Managing the shift to prescribing at registration for pharmacists

From 2026, all newly registered pharmacists in the UK will qualify as independent prescribers. This represents one of the most significant developments in pharmacy practice for a generation. It also reflects a national ambition to fully utilise pharmacists’ expertise in medicines, governance and clinical decision-making. More than half of the competencies in the Royal Pharmaceutical Society (RPS)’s prescribing framework relate directly to these areas, making the shift to prescribing at registration both natural and strategically aligned^​1​.

The question, therefore, is not whether pharmacists should prescribe from day one — that principle is well supported — but how this major change should be implemented across a system involving regulators, universities, employers and commissioners. The General Pharmaceutical Council undertook substantial consultations in 2019 and 2021 when developing its ‘Initial education and training standards’, which indicated strong support for modernising pharmacist training while also highlighting concerns about supervision, clinical exposure and differences between sectors^​2,3​. Many of these issues sit beyond the regulator’s remit, which focuses on standards, public protection and educational outcomes.

At the same time, implementation has taken place during a period of significant organisational change, such as the recovery phase following the COVID-19 pandemic and evolving NHS reform. As a result, different parts of the system across nations have progressed at different speeds. This variation is normal in complex workforce reforms and reinforces the importance of co-ordinated system leadership as prescribing at registration becomes embedded.

Against this backdrop, the Leng review of physician associates and anaesthesia associates — published in July 2025 — provides timely lessons about how large-scale changes can be introduced coherently^​4​. Many themes resonate strongly with pharmacy and offer insight into how prescribing at registration can be delivered safely and sustainably.

What pharmacy can learn

Gillian Leng’s review examined the implementation of physician associate and anaesthesia associate roles and identified several factors that influence the success of new or expanded clinical responsibilities^​4​. Four themes are particularly relevant for pharmacy.

1. A shared national narrative supports local decision-making

The Leng review noted that clarity about a profession’s intended contribution helps organisations understand how to deploy it effectively. In pharmacy, the overarching ambition for prescribing at registration is well established, but the specific expectations of newly qualified prescribers inevitably vary by sector. Hospitals, primary care and community pharmacy settings offer different forms of clinical exposure, shaped by their service models. 

A shared national articulation of early-career prescribing would not impose uniformity. Rather, it would provide a foundation from which local systems could interpret the role confidently within their own service models. Although this articulation is beginning to emerge, it has developed in parallel with the practical design work undertaken by higher education institutions (HEIs), NHS education and workforce bodies, and employers. This is a natural feature of large, multi-agency reforms, but it has meant that programmes have been built in real time, rather than sequenced from a single national starting point.

2. Structured supervision underpins safety and confidence

Structured supervision provides the conditions for safe risk management and professional confidence to develop over time. Evidence across pharmacy and wider healthcare demonstrates that observing expert decision-making, articulating clinical decisions, and receiving timely feedback are central to strengthening clinical reasoning and reducing variability in practice^​5–8​.

Across the UK, a crucial consideration has been where structured supervision for early-career prescribers is embedded: within education and training pathways, and/or within the service models through which prescribing activity is commissioned. Training-led approaches typically involve defined educational oversight and quality assurance over a time-limited period, whereas commissioning-led approaches seek to embed supervision expectations within routine service delivery. Evidence in England indicates that, where supervision relies on service models without explicit assurance mechanisms, consistency and quality of support can be variable in practice^​9–11​. 

Within the devolved nations, structured supervision for early-career pharmacists is embedded within nationally coordinated training programmes, within which prescribing development and supervision are incorporated where relevant. Within Scottish and Welsh programmes, supervision and protected learning time are specified within programme design, with training grants used to support this^​12,13​. These approaches illustrate how supervision expectations can be enabled through education infrastructure, with clearer ownership and assurance at national or regional level.

