Pharmacist prescribing pilots to test new services for depression and minor illnesses

Community pharmacies in Cheshire and Merseyside could soon offer a step-down service for antidepressants, as part of plans to pilot an independent prescribing service in the area.

The service will form part of a wider offering through the NHS Community Pharmacy Pathfinder Programme in the north west of England, which could also see pharmacists prescribe for respiratory or cardiovascular diseases, as well as minor illnesses.

The programme was revealed by The Pharmaceutical Journal in August 2022 and will pilot the first ever pharmacist independent prescribing service to be fully funded by the NHS in England.

In January 2023, integrated care boards (ICBs) were invited to submit bids to NHS England for additional funding to run the pilot service in their areas.

Then, in April 2023, three ICBs in the north west of England invited community pharmacy contractors to register expressions of interest to become pilot sites.

The three ICBs — NHS Cheshire and Merseyside; NHS Greater Manchester; and NHS Lancashire and South Cumbria — presented their models for the pathfinder pilots in a webinar for community pharmacists on 24 April 2023.

Slides presented during the webinar revealed that pharmacies participating in the pilot programme in each ICB will be able to prescribe for “minor infections”, which are “likely to include urinary tract infections, bacterial conjunctivitis for children and sore throats”.

Pharmacies will also be able to choose to offer “additional services” for respiratory diseases, cardiovascular diseases or a service focusing on “step-down of antidepressant therapy”, depending on which ICB the pharmacy is located in (see Box).

Commenting on the step-down service, Roz Gittins, president of the College of Mental Health Pharmacy, said it is “a positive development that opportunities for pharmacists to use their prescribing qualifications are being explored”.

“We know some people can find discontinuing their antidepressants difficult and hopefully having such services will increase the support that people need.

“Community pharmacists are ideally placed to be able to undertake such work, so long as they have appropriate resources and capacity to do so,” she said.

The slides add that the respiratory service will be “focusing on switching to greener inhalers”, while the cardiovascular disease service will link to the NHS Hypertension Case-Finding Service that has been running in some community pharmacies since October 2021.

Adam Irvine, chief executive officer of Community Pharmacy Cheshire and Wirral, said: “It’s really exciting to see those with independent prescriber qualifications be able to use those skills in a community setting on behalf of the NHS.

“We’re just coming towards the end of the expression of interest stage in the potential pathfinder programme and I believe we do have a number pharmacies who are keen to take part — what we don’t know at this stage is the number of pharmacies nor the number of sessions that the programme will have the capacity to commission as there will, of course, be a financial pot to commission this from.”

He added that the local pharmaceutical committee is “encouraging those who are interested to express that formally and, once the full details are known, will be helping contractors to review what works best for their own businesses in delivering these services”.

Plans to enable pharmacists to prescribe medicines through a minor illness pathfinder service come after the government announced on 9 May 2023 that it plans to roll out a ‘Pharmacy First’ service in England by the end of 2023, which will enable pharmacies to supply prescription-only medicines for minor illnesses using patient group directions.

In a letter sent to pharmacy contractors on 25 April 2023, Alison Scowcroft, community pharmacy clinical lead at NHS Greater Manchester ICB, said the pathfinder pilot will “test out and evaluate the requirements and processes behind IP [independent prescribing] with community pharmacy”.

“The aim of the community pharmacy IP pathfinder programme is to establish a framework for the future commissioning of NHS community pharmacy clinical services, incorporating independent prescribing, for patients in primary care,” she said, adding that “funding will be provided to cover the clinical time of the pharmacist IP and support to deliver the programme”, with further details to be announced soon.

Scowcroft added that the ICB “will notify [community pharmacy] applicants in late May to early June [2023] if they have been successful”.