GPs received ‘inadequate’ funding to supervise independent pharmacy prescribers, review finds

GPs received ‘inadequate’ funding to supervise independent pharmacy prescribers, according to a review of NHS England’s Pathfinder Programme, which found it increased GP workload.

The amount of funding GPs had been provided for clinical supervision had not been sufficient and the current shortage of GPs made it ‘very challenging’ to absorb additional workload, the review by the University of Manchester found.

NHS England’s initial intention was to have 210 Pathfinder sites across all 42 ICBs but in practice, the number changed with some ICBs and Pathfinder sites de-registering.

From September, all newly qualified pharmacists will be independent prescribers on the day of their registration, and the programme, which finished at the end of last year, established a framework for future commissioning of NHS community pharmacy clinical services, incorporating independent prescribing (IP) for primary care patients.

These models are broadly categorised into three areas:

• enhancing existing community pharmacy commissioned services such as acute minor illness and contraception;
• managing long-term conditions such as hypertension, lipid management, and respiratory disease;
• and introducing novel services including deprescribing, prescription management, and menopause services.

NHS England said that Pathfinder sites have delivered over 33,000 patient consultations across 164 pharmacy sites, with more than 59% resulting in prescribing interventions that ‘start, stop or change medicines’ that otherwise would have been done by a GP or hospital.

GP supervision was considered by most IP pharmacists as ‘essential’ for building confidence, especially when delivering long-term and novel clinical models, according to the review.  

But formal supervision by GPs was found to place ‘an additional and often uncompensated workload on GPs’, the researchers said.

The report said: ‘Most sites established formal clinical supervision, often provided by a GP, through regular one-to-one sessions.

‘This was highly valued by IP pharmacists as it helped to build their confidence, especially in new clinical areas, and to build GP trust.

‘However, an unintended consequence of supervision by the GP was an increase in GP workload.

‘Although funding was available, it was thought that the amount was inadequate and the current shortage of GPs made it very challenging to absorb this additional demand on their time.’

One programme manager told the researchers: ‘GPs are very busy, they’re under a lot of pressure, so we’re adding and we’re asking them to support something else. There is some funding, but it’s not a massive amount.

‘And actually, we were obviously trying to sell it on the concept that it would take work away from them.’

The evaluation said that participation in the programme was found to ‘sometimes cost more than the funding provided’.

Pathfinder programme funding included the provision of clinical supervision for IP pharmacists, which was viewed as ‘very important’, but participants questioned the sustainability of this model, with less funding likely to be available for infrastructure building and the setup and supervision costs arising from the transition of clinical services from GP practices to community pharmacy.

It also pointed out that Pathfinder sites selected were ‘usually high-performing pharmacies’, often with ‘strong pre-existing relationships with GP practices’ and a track record in delivering clinical services, so Pathfinder sites may not represent typical community pharmacies in England, many of which ‘may lack the same resources and readiness’.

The evaluation also showed that the digital infrastructure for the Pathfinder programme created ‘significant challenges’ such as the time and effort spent, such as using the GP IT system alongside CLEO.

The nationally designated prescribing system, CLEO, was a standalone platform with limited ‘view-only’ access to patient records via GP Connect.

‘Pharmacists found this system inadequate for managing complex or long-term conditions because it lacked access to crucial information like hospital discharge notes and did not support seamless communication with GPs,’ the review said.

The report recommended that NHS England set ‘clear expectations’ around training, continuing professional development, support, and supervision for all IP pharmacists, particularly Newly Qualified Pharmacists (NQP) or those transitioning to IP role.

And ICBs should ‘facilitate access to supervision’ and support for IP pharmacists, essential diagnostic services like phlebotomy and pathology, and provide support for IT integration.

NHS England told Pulse that the programme formally concluded on 31 December 2025 but that they will continue to provide programme support to ICBs who wish to continue activity during the transition period until the end of March.

An NHS England spokesperson said: ‘NHS England commissioned this evaluation to ensure that integrated care boards had the direction they needed to rollout independent prescribing in their communities, and these findings have been shared with them.

‘We will also use these findings to help us develop future clinical services within pharmacy, and as we deliver on the 10 Year Health Plan which aims to improve patient access to services in the community, and pharmacies will have an integral role in that work.’