Developing a pathway for support and CPD for non-medical prescribers

Anna Young, Richard Daniszewski and Kelly Tyers share their work in supporting non-medical prescribers across Sheffield and South Yorkshire, along with advice for others wanting to change workplace culture.

Primary care has the highest proportion of independent or non-medical prescribers (NMPs) in the UK.¹ About 14,000 pharmacists are registered as independent prescribers, with around 6,000 of these working in primary care and community pharmacy, and plans to grow this workforce as we move towards registration as an IP on qualification from 2026.² Yet there is often a lack of organisational understanding about how to both develop this role, and for pharmacists to remain updated and safe within our day-to-day clinical practice in primary care.

Historically, organisations placed the onus on the individual clinician to stay updated and safe and available support often varies between organisations and sectors.

There are many prescribing articles to read and courses to attend, but how do we know if they fit with the local formulary and referral pathways?

Sitting on the Sheffield Formulary support group and Barnsley Medicines Management Team, we see how much time and effort is put into developing these prescribing guidelines, including balancing the financial constraints of health care, evidence-based practice and working alongside the wider local health providers to ensure a commonality in prescribing practice.

Within this context, Anna has developed a monthly lunchtime clinical teaching programme looking at topics such as diabetes, reflux, allergic rhinitis, HRT and the menopause, contraception and anxiety and depression in young people. Here we consider good prescribing practice, using the local formulary, and consider shared decision making, risks versus benefits of medication including when not to prescribe and deprescribing. These sessions have evaluated well in increasing prescribers’ confidence, competence, and safety. Therefore, we worked collaboratively across our ICB to pool resources and reduce duplication, and these sessions are now open to all NHS South Yorkshire ICB NMPs with the added benefit of inter-professional learning.

Revalidation cannot stand alone, and there needs to be a wider framework to support NMP in primary care, including good governance. With this missing, we worked collaboratively with colleagues across the (then) four clinical commissioning groups to develop a South Yorkshire wide NMP policy.

The framework sets out the responsibilities of individual prescribers, their employers, and the wider organisation (the Integrated Care Board) in ensuring prescribing practice is kept up to date and safe. This has been an exciting collaborative, cross-professional, piece of work that will provide the foundation for excellent practice and patient safety going forwards.

Working in primary care is not a ‘boundaried’ or specialist role – as professionals we need support to develop and expand our prescribing practice to meet the growing patient demand.

Our professional roles are dynamic, and we need provision to grow our prescribing practice alongside our clinical competencies. The framework we have written sits alongside the new Royal Pharmaceutical Society guidance, Expanding Prescribing Scope of Practice³encouraging the use of mentors and teaching events.

This work is being driven through the local workforce and training hub and is multi-professional. Increasingly roles are overlapping in primary care, and we need the same provision and support for all who are prescribers.

What we’ve learned

It is not easy to change a workplace culture and ways of working. Coming in as an ‘outsider’ (a clinician without a strategic role and without NMP or training lead in our job titles) required a lot of persistence and relationship building with the key decision makers. There has been no handbook for this, it has been a steep learning curve driven by our passion to see change for the benefit of both the workforce and for the patients we work with.

Finding allies has been key to our success, people who believed in and were passionate about the development of NMPs. This drove our work forward and allowed us to build momentum collectively, to a point where we were pushing against an open door.

We have also learned from Anna’s systematic review of the literature into the development and support needs for NMP in primary care. It is very hard for people to give a good enough reason not to do something when presented with evidence of best practice and a model of what could work, alongside someone passionate enough to drive it.

Anna delivered the first 18 months of this work in her own time, until finding a paid home within the local workforce and training hub. As momentum built, more people have got on board, and a team has been built both of supporters and speakers.

Advice for others

The beginning is always the hardest, and once momentum builds so does the energy, and people start to listen and hear what is being said. It’s ironic, but the project has benefitted from the pandemic in that the introduction of Microsoft Teams has enabled the use of this as a platform for the CPD lunchtime events, and to also attend meetings with leaders and organisations across South Yorkshire to promote this work. It would have been a much more difficult process without this.

Being successful at embedding research into practice and developing a South Yorkshire wide collaboration and framework as a result, has developed all our leadership skills as primary care practitioners and has further fuelled our passion to provide an environment for others to do the same. We are using this platform to speak to the new ICS leaders to ensure that the NMP voice is heard, and our research is utilised to benefit patients and the wider workforce.

Our advice is if you have something that you are passionate about, then go for it.

Do your research – know your topic inside out. You will be challenged on why things need to change so you need to be prepared to defend it.
Do not be shy – invite yourself to meetings, ask to present, believe in yourself and what you know.
Persist – if at first you don’t succeed, reflect on why, ask for help and try again.
Share your journey and your outcomes with others, so we can all learn from each other.
Seek out and utilise any available support such as the NHS Leadership Academy. Here we found not only learning and knowledge of organisational development models, but also a critical friend with no in-depth knowledge of NMP but someone who was there to guide and support us through the process, asking the questions and making the process relevant.

In the few years since Anna’s initial scoping work, we have moved from a position of NMP competence and development being the sole responsibility of the individual to one where the organisation is taking an interest in developing its workforce through targeted CPD events and a supportive framework.

There is much more to do, and the space is now open to do it. The future is bright for NMP in South Yorkshire.

Anna Young is a GPN and primary care ANP in Sheffield, and non-medical prescribing development lead for the South Yorkshire workforce and training hub. Contact her on Twitter: annanursesheff

Richard Daniszewski is lead pharmacist for Barnsley Primary Care Network

Kelly Tyers is lead clinical pharmacist at NHS South Yorkshire ICB (Barnsley).

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