What’s next for a community pharmacist prescribing service in England? — transcript
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Joanna Robertson: Welcome back to The PJ Pod, brought to you this week from the back room of a community pharmacy in Northumbria, where I’m meeting the pharmacists hoping to bring prescribing to the high street.
Mark Burdon [on recording]: So, the ICB [integrated care board] chief pharmacist is really good around here, Ewan Maule, and he thinks this is wonderful, and he often rings me up and says, “I’ve just been thinking, could you do…” [laughs]
And I’ll say: “Yes, Ewan, I can. Let’s have a go. Let’s try it.” So, it’s all about trying things.
Joanna: One of those pharmacists is Mark Burdon, who’s been involved in NHS England’s pathfinder programme, which aimed to figure out what a community pharmacy prescribing service could look like.
Joanna [on recording]: So, you’re just trying out loads of different things?
Mark [on recording]: Trying out anything. Anything and everything.
Joanna: Back in the summer of 2025, I went to the north east of England to see for myself how these services could benefit patients and to hear from pharmacists on the ground about what they thought of the programme.
Omar Sarwar [on recording]: Yeah, so we’ve literally just put him into the consultation room now. It’s happening as we speak. We’ve sat him down. My colleague, who’s trained to provide the health checks, he’s also my trainee pharmacist, has gone in there, and he’s going to do all the bits and pieces, and he already seems a little bit reassured, so that’s really, really good. This is all real-time occurrences that are happening here!
Joanna [on recording]: Live reporting from the pharmacy.
Omar [on recording]: Live and direct. [laughs] Yes.
Joanna: Plus, I wanted to hear other perspectives on how these changes to community pharmacy practice could benefit the future of the workforce.
Ewan Maule [on recording]: If I was coming out of university as a newly qualified pharmacist, as a prescriber just now, would I want to go into a pharmacy, a community pharmacy, where none of these services were an option to me? I wouldn’t. So, I would choose to go somewhere else. I’d choose to go into a hospital or a PCN [primary care network] or a general practice or one of the pharmacies that was offering a lot of private services. I’d want to go into something like that.
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Joanna: I’m Joanna Robertson, senior clinical reporter at The Pharmaceutical Journal, and today I’m taking a closer look at a national programme to test how community pharmacists could deliver prescribing services in England.
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Utilising pharmacists’ prescribing skills to resolve episodes of care on the high street could be game changing for the profession, patients and for the wider health system. According to an evaluation by the University of Manchester, published in January this year, pharmacists who took part in the pathfinder programme reported increased job satisfaction linked to the opportunity to apply their clinical skills.
But the programme — and the funding associated with it — came to an end in March. So, in this episode, I’ll also be exploring what happens next in terms of commissioning a national community pharmacy prescribing service in England.
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Joanna: To understand what’s at stake, I visited pharmacists while they were in the thick of delivering the pathfinder programme.
Omar Sarwar works at Farah Chemist in Benwell, Newcastle.
Omar [on recording]: So Benwell is a great place. It is quite socially deprived, but I love working here because we interact with lots of different types of people from all over the world, and we get to help them with their healthcare.
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Joanna: As part of the pathfinder project, Omar offered a prescribing “add-on” service, enabling him to treat minor ailments that go beyond the scope of Pharmacy First and other PGD [patient group direction]-based services. I asked Omar what difference it makes to patients to be able to get help for minor ailments from a community pharmacy.
Omar: It means that they don’t necessarily have to wait in line for an appointment at the surgery. They don’t necessarily have to go to a walk-in centre; they can come here as a first point of call. Of course, we do have limitations as prescribers. I have my own circumference of clinical competence, I’m very aware of that, so I can’t solve everybody’s problem, but I like to think that we’re a good initial starting point, and if it’s something that I know I can’t deal with, I will signpost them to the next appropriate stop, whether that be the GP, the walk-in centre or, sometimes, even A&E.
Joanna: But in the majority of pathfinder consultations, this onward referral hasn’t actually been necessary. Over the course of the two-year project, nearly 200 sites delivered more than 33,000 consultations, almost all of which were dealt with within the pharmacy.
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Ewan Maule is clinical director for medicines and pharmacy at North East and North Cumbria Integrated Care Board. He told me that placing prescribing in community pharmacy enables them to join the dots between advice and treatment.
