Community pharmacy ‘conflict of interest’ must be tackled in prescribing pilots, says deputy chief pharmaceutical officer

NHS England needs to work through several “difficult issues” before rolling out an independent prescribing (IP) service in community pharmacies, the deputy chief pharmaceutical officer for England has said.

Speaking at The Pharmacy Show in Birmingham on 17 October 2022, Bruce Warner outlined the plans for ‘pathfinder’ sites that will be set up in each integrated care board in England in 2023 to pilot pharmacist IP services, as revealed by The Pharmaceutical Journal in August 2022.

The pathfinder pilots have been called “potentially game-changing” by pharmacy leaders and are designed to evaluate the best governance, reimbursement and IT support to support a wider rollout of IP services across community pharmacy, possibly from 2024.

Warner said that this included the issue of how a ‘clinical check’ can be carried out if both prescribing and dispensing are done on the same premises.

He said: “If we’re holding the pen on prescribing, and if we still have the same funding model, essentially being paid on volume of dispensing, there is a conflict of interest,” he said. “It’s not impossible to mitigate but we do have to think that through.”

He added: “For years we’ve cast a dim view on dispensing doctors prescribing and dispensing and saying ‘well, where’s the clinical check?’

“So if we’re going to have community pharmacists prescribing within the pharmacy, do we still need that clinical check and, if so, how can that best be implemented? And if we don’t need it, what are the implications for that and what are the mitigations?”

Warner said the issue is one of several that will have to be worked through before all pharmacists are able to become independent prescribers at the point of registration in 2026.

“[There are] some really difficult issues that we need to work through between now and 2026,” he said. “In order to do that, we’re introducing what we’re calling a pathfinder programme… where we’re putting some of these issues out there and saying to systems ‘how would you tackle some of these issues?’”

Speaking at an event for members of the Association of Independent Multiple Pharmacies in September 2022, Anne Joshua, head of pharmacy integration at NHS England, announced plans to open the pathfinder IP programme to expressions of interest from October 2022 until November 2022.

She added that the “overarching aim” of the pathfinder project is to establish a commissioning framework for the service by March 2024.