Alongside advances in independent prescribing and digital connectivity, pharmacists in Wales are exploring how working across settings can improve patient care.  

In a recent interview with The Pharmacist, Royal Pharmaceutical Society director for Wales Elen Jones outlined some of the the opportunities and challenges facing the profession.

I think the obvious place for us to start is independent prescribing, with the changes happening in 2026, with everyone coming out as prescribers, but also the exciting changes that are already happening in practice with the amount of people that are now actively using the prescribing qualification.

With the community pharmacy contracts that we've got here in Wales, anyone who is qualified as a prescriber can start to take up the opportunity to prescribe within community settings, which is fantastic for us here in Wales.

And we have got an ambition in our vision for the future of pharmacy in Wales that by 2030, there will be a prescribing pharmacist in every pharmacy, community pharmacy across Wales.

The big change then will be that we can shout a bit louder about what prescribers can do in community settings, and the type of access and care that people can get. Because at the moment, it's a bit more challenging, when it's only available in certain areas, to publicise that more.

We are seeing more and more people working in general practice in Wales, as we're seeing in other parts of the UK, and them being able to utilise their prescribing skills alongside their GP colleagues and other members of the multi-disciplinary team (MDT).

I do think that's really exciting. I guess what we need, as well as consistency in number, is consistency in the type of services that are going to be offered, so that we can make it even easier for the public to understand the support that they can get.

In Wales in particular, we want to move away from sector-specific roles, as we traditionally see them, to thinking more about pharmacists working where the patient needs them.

So if you are a specialist pharmacist that traditionally may have worked in a hospital setting, actually, we want to see you working beyond the walls of the hospital, utilising those skills in community pharmacy, in GP practices, and for you to be seen as a pharmacist working across all sites.

It needs more development in how that works, given the difference in contracts and things like that.

Having more connectivity between people working in different sectors, is I think the first step for us, so that people can have that more specialist care, closer to home, and so that community and primary care pharmacists dealing with more complex patients know who to speak to, so they can support patients.

Hopefully, in the future, we are going to be seeing an increase in point of care testing and things like that in community pharmacy in Wales, even starting to look at hepatitis.

There are constant advancements happening. And I think when we're getting into new areas like that, it's important that we can reach out to colleagues who have been doing specialist work in those areas for a long time, so that we've got the support that we need in community settings as well.

We can already see how pharmacists in community, in primary care are expanding their roles through different services as well as in the practices that they're working in.

We see more and more people working in NHS 111 and out of hours. And often having that primary care skill set is really important in those roles as well.

And for us in Wales, we’re seeing more pharmacists taking up positions in primary care clusters, and actually leading those clusters.

It's great to see pharmacists taking on more leadership roles like that, bringing together other areas of the multidisciplinary team in their locality to help focus on specific areas to help their local population.

We do want to attract people to come and work in Wales, and hopefully the fact that they can use their clinical skills across all settings now is something that's appealing.

A lot of people struggle to think where they want their career to be when they're just graduating from university. I know I did, I was really torn between hospital and community. When I was doing my degree I trained in hospital and went straight into community. It's a hard choice for someone to make early in their career. And so having the ability to understand the work in each of the settings, I think is not just beneficial for you personally, but beneficial for the teams that you're working in and for the patient.

As difficult as it is to get started, I think we've made really good strides forward in making multi-sector work happen. I guess the next step for us now is thinking post-foundation: how do we keep that going? We've got some work happening on that thinking about how that can happen. And there's training available through HEIW [Health Education and Improvement Wales], and then thinking about the whole advanced and consultant pathway, as well. Because hopefully being able to develop your skills in different areas will make it easier for you to demonstrate that advancement as well.

There are workforce challenges across the board. I think, for me, if people are getting the chance to utilise their skills, we can't see it as a loss from one sector to the other – they're still working in our localities for patients.

I think maybe we need that shift of services to happen along with the workforce. We’re all talking about care closer to home, but what that inevitably will mean is that we need more practitioners in community and primary care.

But at the moment, because we haven't seen the shift of patients, things are really tough in hospital settings, because they're still dealing with huge amounts of patients coming through the door – maybe for things that shouldn't necessarily be in hospital.

And I think it's the same at the other end of things for community colleagues. It's great that we're doing all these clinical services, but we haven't managed to get rid of the dispensing volume. At the moment we’re still having to juggle the huge amount of dispensing work, and develop all these new services.

I think it is particularly challenging time for pharmacy. I think we're going in the right direction, but there's a lot more that we need to do to help ease the pressure. And I think particularly in community pharmacy at the moment, because so much change is happening, we really need to get that right.

One of the things that we want to do in Wales that I don't think we've cracked yet is the 56 day prescribing, as opposed to 28 day prescribing. At the moment, through Pharmacy: Delivering a Healthier Wales, we are going to be having discussions about, how do we help make that happen?

Because we have to ease the pressure somehow.

As exciting as the services are, and we know that's the future, we still have to make sure that the current core elements of dispensing are done safely and that members of the team are not overworked and overstretched, which sadly we are seeing across all sectors.

'Big changes' when it comes to digital

Another big advancement for us is digital: being able to get that digital connectivity between all sites so that it's easier for us to understand the patient's record, and being able to give them the advice and care they need, wherever you're practising.

We are seeing big changes happening in Wales over the next few years when it comes to digital, including an NHS patient app. Being able to utilise that from a pharmacy perspective is going to be really important for us.

With increasing automation and potential changes to hub and spoke dispensing, we have to make sure that it's an even playing field so that your independent contractor can have as much access and support from new technologies as those with multiple pharmacies.

I think there's probably more we can be looking at when it comes to that, as well as thinking actually, how do we utilise technology to support the clinical work as well as the volume of work that we're having to deal with?

We already utilise a lot of digital services and equipment and things to help with skills for clinical checking. Obviously, it's important that the pharmacist remains in control of that, but is supported with the right technology, particularly when we're thinking ahead to pharmacogenomics work.

At the moment, we're seeing pharmacogenomics in more specialised areas like cancer care. But it's only a matter of time before those more complex medicines or personalised medicines are seen in primary care and community care.

As we take on those challenges, I think we need to be supported with the right technology to be able to understand those advancements, as well as the education and training and support that goes along with things' like that.

Elen Jones has been the RPS director for Wales since 2019, having previously worked as RPS Policy and Practice Lead in Wales for five years, where she led on projects including pharmacy’s role in supporting care home resident and palliative care residents.

She has worked as a community pharmacist, governance and in academia, and led the development of Welsh language opportunities for Welsh-speaking pharmacy students to ensure that they could confidently and competently consult with patients bilingually.