Ewan [on recording]: If we look at what the potential future is for community pharmacy prescribing, anything where that supply and prescribing has to be more closely linked than it is at the minute, and where the issues are less around diagnosis and more about management of either acute or a long-term condition, and the appropriate drug treatment of it, then to me, community pharmacy is the right place for so much of that stuff. And then, of course, you build into that the accessibility of community pharmacy, available on the high street, you don’t need an appointment, all that sort of stuff. It’s just the right place for a lot of this stuff to happen.
Joanna [on recording]: And that’s a real strength of skill set that community pharmacists have, is responding to that and sort of building a relationship and being spontaneous about it.
Ewan [on recording]: It’s one of the reasons why I’m no longer a community pharmacist, because I found it terrifying to be standing there when somebody would say, “Oh, Ewan, somebody would like a word” and not having a clue what I was going to be faced with — I found that terrifying! So, hats off to people who do that all day, every day, and respond to whatever happens to be in front of them. It’s fantastic.
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Joanna: As the commissioner for pharmacy services in the north east, Ewan has certainly taken advantage of his community pharmacists’ “try-anything” attitude and the exploratory nature of a “path-finding” pilot.
Pathfinder sites across England have looked at how prescribing could be used in a whole range of situations, from contraception to HRT [hormone replacement therapy], depression management, respiratory medicines, de-prescribing and alleviating health inequalities.
Joanna [on recording] And you mentioned the switch that you were able to do for the prescription. Do you want to just highlight how you did that?
Omar [on recording]: Yeah, so literally just after the gentleman went into the room, my colleague here showed me a prescription for which we only had the sugar-containing type of the product, and the prescription was for the sugar-free one. The patient’s mum came in, we discussed if she’d be happy with the product that we’ve got, and she was, so we’re going to do a prescription for that just to kind of save her traipsing back to the GP to get an alternative. So, a prime example of how we can utilise the IP [independent prescribing] pathfinder for prescription management and modification.
And in the north east, Ewan has had his local pathfinders explore prescribing for all kinds of novel services, from delivering Botox services for migraine to exploring other specialist services like weight loss or ADHD.
One big area of focus for lots of pathfinder sites was hypertension management.
In fact, in Benwell, while I was visiting Omar, a patient came in concerned about high blood pressure readings. Here’s Omar telling me what happened.
Joanna [on recording]: You said the guy was quite worried. Did it reassure him that you could do all of that?
Omar [on recording]: Yeah. So, we’ve literally just put him into the consultation room now. It’s happening as we speak. We’ve sat him down. My colleague, who’s trained to provide the health checks, who’s also my trainee pharmacist, has gone in there, and he’s going to do all the bits and pieces. And he already seems a little bit reassured, so that’s really, really good. This is all real-time occurrences that are happening here.
Joanna [on recording]: So that’s a locally commissioned service?
Omar [on recording]: It’s a locally commissioned service, so we are able to check cholesterol, HBA1C, sugar for diabetes, blood pressure as well, BMI, waist circumference, and then we have a general conversation about lifestyle — so diet, exercise, we explore if the patient smokes or drinks alcohol, and we can offer additional support with smoking cessation, if necessary. Also with consultations like this, we can look at the QRISK of the patient, and one of the extensions of the IP [independent prescribing] pathfinder service that we’ve been given is to be able to prescribe statins if necessary, where appropriate, in conjunction with the local surgeries and basically getting the necessary bloods from the surgeries before we actually initiate anyone. But it is one of the extensions of the service that we can provide.
Joanna: You heard Omar mention blood tests just now and having to send patients back to their GP before the medication change could be made.
The pathfinder programme was all about trying things out and identifying hurdles to community pharmacy prescribing. Access to pathology, like these blood tests, was one big issue identified during the evaluation of the pathfinder project. Community pharmacies just aren’t plugged into that infrastructure yet.
Another area of concern was access to patient records, a lack of which pharmacists said impacted their ability to prescribe safely.
The University of Manchester evaluation said that these two aspects were particularly necessary if community pharmacists were to manage long-term conditions.
But if these structural issues could be solved at a national level, Ewan told me he thinks this could unlock even more opportunities for community pharmacy to expand its role.
Ewan [on recording]: If we can resolve those issues, and I’m fairly confident we can, then again, that’s another step change in how community pharmacy is seen as being able to deliver services.
