‘Independent pharmacist prescribing rollout must not repeat PA mistakes’

GP and designated prescribing supervisor Dr Kam Ahmed discusses the challenges of pharmacists automatically becoming independent prescribers from this year, and the urgent reforms needed to ensure and maintain safety

From this September, all newly qualified pharmacists will join the professional register as independent prescribers, as part of a reform intended to expand clinical capacity and improve patient access. The goal is understandable, and pharmacists have demonstrated considerable value within MDTs, but the transition to prescribing at the point of registration introduces significant risks that require much stronger national safeguards.

As a GP, GP trainer and designated prescribing supervisor, I frequently work alongside pharmacists and I value their contribution. It is precisely because of this that there is a responsibility to ensure the reforms do not outpace the profession’s current infrastructure, training capacity or support systems.

This is not a resistance to progress; it is recognition that meaningful reform must be matched by meaningful governance. The concerns expressed here are rooted in issues highlighted consistently across bodies such as the Royal Pharmaceutical Society (RPS), the General Pharmaceutical Council (GPhC), the Pharmacy Schools Council (PSC) and NHS England. They reflect known pressures within education and clinical training rather than anecdotal misgivings.

Quality and consistency of selection and training

One of the most prominent concerns is the wide variation in educational foundations and academic readiness across pharmacy schools. Sector data has repeatedly highlighted substantial differences in assessment outcomes, reflecting variation in entry thresholds, placement availability, learning environments and clinical integration.

In recent years, MPharm intakes have expanded significantly, often through clearing routes and lower entry grades to fill places. While capable students enter via all pathways, this systemic shift raises concerns about consistency when all graduates will soon assume prescribing responsibility from their first day on the register.

Unlike medicine, where national bodies regulate student numbers and align training capacity with workforce needs, pharmacy education remains largely driven by institutional autonomy. Without national oversight of intake size, placement availability and supervision capacity, expansion risks weakening consistency of clinical readiness across the profession.

Limited real-world clinical exposure

A further challenge is the limited and variable level of real patient exposure within many pharmacy programmes. Although reforms have emphasised experiential learning, curricula remain dominated by simulation, theory and structured tasks rather than unpredictable real-world encounters.

Simulation is valuable, but it cannot replicate patients who present atypically, deteriorate subtly or embody diagnostic uncertainty. Many MPharm students report minimal exposure to undifferentiated patients or abnormal clinical findings before graduation.

Supervision as an afterthought

The gap between theoretical knowledge and real-world complexity becomes particularly concerning when newly qualified pharmacists are expected to prescribe without a structured period of supervised practice.

Although GPhC standards have been updated to mandate experiential learning of only 90 hours, they do not specify minimum placement length, case mix, supervision quality or access to suitable clinical environments. Placement quality varies widely, from high-functioning clinical teams to understaffed settings unable to support active learning.

In contrast, medical students complete thousands of hours of supervised clinical exposure, with responsibility increasing through structured, competency-based progression. Elevating pharmacists to prescriber status without equivalent experiential grounding creates a mismatch between responsibility and preparation.

Acceleration of the prescribing pathway

Historically, pharmacists who became independent prescribers did so after years of post-registration experience, often within focused clinical areas and structured hospital environments. This allowed exposure to sufficient clinical variation to support safe decision-making. Even within this experienced cohort, 90 hours of supervised prescribing exposure was recognised as barely sufficient, with over 50% of pharmacists who qualified as independent prescribers not using the skill regularly, and almost one-third have not used it at all.

Under the new model, prescribing rights will be granted immediately at registration. NHS England has acknowledged this acceleration but has not yet outlined how early-career pharmacists will develop clinical maturity. Prescribing requires more than pharmacology; it falls into the final interlude of a management plan derived after applying skills in consultation, physical analysis, technical tests, pattern recognition, risk assessment and anticipation of deterioration. These are all skills developed through repeated exposure under expert supervision.

Governance, regulation, risk and structure

Despite the scale of change, neither GPhC nor NHS England has clearly defined the expected scope of practice for newly qualified pharmacist prescribers. There are no national limits on the patients they should manage early in practice, nor a supervised transition period equivalent to medical foundation training.

Pharmacists will have full prescribing authority from registration, despite wide variation in experiential learning. GPhC revalidation remains relatively light-touch and heavily reliant on self-assessment. The current regulatory framework has not kept pace with the increased risk inherent in widespread prescribing.

Lessons from Professor Leng’s review into physician associates are directly relevant. That review highlighted how unclear boundaries, insufficient supervision and premature deployment into general practice created safety risks and professional tension. It recommended restricting undifferentiated patient exposure, strengthening supervision and grounding early practice in supportive environments; principles equally applicable (yet seemingly ignored) to pharmacist prescribing.

Ethics, incentives and private prescribing

Another concern is the commercial nature of community pharmacy, where prescribing and dispensing operate within the same business model. While pharmacists act ethically, structural incentives can influence behaviour in the absence of strong governance.

To date, no rise in antibiotic prescribing has been observed, but this reflects experienced pharmacists who trained under more restrictive models. The rapid expansion of private prescribing, particularly in weight management, demonstrates how quickly new markets can develop without robust oversight.

The UK lacks a national system to monitor pharmacists prescribing across NHS and private sectors. There is no performers list, no centralised prescribing surveillance and no structured audit process to identify unsafe practice.

The GPhC vision allows pharmacist prescribers to practise only within a self-declared ‘specialist area’. While sensible in principle, this is currently unworkable. There is no national framework defining specialist status, no recognised ‘specialist’ training pathways, and no clear limits on scope or movement between specialties.

This is particularly evident in weight management, where no accredited specialist training exists. Under current GPhC guidance, this should preclude prescribing in this area, yet pharmacist prescribing has been widespread. The GPhC has recently acknowledged this practice in updated public FAQs, showing a clear gap between regulatory expectations and real-world activity.

Speed of roll out

Taken together, these issues reveal a structural misalignment between ambition and infrastructure. Without safeguards, early-career pharmacists may be exposed to professional risk, general practice teams may be asked to supervise without assurance frameworks, and patients may face unintended safety consequences.

The goal of empowering pharmacists as prescribers is sound, but rapid implementation without aligned training, supervision and governance risks creating additional pressure rather than relieving it.

How do we move forward?

Pharmacists can make valuable contributions to patient care, and independent prescribing could modernise the profession. However, reforms of this scale require safeguards that match the level of responsibility. At present, the pace of change has exceeded the systems needed to ensure safe, consistent early-career prescribing.

There are several key actions we must take now to ensure the safe evolution of pharmacist prescribing:

• Establishing a clear scope of practice for newly qualified prescribers;
• Setting firm boundaries around the types of presentations and prescribing decisions appropriate during early practice;
• Verifying clinical competence through supervised and quality-assured placements that expose trainees to a meaningful range of real clinical presentations;
• A standardised and accredited supervisor model, including funded supervision time and defined supervisory responsibilities;

The principles of the Leng Review should be applied to pharmacist prescribing, embedding staged responsibility, structured supervision and clear role limits. Revalidation should be strengthened with peer review, prescribing-specific CPD and audit. Integrated care systems should monitor prescribing quality and support early intervention where concerns arise.

If these measures are adopted, pharmacist independent prescribing can strengthen multidisciplinary care and improve access. If not, the system risks repeating avoidable mistakes seen in other workforce expansions. Acting now will ensure this reform becomes a foundation for sustainable progress rather than systemic vulnerability.

Dr Kam Ahmed is a GP partner, PCN CD and CEO of a GP federation in Wolverhampton. He also provides minor ailment and clinical skills training to ancillary staff