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The upcoming workforce plan from NHS England is expected to set out a future where there are not only more health care staff, but also different types of staff, which could encompass new skills or new professions. If it is not simply 'more of the same’, what could this different future look like? We already have one example well in train.
Most people encounter pharmacists in a high street pharmacy to get their medicines dispensed or to seek advice about a minor ailment. Others see them on a hospital ward, working alongside other clinicians, making sure prescriptions are appropriate, safe and effective. More people are starting to see them in general practices for medication reviews, working with GPs and nurses. Some of these pharmacists will have done lengthy extra training to allow them to prescribe medicines, particularly in hospitals and general practices. While pharmacist prescribers are increasing in number, they are still a significant minority of the 61,000-strong pharmacist profession, despite being able to train as a prescriber in one form or another for two decades. And a proportion of those able to prescribe don’t use these skills regularly. But from 2026, when pharmacy graduates register with their professional regulator – the General Pharmaceutical Council – and become pharmacists, they will all automatically also become prescribers.
'For those not associated with pharmacy, the response might be, so what? ... But for the profession, and for patients, it could be a revolution.'
For those not associated with pharmacy, the response might be, so what? After all, who can’t prescribe these days? But for the profession, and for patients, it could be a revolution. Imagine walking into a community pharmacy to have your high blood pressure or depression treated and monitored there by a pharmacist. Or imagine a hospital where a specialist pharmacist routinely leads clinical trials of new medicines for cancer, or leads and delivers rational prescribing of antibiotics. Or an A&E or out-patient clinic, where the pharmacist sees, treats and discharges a patient. Or in a general practice where a clinical pharmacist reviews a patient’s medicines and rationalises them down from 10 regular medicines to 3, while also expanding clinical trials of medicines in primary care. Or in a care home where a pharmacist could be based, on hand to provide specialist care for residents and support staff. All this with the pharmacists as part of an integrated multi-professional team, where everyone knows who’s doing what and who’s responsible for what. All involved have access to social prescribing alternatives, digital therapeutics, and to genomic testing to target the right medicines to the right people and minimise avoidable adverse effects – adverse effects that currently lead to 16.5 per cent of hospital admissions. And, where appropriate, done remotely, assuming that is wanted by the patient, and is safe.
To get safely to the point where new pharmacists prescribe at the point of registration, pharmacy training is changing radically. New education standards require an upgrade in clinical training and schools of pharmacy are making the necessary changes, funded through government-backed clinical placement funding.
Why is pharmacists prescribing different from say nurses or physios prescribing, or indeed doctors? Medicines are still the most common therapeutic intervention in health care. In primary care, 1.14 billion prescription items were dispensed in 2021/22. The volume of prescriptions dispensed in primary care has doubled over the past 20 years. The NHS spends a lot on prescription medicines too – £17.2 billion in 2021/22 (about a 50:50 split between hospitals and primary care), the biggest NHS spend after staff. And as my overprescribing review for government clearly demonstrated, too many medicines are used too often. 15 per cent of adults in England are taking 5 or more medicines a day; 7 per cent are taking 8 or more medicines per day. Clinical review of the need for those medicines is too often infrequent. The review concluded that 10 per cent of medicines prescribed in primary care are unnecessary – that’s 110 million prescription items per year.
Pharmacy is a Masters-level qualification. Five years of scientific and now enhanced clinical training leading to patient-facing, clinical specialists in medicines and their optimal use, sharing decisions with patients to reach agreement on the right treatment. And that decision could be to opt for social prescribing, not a medicine. Pharmacists could revolutionise not just everyday patient care, but could play a significant role in putting the UK back on track with clinical trials, which have nose-dived since the Covid-19 pandemic. A form of this new breed of pharmacist is already being deployed into general practices. So far, some 4,000 clinical pharmacist prescribers with enhanced clinical training are practising alongside GPs and practice nurses every day, and there are plans for more clinical pharmacists to be trained and deployed into general practice.
'In the heat of a NHS under huge pressure where day-to-day operational pressures distract from medium- to longer-term strategy, where is the comprehensive plan to make best use of this new pharmacist asset across the health and social care system?'
So the future is bright. Or is it? In the heat of a NHS under huge pressure where day-to-day operational pressures distract from medium- to longer-term strategy, where is the comprehensive plan to make best use of this new pharmacist asset across the health and social care system? Where’s the strategy to ensure this new breed of pharmacist is safely and effectively integrated into future workforce plans, clinical pathways and research programmes? That plan has to include not only ongoing support and clinical supervision but also structured career development. What about existing pharmacists, prescribers or otherwise, how are they integrated or upskilled effectively? And how is all this done is a way where patients not only understand, but want, the benefits. The NHS England pharmacist prescriber pathfinder programme, focused on community pharmacy, will address some important issues such as governance, access to patient records and mitigating any conflict of interest generated by medicines prescribing and supply residing in the same entity. But the opportunity is much bigger and could bring benefits across the health system. Let’s not forget the new breed of pharmacist, now only three years or so away, won’t want to be spending much time dispensing medicines, so government, regulators and employers need to urgently resolve the longstanding, controversial issue of using the other regulated profession in pharmacy – the pharmacy technicians – to step up to some roles previously occupied by pharmacists, while expanding the use of technology to automate repetitive dispensing tasks. So a joined-up, system-wide approach is needed. I fear there is a risk that in 2026 yet another innovation that could help transform patient care just falls over the cliff edge into the world of piecemeal and largely unplanned utilisation. I hope I am wrong, and Department of Health and Social Care and NHS England policy-makers and clinical leaders will make the most of all new pharmacists becoming prescribers. It just needs an NHS strategy, robust planning and thoughtful implementation. If the NHS does not use pharmacist prescribers, then private health care may. Prescribing skills in all new pharmacists could facilitate a range and scale of private services through pharmacies that would herald a significant rebalancing of public and private provision. At best, that is likely to enhance inequality. At worse, it could see overuse of important public health resources such as antibiotics, undermining the fight against antimicrobial resistance.