Community pharmacy has kind of chipped away at the edges of the minor ailments, the self-limiting conditions, all that sort of stuff. Now, that’s valuable, and that’s important, and people need access to services when they have those things. So that is definitely part of it. But I think community pharmacy is only going to realise its potential when it properly gets into long-term condition management. It’s just tinkering around the edges otherwise. And once I’ve been diagnosed with hypertension, atrial fibrillation, hypercholesterolemia, whatever it is, the diagnosis is there. I don’t need to see my GP. I want to see my GP when I’ve got a lump that I think might be cancerous, and I need an urgent diagnosis or whatever. That’s the sort of thing I want my GP to be there for. I don’t want to have to go back to my GP for an inhaler review. That’s utterly pointless. That’s the totally wrong place for those resources to sit. So, I think community pharmacy has to get into the long-term condition management and own it and be bold about owning it.
Joanna: Harry McQuillan, who was involved in negotiating Scotland’s community pharmacy prescribing service, shared a similar vision of pharmacist prescribing with me.
Harry McQuillan [on recording]: Wouldn’t it be fantastic if our diagnosticians, our GP medical colleagues — which they are experts in, far more than I am — to let me know actually what’s wrong with someone, and then the prescribing expert, i.e. the pharmacist, based on the pharmacology, the kinetics, and all the training that we’re given, steps in and prescribes? And that I could see being a real, a clinical future, particularly in the community network, as it would be in primary care, as it would be in the hospital setting as well.
Joanna: This vision will be particularly attractive to the new intake of pharmacist prescribers that will enter the workforce from July, the first cohort who completed their prescribing training as an integrated part of their MPharm and foundation year. And as Harry describes, pharmacists with those skills will want a job where they can use them.
Harry [on recording]: Because the biggest risk, as I say, is that we have new pharmacists joining the workforce with a skill that they find less opportunity to deploy. And therefore, you can understand how other sectors of the profession become attractive — either perceived or real — because they’re going to move and use that skill somewhere else.
Whereas I think the community network, with its patient contact, the number of opportunities that present every day, is actually the ideal place to deliver it.
So, we need a service therefore to allow that to happen. Attract a workforce, give good patient outcome and excellent clinical intervention.
Joanna: Harry told me that the network in England needs a commissioned prescribing service as soon as possible and definitely within the next three years.
Harry [on recording]: And it gives that incentive, one, to a pharmacy owner, that there’s an NHS commission service that has a new revenue stream, and that’s fine, and a new clinical area to practice in for the workforce.
Then you can accelerate that because you have a purpose. And once the purpose is defined, then people can see there’s a reason for doing the training and a reason for delivering the service.
Joanna: In the lead up to winning the 2024 general election, the Labour Party did promise to establish a community pharmacist prescribing service in England. But at the time of recording this podcast, there’s been no indication of what that might look like or when it will happen. We have approached NHS England repeatedly about this since November 2025, but it’s declined to provide us with an interview or any details on what’s next for community pharmacist prescribing.
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Joanna: Until a national service is agreed, it’s up to local integrated care boards to continue commissioning pathfinder services where they can afford to and where they’re delivering patient benefit. In some places, that’s happening, but in others, discontinued national funding means prescribing services have been stopped or limited since the pathfinder programme came to an end.
When I spoke to Omar last year, he said stopping the prescribing services would be devastating for patients.
Omar [on recording]: So far so good. I just hope that the funding continues so that we can continue to do this, because what would be tragic is if we continue to provide this service and then at some point they’re like, “Okay, it’s being decommissioned now. It’s over, and that’s it”. Because the surgeries and the patients are kind of used to a certain level of service, and we want it to continue so that everyone can continue to benefit.
Joanna: It’s not just primary care that benefited from the pathfinders. The more novel services that were trialled, such as migraine or weight-loss management, have demonstrated the ability of community pharmacies to make a difference in the wider health system, as Mark describes.
Mark [on recording]: So, in neurology, Gina, the consultant, told me recently that her waiting list is 33 weeks. Three three. She’s obviously massively under pressure.
Joanna [on recording]: That’s for migraine?
Mark [on recording]: That would be her migraine service, yeah. Obviously, emergencies is handled via A&E, so if somebody presented with really worrying symptoms, they would be seen more quickly.
Joanna [on recording]: But by the time the patient gets to her, they’ve already probably had symptoms for months, years…?
Mark [on recording]: And they’re going to lose faith, and they’re probably debilitated and not able to work or not able to do certain things. So, it’s just in everybody’s interest to expedite that. And where it’s a medicine that’s the block, that’s where community pharmacy fits in. We’re not doing diagnosis, because it’s a safe diagnosis from a consultant of migraine.
So, unless something changes — and we would screen for any changes or any new red flags — you don’t really need to involve the GP, because all you’re asking the GP to do is, “Please prescribe the following.”
