Pathfinders show community pharmacy ‘can be trusted with prescription pad’

Community pharmacy prescribing pathfinder sites have generated almost 20,000 items being prescribed since the programme began, with 59% of consultations resulting in prescribing activity that would otherwise have required a GP appointment, according to project leaders.

The pathfinder programme was established in 2023 to test how independent prescribing by pharmacists could work in community pharmacy settings and to develop a framework for future commissioning of prescribing services.

Speaking at a Pharmacy Show panel session on the NHS 10-year plan and learning from the pathfinders last week, Wasim Baqir, head of pharmacy integration at NHS England (NHSE), said the programme had delivered over 40,000 consultations across around 200 sites in seven regions covering every part of England.

The programme has tested both acute clinical models, similar to Pharmacy First-style services, and long-term condition management including lipid management, atrial fibrillation, blood pressure and respiratory disease.

Mr Baqir said only 0.45% of prescriptions were for low-value medicines, demonstrating that 'community pharmacy can be trusted with a prescription pad'. One in five prescribing instances were for people in areas of highest deprivation, he added.

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The pathfinder programme, which has involved 40 integrated care boards (ICBs), is due to end in December 2025, but Mr Baqir said NHSE was 'working hard' to translate learning from the programme into clinical services for community pharmacy.

'Pharmacists love it,' he said. 'They think it's good. They think they add value to the service, that gives them satisfaction. It's feasible, it's safe, but we need to understand that it requires setting up. It requires a little bit of support.'

He added that acute models had worked 'really well' and could be viable for a future Pharmacy First-style model, while long-term condition management had shown pharmacists doing 'quite complex stuff' and keeping people away from GP and hospital front doors.

Charlotte Welsh, acting head of community pharmacy contract design and reform at NHSE, outlined four priority areas for community pharmacy in the coming years to ensure it is 'at the heart of neighbourhoods'.

These are:

• embedding and growing a prescribing-enabled service model;
• optimising existing services;
• simplifying access through technology; and
• optimising prescribing and dispensing systems to support medicines delivery.

'We are at a pivotal point for community pharmacy,' she said. 'The future is full of opportunity.'

Ms Welsh emphasised that the NHS 10-year plan commits to offering more clinical services in community pharmacy, increasing the role in managing long-term conditions and complex medication regimes, expanding vaccines and case-finding, and ensuring seamless integration with the single patient record.

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Anne Joshua, deputy director of pharmacy transformation and commissioning at NHSE, said some ICBs were already committing to continue pathfinder work beyond the December end date. 'That is hugely positive,' she commented.

However, concerns were raised about maintaining momentum. One delegate warned: 'I actually don't think it is a 10-year plan. I think it's a three-year plan, because if we don't do a three-year plan, then we won't get the chance to do the other seven years of it.'

The delegate urged NHSE to maintain pace and prevent pathfinders from 'peeling off and doing more and more private services’.

Mr Baqir acknowledged the need for 'building blocks' to be in place, including ensuring EPS-enabled systems are available for community pharmacy, working with the NHS Business Services Authority on safe scaling, and getting professional assurance and governance structures right.

'You've got 10,000 pharmacies that can't do it all today, but we've got a journey to make them all do, to get them there at some point in the future,' he said.

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The session came as training changes mean new pharmacists will register with the General Pharmaceutical Council with an independent prescriber qualification from next summer. The Pharmacist editor, Victoria Vaughan, recently discussed the issues around this move with course leaders from across the UK.

Also speaking at the Pharmacy Show last week, Community Pharmacy England chief executive Janet Morrison said stressed the need for an extension of Pharmacy First to include a community pharmacist prescribing service and for independent prescribers to have an established role.

When the pathfinder project began in 2023, The Pharmacist revealed that NHSE would allocate £12m in funding for the programme, a portion of which would be available to pharmacies involved in the delivery of the programme.