Significant 'gap between reality and ambition' in plans for independent prescribing, report says

Policy experts have warned of a ‘significant gap between reality and the ambition’ to increase the independent prescribing (IP) workforce in community pharmacy.

A new report by the Nuffield Trust raises concerns that current arrangements for funding, supervision and regulation ‘may not be fit for purpose’ as the IP workforce expands.

Pharmacists already have the highest proportion of IPs among all professional groups, with around a third of the workforce qualified and the number of pharmacists with an IP annotation has significantly increased over time, from 6,281 in March 2018 (11% of pharmacists) to 21,804 in March 2025 (33% of pharmacists), the report shows.

This figure is set to rise further, as the first cohort of pharmacists who graduated with the IP qualification in 2025 will finish their foundation training year and register to practice in September 2026.

The Nuffield Trust raises several concerns ahead of this change, including the lack of sustainable funding for independent prescribing, the need for legislation changes that enable professions’ prescribing rights, gaps in the current regulatory approach, issues created by NHS reorganisation, and a lack of support.

The report said: ‘There is a lack of overall oversight and planning of the independent prescribing workforce, to ensure that it can support policy ambitions for independent prescribing.’

A lack of suitable designated prescribing practitioners (DPPs) to support the ‘vulnerable’ population of newly qualified IPs was one of the biggest concerns – especially in community pharmacy settings. The report said this was a ‘significant barrier’ to accessing independent prescribing training.

‘The training pipeline is fragile: funding to cover both training and the clinical oversight required for trainees is not assured and there is high competition for training places,’ it added.

It recommends that integration of independent prescribing across settings is part of the upcoming NHS 10 year workforce plan and for funding of designated prescribing practitioners (DPPs) in community to be addressed.

The report also highlighted the fact that there are no additional revalidation requirements for IPs, and no data is collected on whether they are using their prescribing skills, which makes it difficult to understand the ‘balance of risks and benefits from widening prescribing roles in different settings’.

Concern has been raised that the payment mechanisms for community pharmacists, where there is a financial incentive for pharmacists to prescribe, could encourage over-prescribing, the report said.

Meanwhile, NHS reorganisation – such as the changing scope and function of integrated care boards (ICBs) – is ‘likely’ to impact the capacity and oversight of independent prescribing at a local level.

Henry Gregg, chief executive of the National Pharmacy Association (NPA) said: ‘We share the Nuffield Trust's concerns about the insufficient planning by the NHS and government to utilise the skills of thousands of independent prescribers who are currently working in pharmacies or will be qualifying in the coming months.

‘Prescribing absolutely cannot come at the expense of fully funding pharmacies for their dispensing work but without improved planning, there is a growing risk that newly qualified pharmacist prescribers will leave community pharmacy for hospitals or GP practices’

He also stressed the ‘enormous’ role community pharmacy could have in bringing care closer to home, supporting implementation of the 10 Year Health Plan and the shift from hospital to community.

The Nuffield Trust makes several recommendations to the Department of Health and Social Care (DHSC) in its report, including:

• Incorporate independent prescribing into the upcoming NHS 10 Year Workforce Plan for England;
• Consider the funding and support needs for the entire training pathway;
• Consider the balance of incentives for independent prescribing in community pharmacies to ensure that prescribing qualifications are used in the community, recognising resource needs for supervision and support;
• Commission an evaluation of the effectiveness and cost-effectiveness of independent prescribing across different settings;
• Design an independent prescribing monitoring system, building on existing data sources.

It also urged regulators, employers and professionals to develop and maintain a consistent approach, underpinned by regulation, to ensure the safety of independent prescribing.

And said regional workforce leads should develop well-considered and thorough plans for the independent prescribing workforce, working with integrated care boards and neighbourhoods.

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA) said: ‘The Nuffield Trust report rightly highlights several challenges the CCA have been raising for some time. At the core of the issues is the absence of a nationally NHS commissioned independent prescribing service in England. Without this, the full benefits of pharmacist prescribing cannot be fully realised.

‘An independent prescribing service would enable community pharmacy employers to develop their own network of prescribing practitioners, meaning they would be better placed to provide prescribing supervision to their own trainees, reducing their reliance on other parts of the system and create a more sustainable training model.’