
• Practising pharmacist IPs.

These interviews identified current work related to the factors identified in the Box above in all UK jurisdictions. Participants were asked to prioritise their top three areas that they felt were the most important things to be addressed to enable the successful rollout of PIP at scale in community pharmacy.

Transcripts were recorded using Microsoft Teams, with important themes and priorities identified through manual thematic analysis and the use of Microsoft Copilot.

Findings and discussion

Interviews with key stakeholders, used to support and shape policy thinking, identified three interdependent priorities: 

• Immediate prescribing post-qualification. Prescribers need to begin prescribing, with support, immediately after qualifying;
• Structured ongoing support. Support, in both real-time and reflective, is critical and whilst a shared responsibility between prescribers, employers and commissioners, should be built into commissioning frameworks;
• Embedded experiential learning. Experiential learning should be built into all training programmes.

Each priority represents both opportunity and challenge across practice settings. These are shown in the Figure below, along with recommendations regarding how those might be addressed. 

Figure: Priority areas and potential actions

In addition, the following observations were made from the same interviews and literature review.

Bridging the transition from qualification to practice

There was strong consensus that newly qualified IPs must begin using the competencies that underpin prescribing, which may include writing prescriptions immediately after qualification. This aligns with wider health workforce literature that shows that delays between qualification and practice lead to skill decay, reduced confidence and attrition of clinical competence^​18​. The absence of a national community pharmacy prescribing service in England currently prevents many pharmacists from consolidating their skills, creating both professional frustration and a potential patient-safety risk through de-skilling.

Structured transitional pathways — such as Scotland’s ‘Teach and treat’ hubs or supervised prescribing models — could offer a continuum between qualification and full practice responsibility. These models enable graduates to develop confidence while maintaining safety under supervision.

Patient group directions (PGDs) and initiatives such as ‘Pharmacy First’ may serve as interim platforms, allowing early-career prescribers to apply skills in defined contexts; however, they must be viewed as transitional models of practice, rather than terminal. Sustainable prescribing competence requires progression from protocol-led to autonomous, patient-centred decision-making.

Embedding support as a condition for safe practice

Stakeholders consistently identified the lack of systematic post-qualification support, especially in community pharmacy, as a critical gap. The importance of this support has been recognised and the RCPharm is developing a new enhanced curriculum aimed to support newly qualified pharmacist prescribers from summer 2026^​19​. While informal peer networks have emerged, they remain inconsistent, unfunded and reliant on individual goodwill. In contrast, prescribers in hospital and GP-integrated settings benefit from access to senior colleagues, structured supervision and established governance systems that foster reflective learning and shared accountability.

This unevenness risks exacerbating inequities in both professional confidence and patient safety. To address this, establishing regionally commissioned support hubs, with defined mentorship, supervision and escalation structures, should be seen as a precondition of service rollout rather than a discretionary enhancement, ensuring parity across sectors. 

Studies and national frameworks in pharmacy and nursing show that prescribers who receive structured post-qualification support report^{​20–23​}:

• Higher prescribing confidence;
• Lower error rates;
• Better integration into multidisciplinary teams (MDTs);
• Greater retention in prescribing roles.

Without such structures, expansion of prescribing risks overburdening professionals and undermining patient safety.

Support should also be conceptualised as a shared responsibility:

• Commissioners must fund and mandate it;
• Employers must operationalise it; and
• Practitioners must actively engage in reflective supervision and see supporting one another in a supervisory and mentoring capacity as a professional obligation, as in other vocational professions.

Reframing experiential learning as a continuum

Experiential learning is widely recognised in healthcare education as essential for developing clinical competence, professional identity and interprofessional collaboration. Studies have suggested that it enhances retention, confidence and readiness for real-world practice^​24​. In this scoping report, experiential learning emerged as the cornerstone of preparedness for prescribing. Interviewees agreed that authentic, longitudinal clinical exposure — rather than brief observational placements — is essential for developing competence, confidence and professional identity.

However, the current MPharm structure and financial model limits opportunities for extended placements, given its classification as a non-vocational degree. This structural barrier not only restricts capacity for experiential learning and assessment but reinforces pharmacy’s identity as a product-focused rather than patient-facing profession. Reclassifying pharmacy education as a vocational programme, akin to medicine and nursing, could unlock year-round placement opportunities and better align educational funding with modern practice requirements. In reality, the funding required to do this would be significant and would require the will of government.

