A prescribing service for pharmacies in England: everything you need to know

An independent prescribing pharmacy service, announced as part of the ‘Community pharmacy contractual framework’ in May 2026, allows qualified pharmacists to prescribe within existing Pharmacy First and contraception services, additional service pathways and prescription management.

The service arrives as prescribing becomes part of pharmacists’ training: all those trained under standards introduced in 2021 now join the register as qualified prescribers, while some who trained earlier have also qualified as independent prescribers. 

By September 2026, 41.3% of pharmacists in England held an independent prescribing annotation^​1​, but the proportion drops to around one in five within community pharmacy. An NHS prescribing service is expected to help the sector attract and retain more prescribers.

Path to prescribing

From 2024, around 200 community pharmacies in England tested NHS prescribing services through the national ‘Independent prescribing pathfinder programme’.

The programme piloted prescribing for a range of conditions, including minor ailments, hypertension and lipid management, contraception and women’s health, as well as prescription management.

NHS England data cited in a University of Manchester evaluation report, published on 8 January 2025, show that pathfinder sites delivered more than 33,000 consultations, 97% of which concluded without patients needing to be seen by anyone else. 

However, the evaluation identified concerns about access to the pathology and digital infrastructure needed to manage long-term conditions.

The national service that followed — ‘NHS community pharmacist prescribing’ — launched in autumn 2026, does not yet extend to long-term conditions. Instead, it covers Pharmacy First, contraception and prescription management, plus five new prescribing-only pathways.

How will prescribing extend Pharmacy First?

Prescribers will be able to build on the seven existing Pharmacy First patient group directions (PGDs) in England.

For each clinical pathway (see table 1) prescribers can treat patients outside of eligibility criteria, with flexibility around age and whether the patient is breastfeeding or pregnant, if clinically appropriate.

There is also flexibility around the treatment they can offer, as long as the prescribed treatment is in line with national guidance and local formularies. For example, if a patient is hypersensitive to the first-line agent or excipients or if they have an inability to swallow tablets or capsules.

“Ultimately, as a prescriber, you are making a clinical decision yourself, and you will document why you have made that decision, and what you’ve excluded, and what your differential diagnosis thought process has been,” Kirsty Armstrong, senior policy lead for clinical strategy for pharmacy at NHS England, said at the Pharmacy Show, held in Birmingham on 12 October 2026.

Pharmacists must undertake prescribing activity within their scope of practice and competency, as set out in the Royal College of Pharmacy’s competency framework for all prescribers, the NHS England service specification says.

Available prescribing possibilities within the existing seven clinical Pharmacy First pathways include:

• Flexibility on age and other eligibility criteria, such as breastfeeding and pregnancy, if clinically appropriate;
• Flexibility on treatment if needed (e.g. hypersensitivity to first-line agent or excipients, inability to swallow tablets or capsules, concurrent interacting medicines, long-term antibiotic treatment or prophylaxis, known or suspected liver disease, electrolyte disturbance), in line with national guidance and local formularies.

Table 1: Prescribing within existing seven Pharmacy First pathways

Prescribing pharmacies can also offer as many of the five new prescribing-only pathways as they feel competent to, and they must have a clear plan in place for the prescriber to upskill to be able to deliver the rest of the five prescribing pathways. They may not prescribe for the minor illness and urgent repeat medicines elements of Pharmacy First.

Table 2: Five new prescribing-only Pharmacy First pathways

What additional contraception can prescribers offer?

Under the existing pharmacy contraception service, pharmacists can initiate and continue oral contraception without prescribing, free of charge to all patients.

This covers the combined oral contraceptive pill and drospirenone from menarche up to and including patients aged 49 years and other progestogen-only pills (e.g. norethisterone, levonorgestrel and desogestrel) up to and including patients aged 54 years.

Prescribers will be able to supply additional options, including vaginal rings, patches and — where administration is locally funded — contraceptive injections. 

Non-contraceptive benefits may inform the choice of contraceptive, but prescribing solely for a non-contraceptive indication is outside the scope of the NHS service and not eligible for payment, the specification notes.

No prescribing extension is currently proposed for emergency hormonal contraception.

What is prescription management?

Guidance on prescription management sets out when pharmacist prescribers may amend or optimise a prescription, in line with local agreements.

Pharmacist prescribers must seek informed patient consent, document their actions and take full professional responsibility for any prescribing decision.

The draft guidance does not allow pharmacists to amend another prescriber’s prescription on their behalf. Instead, the pharmacist carries out an independent clinical assessment and, where appropriate, issues their own prescription to resolve the issue, it adds. 

Prescription management should be used only if the issue cannot be resolved through routine dispensing; the intervention is clinically appropriate and in the patient’s best interests; the patient has given informed consent; and appropriate communication and governance arrangements are in place with the original prescriber.

