Why clinical mentorship should be embedded into community pharmacist prescribing

The ‘NHS long-term plan’ set out a clear ambition to redesign primary care to improve access, reduce unwarranted variation and shift care into community settings^​1​. Within this vision, community pharmacy is positioned as a highly accessible part of the primary care system, with pharmacists increasingly expected to deliver direct clinical care, including independent prescribing^​2​. 

The independent prescribing pathfinder programme — which tested different ways that community pharmacy could deliver prescribing services in England — represents a critical step towards realising this ambition. Since the first sites went live in spring 2024 until the programme concluded on 31 December 2025, the pathfinders explored how pharmacist independent prescribing could be delivered safely and effectively outside traditional medical settings, generating important learning to inform future community pharmacy commissioning models^​3​. The University of Manchester’s evaluation of the programme, published in January 2026, identified supervision and support for independent prescriber (IP) pharmacists as “crucial”^​4​.

As lead clinical mentors supporting the pathfinder programme across Greater Manchester, Cumbria and South Lancashire, we have worked closely with community pharmacist IPs as they transition into autonomous prescribing roles. The lessons from this work are consistent and clear: prescribing in community pharmacy is feasible and beneficial for patients, but only when supported by appropriate clinical and system infrastructure.

Why clinical mentorship is essential 

Independent prescribing is well established within general practice and secondary care environments supported by multidisciplinary teams and embedded governance structures. 

However, community pharmacy presents a distinct clinical context. Pharmacists may be the only prescriber on site, consultations frequently occur at first point of contact, and clinical information may be incomplete. Evidence suggests that successful integration of pharmacist prescribing depends heavily on organisational support, professional collaboration and access to clinical supervision^​5​.

Clinical mentorship therefore fulfils several essential functions:

• Supporting safe and defensible prescribing decisions;
• Reducing unwarranted variation in practice;
• Strengthening clinical governance and accountability;
• Providing professional support and reducing isolation;
• Enabling continuous service improvement.

Recent scoping reviews demonstrate that pharmacist IPs improve patient access and care delivery but highlight variability in implementation where structured support mechanisms are absent^​5,6​. Clinical mentorship should therefore be understood not as optional professional development but as a core patient safety intervention.

From qualification to clinical readiness

This is particularly important for newly qualified prescribers — a workforce that is being significantly transformed by the introduction of pharmacist independent prescribing at the point of registration^​7​. From September 2026, newly qualified pharmacists will join the register as IPs, substantially expanding prescribing capacity across primary care^​8​.

However, qualification alone does not equate to clinical readiness. Research examining pharmacist IPs consistently highlights that confidence, clinical reasoning and integration into practice develop through supported experiential learning and supervised application rather than formal training alone^​6,9​.

Within the pathfinder programme, clinical mentors have supported pharmacist IPs through:

• Structured case-based clinical supervision;
• Development of clinical reasoning and management of uncertainty;
• Risk assessment and escalation decision-making;
• Safe prescribing documentation and safety netting;
• Reflective practice and professional confidence building.

In 2024, research into community pharmacist prescribing integration revealed that implementation succeeded when education was combined with ongoing professional support structures, allowing clinicians to contextualise learning within real patient encounters^​9​. Similarly, evaluation work exploring pharmacist independent prescribing models — based on the realist model by Pawson and Tilley — emphasised how workforce capability develops through iterative supervision, feedback and supported practice environments^​10,11​.

Without this structured transition, prescribing activity risks remaining inconsistent or underutilised — a challenge already identified within community pharmacy, where lack of supervision and opportunity remain crucial barriers to prescribing adoption^​12​.

System-level leadership

Clinical mentorship alone cannot deliver workforce transformation. Integrated care board (ICB) leaders have played pivotal roles in enabling pathfinder delivery. Their work has included:

• Translating national policy into locally deliverable service models;
• Aligning prescribing pathways with ICB priorities;
• Coordinating training, workforce development and governance frameworks;
• Managing operational risk and funding flows;
• Facilitating collaboration between community pharmacy, general practice and wider system partners.

The pathfinder programme itself reflects a system-level approach designed to test how prescribing models can operate safely within integrated neighbourhood services^​3​. Leadership coordination has enabled shared learning events and communities of practice to function across regions, ensuring that mentorship, education and governance operate as a coherent infrastructure rather than isolated initiatives.

Implications for integrated care boards

Learning from the pathfinder programme will directly inform future commissioning decisions for community pharmacy services^​3​. As ICBs consider continuation beyond pilot funding, commissioning must reflect the realities of safe prescribing practice.

ICBs should:

• Explicitly commission clinical mentorship within prescribing services;
• Recognise lead clinical mentor roles as core clinical governance functions;
• Sustain leadership and programme management capacity;
• Move away from short-term pilot funding models that undermine workforce confidence;
• Embed mentorship and governance requirements into service specifications.

Commissioning prescribing activity without funding the clinical infrastructure that supports it risks increasing variation and limiting service sustainability — barriers already identified within community pharmacy workforce research^​12​.

Overall, the independent prescribing pathfinder programme has demonstrated that community pharmacy can deliver high-quality prescribing services aligned with the strategic direction of the NHS. However, it has also made visible the infrastructure required to do so safely.

Clinical mentorship, supported by leadership, structured education and programme management, is the mechanism through which prescribing policy becomes safe clinical practice. If community pharmacy is to fulfil its expanding role within primary care, commissioning frameworks must recognise and fund this reality.

The ambition is clear. The learning is available. The next step is for commissioning decisions to match expectation with investment.