Where live clinical exposure remains constrained, high-fidelity simulation, entrustable professional activities (EPAs) and spiral curricula can strengthen decision-making and clinical reasoning. These tools allow students to practise managing clinical uncertainty, which is an essential skill for safe prescribing.

Experiential learning should be viewed as a continuum from undergraduate training through early-career development, supported by supervision and reflective practice. This is happening to an extent in MPharm curricula accredited under the 2021 GPhC’s initial education and training standards^​5​. Embedding learning and assessment within authentic clinical environments ensures that prescribing competence evolves alongside professional identity.

Governance, scope and culture: enablers of safe scale-up

Beyond education and support, systemic factors in governance and professional culture will determine whether prescribing can be safely scaled. Governance frameworks currently vary widely — from restrictive formularies to unmonitored autonomy — creating uncertainty and inequity across sectors.

A consistent national framework for expanding scope of practice, underpinned by self-assessment and reflective learning rather than condition-specific credentialing, would help pharmacists adapt safely to evolving clinical roles. Such a framework would allow flexibility for professional growth while maintaining accountability and patient safety.

Equally, professional culture must shift from “risk aversion” to “risk management.” Results from a 2021 study showed that pharmacists often exhibit cautious decision-making, especially when clinical risk is perceived to be high or when governance structures are unclear^​25​. Pharmacists’ traditional focus on error prevention, while valuable, must evolve to include comfort with clinical ambiguity and the understanding that inaction can itself constitute risk. Building comfort with clinical ambiguity and shared decision-making requires structured exposure to real-world prescribing scenarios, case-based learning and simulation of uncertain or complex cases, and must be embedded throughout training and early practice.

This cultural evolution will help reposition pharmacists as active clinical decision-makers rather than custodians of safety boundaries.

Integration and multidisciplinary collaboration

As prescribing becomes mainstream, pharmacist IPs must be integrated into MDTs to maximise clinical safety and patient benefit. PIPs must work alongside doctors, nurses and allied professionals in shared-care models that promote communication, referral and joint accountability. In 2023, results from a systematic review revealed that including pharmacists in MDTs significantly reduced adverse drug events^​26​. The review concluded that pharmacist integration improves medication safety through real-time review, reconciliation and education. The RCPharm prescribing competency framework includes collaborative working as a core competency, stating that safe prescribing requires effective communication and shared decision-making with other professionals^​27​. 

The relative isolation of community pharmacists poses a barrier to this, though digital connectivity, shared electronic records and hub-and-spoke networks linking community pharmacies with primary care MDTs can bridge this gap. Exposure to MDT practice — both during training and in early career — not only enhances communication and referral pathways but also normalises shared accountability, collaboration and supports safe escalation of complex cases.

Commissioning prescribing services that include explicit referral and review mechanisms would further facilitate safe integration, reduce professional isolation and ensure that patient care remains continuous and coordinated.

Policy and implementation implications

Further reviews have highlight how national policy enabled widespread adoption of link worker models in primary care^​28,29​. To realise the vision of a fully prescribing-enabled pharmacy workforce by 2026, policy must synchronise three domains: education, practice and governance.

• Education providers should prioritise longitudinal experiential learning and simulation-based assessment to prepare graduates for clinical decision-making;
• Employers must invest in supervision infrastructure and protected learning time for early-career prescribers;
• Commissioners and regulators should embed expectations for mentorship and governance within service specifications.

Liability clarity, structured revalidation and proportionate performance management frameworks should underpin these reforms, and regulation should focus on maintaining competence and professional reflection rather than imposing rigid credentialing frameworks. Credentialing will become essential for maintaining standards of practice across the workforce and reflective revalidation as now is not enough.

Ultimately, the goal is not simply to enable pharmacists to prescribe but to ensure they do so within systems that sustain competence, collaboration and public trust.

Conclusion

PIP has the potential to transform access, safety and efficiency in primary care; however, without deliberate attention to the transition from qualification to practice, the establishment of robust support mechanisms and the embedding of experiential learning and curricular throughout education and early-career stages, there is a risk that policy ambition will outpace professional readiness. The findings of this scoping exercise therefore offer a roadmap for safe and sustainable scale-up, anchored in the principles of preparation, support and governance.