Expansion of Pharmacy First a ‘key step’ in delivering preventative care

Expanding the Pharmacy First scheme to include independent prescribing (IP) is a ‘key step’ in enabling the shift to preventative care, England’s largest integrated care board (ICB) has said.

But West and North London ICB also said that managing challenges such as variations in workforce readiness and clarity around commissioning models and funding flows was essential for integrating these new services into local pathways.

Pharmacy First will be expanded to include independent prescribing (IP) as part of the new community pharmacy contract for 2026/27, with the changes to be rolled out from the autumn.

Louise Coughlan, ICS chief pharmacist at NHS West and North London, said: ‘We welcome the direction of travel, particularly the expansion of independent prescribing within community pharmacy.

‘We see community pharmacy playing an increasingly central role in delivering preventative care and managing demand.

‘The expansion of independent prescribing is a key step in enabling that shift and delivering more joined-up, accessible and high-quality care.’

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However, Ms Coughlan also said that there would need to be work carried out between community pharmacies, general practice and other system partners to integrate the expanded services into local pathways.

‘It will take work between community pharmacy, general practice and wider system partners to integrate expanded services into local pathways, ensuring clear referral routes between pharmacies, GP practices and urgent care services are fully utilised,’ she said.

Ms Coughlan added: ‘To do this effectively will also require careful management of a number of challenges, including variations in workforce readiness, clarity around commissioning models and funding flows, and ensuring consistent digital and governance infrastructure across providers.’

She also said that the expansion of IP could support a shift towards more responsive services, but there would need to be consideration for how services can be commissioned to make use of the opportunity this presents.

She added: ‘The expansion of independent prescribing could support a shift towards more clinically-led, responsive services, enabling community pharmacies to manage a broader range of conditions and reduce the need for onward referral. This will be particularly important in improving access in areas of high demand and supporting earlier intervention.’

‘As more pharmacists qualify as independent prescribers, there will be a need to consider how services are commissioned in a way that fully utilises this clinical capability, particularly for common acute conditions, long-term condition management and prevention services.’

Ruth Rankine, director of primary, community and neighbourhood health at The NHS Alliance also welcomed the focus on independent prescribing but said there needed to be time for local clinicians and commissioners to implement it.

‘The rollout of independent prescribing is a crucial step in unlocking the full expertise and community reach of pharmacies, helping to support a successful neighbourhood model of care,’ she said.

‘However, to ensure this is successful, we must learn from the challenges associated with Pharmacy First. There must be protected time for local clinicians and commissioners to implement this practice safely and effectively, alongside targeted communications to help patients access these services.’

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The Pharmacist understands that under the proposals ICBs will retain commissioning responsibility for Pharmacy First and IP services and will manage delivery at a contractor level, while NHS England will retain responsibility for the national service specification and ensuring payment and claiming infrastructure is in place.

At a press briefing yesterday, director of NHS services at Community Pharmacy England (CPE) Alastair Buxton said there already were a range of IP services that ICBs can commission pharmacies to deliver locally, including hypertension management, lipid management, assessing cardiovascular risk, weight management, and women’s health.

Mr Buxton added: ‘There will be guidance issued by NHS England as part of this commissioning at a national level, and I think that will provide a really important foundation for ICBs to use at a local level to commission [IP services].

‘We are laying some foundations here with NHS England and DHSC to support more local commissioning.’

The Pharmacist understands that the government hopes that the investment into new IP services will encourage more ICBs to commission these services locally.

The expansion of Pharmacy First and the pharmacy contraception service to include independent prescribing will involve:

• Prescribing within existing Pharmacy First clinical pathways and the contraception service;
• Up to five new prescribing-only pathways, to be announced in autumn; and
• Pharmacists being able to prescribe alternative medication where necessary – for example, where the original prescription drug is out of stock.

CPE has said that bacterial conjunctivitis, allergic conjunctivitis, oral thrush, skin infections and respiratory tract infections services could be considered for the expanded Pharmacy First service.

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During the summer, NHS England will create a clinical reference group of experts across primary care who will consider the new pathways for IPs under Pharmacy First, The Pharmacist understands.

Several ICBs are extending their support for the independent prescribing pathfinder programme, which authorises specially-trained pharmacists to prescribe NHS medicines directly to patients for a range of illnesses.

A version of this article first appeared on The Pharmacist's sister title Healthcare Leader.