Pathfinder prescribers will shape profession’s future, says Bruce Warner
Community pharmacists who sign up to ‘pathfinder sites’ for independent prescribing (IP) help shape the future of the profession, deputy chief pharmacist Bruce Warner has said.
In a presentation to the Pharmacy Show on Monday, Dr Warner looked forward to 2026, when all pharmacists joining the register would do so as prescribers.
“That changes the whole game, but we have to guard against having a two-tier profession,” he said. “We can’t be in a position when all our new graduates can prescribe, but our existing workforce is unable to (although around 10 per cent already do so).”
NHS England is searching for a number of pathfinder site pharmacies in each region, with integrated care boards working with LPCs to identify suitable sites. Dr Warner said of the testing process: "Let’s see if by 2026 we can come up with a framework that is robust enough for us to roll out IP in a mainstream way into community pharmacy.”
Outlining NHSE’s programme to upskill the profession, Dr Warner said those involved in the early stages would help shape its roll out, explaining: “It feels to me the time is right for independent prescribing to become a fundamental bedrock of community pharmacy practice, but we have a lot of things to work through before that can become reality”.
There are clinical considerations, he said, such as whether pharmacists will be working from a limited formulary or the BNF in its entirety. “From a legal perspective, IPs can prescribe anything, but is that what we need from a commissioned service perspective or not?
“I make no judgement on that, but it’s one of the things we need to work through.”
Dr Warner outlined other considerations such as IT and data sharing, training for support staff, ‘safety netting’ procedures and the need to put medicines optimisation principles in place.
“It gets really tricky when you get to the dispensing process and the clinical check,” Dr Warner said. “For years, we’ve cast a dim view on dispensing doctors prescribing and dispensing; if we are to have community pharmacists prescribing within the pharmacy, do we still need that clinical check and, if so, how can it be delivered?
“If we don’t need it, what are the implications and what are the mitigations?” Dr Warner said the sector must face what he described as the conflict of interest inherent in prescribing and dispensing, adding: “It’s not impossible to mitigate, but we do have to think that through.”
He described funding mechanisms as another “thorny issue,” including how the work will be funded, the allocation of prescribing costs and monitoring spend and cost-effectiveness.
Indemnity and governance were also on his list, as was ensuring community pharmacy was in a position to engage, given the capacity constraints in the system.
“Community pharmacy has a fantastic track record,” he said. “We need to build on that engagement, but facilitate it.”
Prescribing will also require a shift in mindset, he said: “It’s very different when you are signing that prescription, as opposed to advising someone else what they might like to do.
“Are we ready for that? Have people really clocked the professional implications. Some will have done that, but we need the whole profession to be with us.”
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