Independent prescribing: Must guard against ‘two-tier’ profession, says deputy CPhO

Dr Bruce Warner, deputy chief pharmaceutical officer (CPO) for England, has warned of the ‘need to make sure we don't end up with a two-tier profession', divided between the current pharmacist workforce and graduates qualifying as independent prescribers (IPs) from 2026.

Speaking at an Association of Multiple Pharmacies (AIMp) members’ meeting in Birmingham yesterday, Dr Warner emphasised the need to train the current workforce as IPs order to ‘guard against a two-tier service where pharmacists don't even have the opportunity to take advantage of what is coming along’.

Dr Warner described the introduction of independent prescribing on a widespread scale as ‘the biggest and most important change in our profession’, which he said would open the door to ‘a whole range of things’ that pharmacies could do, such as more involvement with managing patients’ long-term conditions.

Dr Warner said that at the moment, around one in ten pharmacists are qualified IPs, and from 2026, all new pharmacy graduates will be IPs.

NHS England has also said it is embarking on a pathfinder pilot programme to work out the details of how independent prescribing will work in a community pharmacy setting.

The pilot will fund the training of independent prescribers within pathway sites, to increase the numbers of independent prescribers in the workforce. 'Once we have a critical mass, we can think about services and what to do with them,' said Dr Warner.

Anne Joshua, head of pharmacy integration at NHS England, said that she wanted to learn from community pharmacies where independent prescribing is already happening.

'This is a plea for help', she told delegates at the AIMp event. 'This [transition to IPs] is the biggest transformation project we have ever done through the Pharmacy Integration Programme.'

The pathfinder project will explore best practice for challenges such as integrating IT systems between prescribing and dispensing and accessing patient records, as well as governance issues such as whether a separate pharmacist will do a clinical check after the prescription is issued.

It will also explore whether there is sufficient funding to use independent prescribing to deliver clinical services like the management of long-term conditions.

Dr Warner commented that ‘it's almost inconceivable’ that the current funding model is ‘fit for purpose’ and said that new funding models may need to be explored.

Ms Joshua said that the funding for the pilot scheme was ‘a small drop in the ocean’ but ‘would help to build the business case’ for independent prescribing within a community pharmacy setting.

Dr Warner acknowledged the challenges facing community pharmacies at the moment, but said: ‘If we wait for conditions to be right before we even start [working out the details of independent prescribing in community pharmacy] then we are going to miss the boat.’ He added: ‘This is going to take years.'

In May, the GPhC removed the requirement for current pharmacists to need two years’ experience before beginning an accredited independent prescribing courses, instead asking that they have ‘demonstrated readiness’.

In August, Health Education England opened applications for almost 3,000 pharmacist independent prescribing training places in England for pharmacists employed in the community, including locums.