Joanna [on recording]: Yeah. So, you’re really doing exactly what the…
Mark [on recording]: And it would either be a GP or a pharmacist within a GP practice who would do that. The plan is to kind of open that out and allow the pharmacist in the community to do that.
And we’ve got a consultant neurologist raving about the potential for using community pharmacy.
I mean, what an advocate for our service!
Joanna: Ewan Maule, the ICB commissioner you heard earlier, was also raving about the wide impact community pharmacy prescribing could have.
Ewan [on recording]: I see my role as a strategic commissioner to be able to step away from the slightly more transactional, to think about what’s important for the outcomes of our population. And that’s health outcomes, so do people present at hospital less and get less ill and develop fewer comorbidities. But actually, one of the core principles of an ICB is to look at the wider societal impact of healthcare services. If you’ve got people who are unable to hold a job because they’re under-diagnosed or under-treated, well, then the impact of that goes far beyond healthcare services.
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Joanna: In the north east, Ewan says he wants to keep pathfinder services going, where possible.
Ewan [on recording]: Yeah, so we’ve identified it as being one of our critical services, so it’s working the way through the process at the minute. Our intention is to do it, because I think… I certainly feel as though if we were to drop it just now, it’d be harder to pick it up again at some point in the future. So, I’m really keen that we keep something going in the interim, but we’ve still got a process to work through to make that happen. But I think, I would hope that in the not too distant future, we are realistically seeing community pharmacy as a very viable market for future commissioning of services. So, the motivation is there. It’s just sometimes working with NHS approval processes can be tricky.
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Joanna: Bringing plans to reality has probably never been more tricky than right now, with local and national NHS teams currently losing around 50% of their funding and headcount as part of nationwide cuts.
Ewan [on recording]: Now, the timing of it is unfortunate, because ICBs are all undergoing reorganisation and restructuring, and are in sort of organisational chaos at the moment. So, we probably don’t have the focus on this that we would otherwise have.
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Joanna: As well as a wider NHS in transition, the current strain on community pharmacies in England doesn’t leave much capacity for investing in new services, something I asked Harry about given his experience negotiating the service in Scotland.
Joanna [on recording]: Do you see any… what are the differences that you see that might affect the viability of a national prescribing service in England?
Harry [on recording]: I suppose the main difference, I think, is how the network is financially supported. It’s a difficult landscape. In fact, it’s a difficult landscape across all the four countries in the UK. But just some, certainly if I look to Scotland, they appear to be better supported financially and with that gives comfort to be involved in the delivery of NHS services and everything else that goes with it.
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Joanna: But despite challenges, Ewan thinks community pharmacy has no option but to transition from dispensing-based income to service-based income. And to do that, it has to make progress on prescribing now.
Ewan [on recording]: The existing business model is Blockbuster in a Netflix world. It’s just going to die a slow death. If community pharmacy is going to still exist, it’s got to do something else. Now, to me, you look around the NHS, and you look around the environment and you think, well, there’s left shift, there’s hospital to community, there’s treatment to provision. All these things speak really well to what community pharmacies accessible in communities could do. So, it’s just a case of grabbing the opportunity that’s there.
Joanna: With both commissioner and practitioners under pressure, realising this vision is going to require collaboration from both sides.
Ewan [on recording]: How we get from here to there can either be done really well or really badly. And we can engage with each other in good faith and find ways to bridge that, or it can become combative. And that doesn’t end well for anybody, frankly. So, I think… I know that’s an easy thing to say from my perspective because my mortgage doesn’t depend on it, but I don’t see it playing out any other way. It has to be done in a collaborative way that recognises the limitations and the challenges on both sides of the table.
Joanna: Even if services begin locally or prescribing skills are gradually added to existing services like Pharmacy First, community pharmacy could be laying the foundation for an exciting clinical future, one that makes the most of pharmacists’ expertise in medicines and community pharmacy’s easy access for patients. To underpin this, pharmacies in England and the other UK nations do need to be equipped with that crucial infrastructure, like pathology and patient records, that will enable them to get plugged into the wider health system so that they can play even more roles in patient care, just like the pathfinder programme has proven that they can.
That’s it for this episode, but we’ll keep reporting on this issue in The PJ, so keep an eye out for any updates on how our national service develops. Thanks to our contributors, Omar Sarwar, Mark Burdon, Ewan Maule and Harry McQuillan. And thanks to you, for listening to this episode. For more like this, please like and subscribe to The PJ Pod. I’m Joanna Robertson, thanks for listening!