What cannot be prescribed under prescription management?

Prescription management must not be used for complex medicines — including specialist and shared-care medicines, medicines requiring ongoing monitoring, controlled drugs and other high-risk medicines — unless covered by local agreements and the pharmacist is competent to prescribe them. 

Pharmacists must not prescribe products excluded by national regulations or national or local guidance. Depending on that guidance, they may also be unable to prescribe dressings, appliances, products on local integrated care board (ICB) ‘blacklists’ or deemed unsuitable for community pharmacy prescribing by ICBs, and items that should not be routinely prescribed in primary care. 

They also must not prescribe over-the-counter (OTC) or Pharmacy (P) medicines unless a national or local service specifically permits this.

Branded products are excluded unless there is a clinical indication, while prescription management must not be used to switch between a prescribed brand and a generic solely for cost reasons, or for the pharmacy’s financial gain, including through rebate schemes.

How do pharmacies sign up to become a prescribing pharmacy?

According to NHS England, contractors first make a declaration on the NHS Business Services Authority (NHSBSA) website, giving details of their prescribing pharmacists. An NHS prescribing pharmacist must be available for a minimum of 24 hours per week during the pharmacy’s core and supplementary opening hours, and for at least 45 weeks in each financial year, recognising periods of annual leave and sickness absence.

Their ICB then approves the application and asks the NHSBSA to set up a cost centre.

Prescribers are added to the cost centre using their General Pharmaceutical Council number and can be linked to more than one pharmacy. Once the ICB confirms it is in place, the pharmacy becomes a prescribing pharmacy and can receive set-up and infrastructure payments.

What IT arrangements need to be in place?

Prescribing pharmacies must be able to issue electronic prescriptions through an approved NHS electronic prescription service (EPS) supplier. A previous investigation by The Pharmaceutical Journal, carried out in May 2026, found variation in local funding for IT systems, suggesting the cost may have deterred some contractors from offering prescribing before a national service was commissioned. 

Speaking at the Pharmacy Show, held on 13 October 2026, Anne Joshua, deputy director of pharmacy commissioning and transformation at NHS England, warned pharmacies against signing long-term contracts with new IT suppliers as she outlined plans for patient medication record (PMR) suppliers to build and assure integrated systems over the next two years.

In the meantime, pharmacies will need to document consultations and make NHSBSA claims separately, which could involve “some very manual elements”, said Daniel Ah-Thion, IT lead at Community Pharmacy England. The negotiator has previously warned of “significant shortcomings of the interim NHS IT arrangements”.

How will pharmacist prescribing be funded?

Participating pharmacies will receive a one-off set-up fee of £500 once their registration and assured EPS product are confirmed.

They will then receive a monthly infrastructure fee of £525 to support ongoing costs, such as the EPS system and clinical supervision. 

Contractors will receive the existing £17 fee for Pharmacy First and £20 or £25 for contraception consultations but no additional fee for prescribing.

Pharmacy leaders have raised concerns that the funding for the service will not cover costs.

“Our view is [contractors] should think really carefully about whether to actually engage with the service,” Janet Morrison, chief executive of Community Pharmacy England, told The Pharmaceutical Journal in June 2026.

Will prescribing extend to long-term conditions?

Wasim Baqir, head of pharmacy integration at NHS England, confirmed at the Pharmacy Show that prescribing for long-term conditions — highlighted by the pathfinders — is still being explored.

A ‘Prescribing development programme’ is testing how prescribing pharmacies could work within local neighbourhoods, trialling clinical pathways starting with cardiovascular disease, he added.

Baqir noted that the programme is also looking at how to strengthen multidisciplinary team working and developing potential commissioning and contractual models.

“We want to really understand over the next year and a half what it looks like for commissioning, and especially local commissioning and in neighbourhoods,” he said.

How quickly will prescribing roll out?

At the Pharmacy Show, Armstrong suggested that prescribing was being introduced gradually, with a “balance” of familiar and potentially more complex conditions.

Prescribing is expected to roll out more widely as more pharmacists qualify and feel confident to prescribe, and more pharmacies sign up. 

Ali Sparke, director for pharmacy, optometry, dentistry and the NHS standard contract at NHS England, told attendees at the Pharmacy Show: “It is inevitable when rolling out something like prescribing that we need to work with the pharmacies who can do it safely.

“We don’t have 10,000 pharmacies who can deliver prescribing at the moment, there just aren’t enough pharmacists with that qualification working in the sector.

“It also does give us a chance… to roll things out over time, to make sure it works for patients before we go further, so I’m really keen to make sure we get that right.”

Sparke added that he wanted feedback from pharmacists and pharmacy teams too.

“This is the first time we’re introducing this type of provision into the contract. We need to learn how it works from you guys as we continue to try and get it right,” he said.