All 42 integrated health boards in England submit bids for pharmacy independent prescribing services

All 42 integrated care boards (ICBs) in England have submitted expressions of interest to trial a community pharmacy independent prescribing service, a lead pharmacist at NHS England has said.

ICBs were invited by NHS England to express their interest in participating in the pathfinders programme — revealed by The Pharmaceutical Journal in August 2022 — in January 2023, to pilot the first ever pharmacist independent prescribing service to be fully funded by the NHS in England.

Speaking at the Clinical Pharmacy Congress in London on 12 May 2023, Wasim Baqir, lead pharmacist for the Pharmacy Integration Fund at NHS England, said: “It was great to see every ICB in England — all 42 — came back with something.”

Baqir added that ICBs submitted “15 different service types” in their expressions of interest, with those focusing on cardiovascular disease (CVD) the most commonly proposed.

Slides presented by Baqir said the cardiovascular services proposed would include prescribing “statins following CVD risk assessment” and initiating hypertension therapy as part of the NHS Blood Pressure Check service, which has been running in some pharmacies since October 2021.

The slides also showed that 25 ICBs proposed prescribing through the Community Pharmacist Consultation Service, 13 proposed a respiratory service that could provide “rescue therapy with corticosteroids and antibiotics” and increasing or decreasing inhaled corticosteroids, while 12 proposed a contraception service which would “add on to tier 1 or tier 2 advanced services”.

Under tier 1 of the NHS Pharmacy Contraception Advanced Service, which rolled out nationally on 24 April 2023, pharmacists are able to continue the provision of oral contraception. Tier 2, which is currently being piloted, allows pharmacists to initiate oral contraception.

Three ICBs in the north west of England have put forward plans for community pharmacists to offer prescribing services for “minor infections”, respiratory diseases, cardiovascular diseases and a service focusing on the “step-down of antidepressant therapy”.

The proposals were submitted to NHS England before it announced plans to roll out a ‘Pharmacy First’ service by the end of 2023, as part of its efforts to ease pressure on general practice. The service will enable pharmacists to supply prescription-only medicines using patient group directions for minor ailments, including earache and sore throat.

Having received the expressions of interest, Baqir said NHS England will now consider how the service “will look as a national programme”.

“When we set up the pathfinder sites in the next few weeks, we really need to set them up not as a service but as a way of learning,” he said.

In October 2022, Bruce Warner, deputy chief pharmaceutical officer for England, noted several “difficult issues” that needed to be addressed before rolling out an independent prescribing service in community pharmacies, including concerns around a “conflict of interest” if both prescribing and dispensing are done on the same premises.