IP model 'difficult to cope with' alongside day job, pathfinder evaluation finds

Independent prescribing (IP) pathfinder sites have delivered more than 33,000 consultations but pharmacy teams found it ‘difficult to cope’ with demand alongside their existing duties.

An evaluation of the programme found that many pathfinder sites used a two-pharmacist model to safely and effectively deliver the service, but this meant some pharmacists were ‘operating at a loss’.

One Independent Prescribing (IP) pharmacist told researchers from the University of Manchester and ICF International, who conducted the evaluation, that there was ‘no way’ a single pharmacist could deliver this IP service while also running the normal activities of the pharmacy.

Yet an ICB senior pharmacy lead said: ‘With the lack of funding currently in pharmacies, it’s not sustainable for all [pharmacies to have two pharmacists, so] it’s going to be tricky to implement [this IP service] nationally.’

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Despite these concerns about capacity and funding, the IP pathfinder ‘saved’ some pharmacists from leaving the sector by giving them job satisfaction and allowing them to fully utilise their skills.

Almost all (97%) of the consultations concluded without the need for patients to be seen by anyone else.

GP supervision was considered ‘essential’ for building the IP pharmacist’s confidence – especially when delivering long-term and novel clinical models – and some GP supervisors met up with an IP pharmacist weekly to discuss their experiences.

However, an unintended consequence of this was an increase in GP workload without adequate funding. ‘GPs are very busy and they’re under a lot of pressure. There is some funding [for the GP supervisors], but it’s not a massive amount,’ said one of the programme managers.

The report concluded that a successful national IP service depends on five things: clinical governance, supervision and support, skill mix, digital infrastructure and funding.

And it reminded NHS England that community pharmacies are businesses that need long-term, sustainable business models to continue delivering high-quality patient services.

This requires ‘enough funding and sustainability to allow employers to invest in their workforce’, the evaluation said.

Change must be implemented ‘incrementally’, it said.

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It said that behavioural and cultural change would be involved in independent prescribing at scale, noting that both pharmacists and the wider healthcare system needed time to build confidence in the model.

The independent prescribing pathfinder programme was set up to establish a framework for the future commissioning of NHS community pharmacy clinical services incorporating independent prescribing for patients.

As of 31 July 2025, 197 sites across 40 ICBs had registered to take part in the pathfinder programme.

In a letter to ICBs at the end of October, NHS England confirmed that it would be consulting with Community Pharmacy England (CPE) to determine what a national prescribing service will look like.

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Discussions will begin in April and these learnings from the pathfinder programme will ‘inform any potential service models where prescribing could be part of national community pharmacy services’.

In response to the evaluation of the IP pathfinder programme, chair of the Royal Pharmaceutical Society (RPS), Tase Oputu, said: ‘This latest evaluation is a renewed call to action for the Government and NHS to unlock the potential of pharmacist prescribing to support the 10-Year Health Plan.

‘Making the most of this opportunity depends on commissioning new pharmacist prescribing services, investing in training capacity, and funding protected time for professional development and system leadership.’