3. Workforce expansion must align with service infrastructure

The Leng review highlighted that when a workforce expands rapidly, supporting systems — such as governance arrangements, work patterns and team configurations — often develop at different speeds^​4​. This is not a criticism of any particular setting or stakeholder for change, but a predictable feature of large-scale transformation. It is directly relevant to prescribing at registration across the UK, which introduces prescribing responsibility early in professional practice and places new demands on how clinical work is organised and supported in day-to-day settings.

Emerging integrated models of care across the UK, including neighbourhood-based models in England that have been further reinforced through recent national policy present both opportunities and challenges for early-career prescribers^​14​. Designed to address fragmentation and improve continuity, these models have the potential to support more integrated clinical decision-making through closer multidisciplinary working, pooled expertise and more flexible use of estates across settings. Shared clinical hubs, hub-and-spoke service models and/or cross-sector supervisory or mentoring roles could enable more consistent access to senior clinical input while making better use of limited supervisory capacity.

For the pharmacy workforce, however, working across organisational and sectoral boundaries introduces new complexities. For example, in England, early-career prescribers may need to navigate multiple teams, sites or governance arrangements in new neighbourhood models of care, which can dilute continuity of oversight unless ways of working are explicitly designed to support this.

Within hospital settings across the UK, pharmacists are encouraged to participate in ward-based clinical activity and multidisciplinary discussions. In practice, operational pressures can limit sustained presence in multidisciplinary teams and board rounds, and pharmacists’ professional accountability and job planning often sit within pharmacy departments rather than ward teams^​15​. This can create a disconnect between where prescribing decisions are made and where clinical oversight and feedback occur — an issue of particular importance for early-career prescribers, who will undoubtedly benefit from repeated exposure to shared clinical reasoning in situ.

A central lesson from the Leng review is that professional reforms are most likely to succeed when accompanied by sustained system capability to adapt roles, workflows and team structures. Recent developments in England, including the proposed abolition of NHS England and a shift in the role of integrated care boards towards more strategic commissioning, risk further constraining the local transformation capacity required to support workforce integration at scale^​16​.

4. Clear professional identity supports patients, employers and pharmacists

The Leng review highlighted that uncertainty about expanding clinical roles can arise when responsibilities and expectations are not clearly communicated^​4​. Pharmacy is in a stronger position than many professions, yet research still shows variation in patient awareness of pharmacist prescribers and differing levels of clinician confidence depending on prior experience^​17​. Clear, consistent messaging about the scope of early-career prescribing — including responsibilities, limitations and expected supervision — will help align expectations across settings.

Earlier articulation of these expectations might have supported sequencing between education, governance and service design. Instead, HEIs, national governance bodies and employers have had to develop their approaches in real time, which is common in large system reforms but highlights the value of defining the point-of-registration role more explicitly where possible.

Professional identity also relates to how pharmacists evidence progression beyond the point of registration and demonstrate that to employers and the public. The RPS provides nationally recognised standards for levels of practice; however, uptake has remained limited in practice, reflecting wider system and organisational factors rather than the utility of the standards themselves.

While nationally recognised credentialing mechanisms are in place, their uptake cannot rely solely on individual professional motivation. For commissioners and employers, clear signals of level of practice are important for workforce planning, assurance and governance; however, credentialing must be supported by aligned incentives, proportionate expectations and avoidance of unnecessary duplication where equivalent development — such as postgraduate diplomas — has already been completed. Consideration is also needed as to how credentialing aligns with existing signals used within the workforce, including job titles and Agenda for Change banding, to ensure coherence rather than confusion in how professional capability is recognised.

The challenge ahead

Prescribing at registration is a forward-looking reform that aligns with national priorities and the evolving role of the pharmacist. The challenge now is to ensure that implementation continues in a coordinated, evidence-informed and transparent way. 

With clear expectations, structured supervision and coordinated system leadership, pharmacy can ensure that prescribing at registration strengthens patient care and makes a meaningful contribution to the multidisciplinary workforce.