Independent prescribing in community pharmacy – the pathfinder programme

As chair of Community Pharmacy London, which represents 1,500 community pharmacy contractors in London, I write to express our concerns regarding the commissioning of the community pharmacy independent prescriber pathfinder service, a programme aimed at expanding primary care pharmacy services.

While we share the common goal of enhancing community pharmacy services, the current framework falls short of delivering quality care to patients and providing value to both the NHS and community pharmacies. 

Our primary concern revolves around the need for increased investment from NHS England to bolster primary care pharmacy services. The lack of adequate funding has hindered our ability to fully realise the potential of certain services, such as the discharge medicines service (DMS), leading to suboptimal patient outcomes. 

Here are some key issues that need urgent attention: 

Patient safety and software: Independent prescribers (IPs) require seamless access to GP records and real-time communication with GPs to ensure patient safety. The proposed IT solution poses significant risks and alternatives with greater interoperability should be explored to enhance patient safety. 

Use of locum agency fees: Benchmarking funding for independent prescribing services based on locum agency fees is problematic owing to the considerable difference in compensation between locum pharmacists and IPs. The proposed rate fails to account for additional costs, such as national insurance and pension contributions, further exacerbating the issue. 

Opportunity costs: The funding model overlooks the opportunity costs incurred by pharmacies with limited consulting rooms. It fails to incentivise the recruitment of registered professionals or support the development of new consultation spaces, which are crucial for the successful implementation of advanced services. 

Recruitment costs: The proposal only covers the cost of IPs, neglecting service fees and return on investment for contractors, potentially resulting in financial losses. 

Specialist insurance and set-up costs: The need for specialist independent prescribing insurance and other setup costs are not adequately addressed in the funding allocation, creating additional financial burdens for contractors and prescribers. 

Local enhanced service: While labelled as a local enhanced service, the community pharmacy IP pathfinder service is, in reality, nationally specified. Clarity is needed on the source of additional funds for this service. 

We understand the constraints of a pilot programme with limited funding, but striking a balance between fiscal responsibility and the successful implementation of high-quality healthcare services is paramount. We urge NHS England to review the funding structure for community pharmacy IP pathfinder sites, significantly increasing the hourly rate to reflect the true costs. 

Furthermore, we propose exploring new payment models that appropriately reward outcomes, training and quality assurance. Community Pharmacy London is willing to collaborate with NHS England and Community Pharmacy England to develop a transparent and effective mechanism for implementing and benefiting from this transformative service. 

Ensuring the safe and successful scaling of this service nationally is of utmost importance. 

Raj Matharu

Last updated
The Pharmaceutical Journal, PJ, September 2023, Vol 311, No 7977;311(7977)::DOI:10.1211/PJ.2023.1.197234

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