Can pharmacists prescribe medicines?
On 8 May, the government announced new plans for the way that people access healthcare in England.
This included the Pharmacy First scheme, which will make it easier to get prescription-only medicines for seven common conditions without seeing a GP.
When describing the new scheme, both the Prime Minister and NHS England said it was the “first time” that such a service would be available from pharmacists.
This is broadly true, but it doesn’t mean that pharmacists in England couldn’t prescribe medicines already.
So how can people in England get prescriptions now, and how will this change in future?
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Some pharmacists can already write prescriptions
A minority of pharmacists have been able to prescribe medicines since at least 2003, when the role of “supplementary prescriber” was created, followed by the broader “independent prescriber” (IP) role in 2006.
Data from 11 May shared with Full Fact by the General Pharmaceutical Council (GPC) shows that 12,904 pharmacists in England had at least one of these qualifications, with almost all of them being independent prescribers.
As the GPC says, “a pharmacist independent prescriber may prescribe autonomously for any condition within their clinical competence”. A pharmacist’s clinical competence or scope of practice is different for different pharmacists.
As far as we can tell, NHS England does not currently commission prescriptions from IP pharmacists working in community pharmacies—but it does if they work in hospitals or GP surgeries, which many do. And IP pharmacists can prescribe medicines privately instead.
In practice, this means that someone in England who needs a prescription might already be able to get one privately from a community pharmacist, but not on the NHS. Alternatively, they might be able to get an NHS prescription from a pharmacist who works in a hospital or a GP surgery.
Some nurses, physiotherapists and other healthcare professionals who are not doctors or pharmacists can also prescribe in a similar way.
A version of the Pharmacy First plan already exists in Scotland, where some pharmacists can prescribe. The Choose Pharmacy scheme in Wales also allows some pharmacists to prescribe for patients on the NHS, and there are plans to introduce non-medical prescribing in Northern Ireland.
What do prescribing pharmacists do?
According to a GPC survey of registered pharmacists in 2019, about 8% of respondents who were prescribers at the time worked in a community pharmacy (although this may not be representative of prescribing pharmacists as a whole). Most of the rest worked elsewhere in primary care, or in secondary care (which includes hospitals).
Prescribing pharmacists who work in the community are “usually involved in running minor ailment services or visiting care homes”, according to the Pharmaceutical Journal.
The journal also separately reported that “pharmacists working outside hospitals in England prescribed 32,479,133 items in 2020/2021”.
What is changing?
The Pharmacy First scheme for England is designed to cover seven common conditions, namely sinusitis, sore throat, earache, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women.
The scheme does not technically mean that more pharmacists will start prescribing. Instead, medicines for these conditions will be supplied with a Patient Group Direction (PGD). This means that individual pharmacists are not writing prescriptions themselves, but following instructions for a general prescription that’s been written in advance for patients who meet certain criteria.
In recent years, some pharmacists have already been using PGDs to dispense for some of these conditions in pilot schemes around England.
For instance, women in Oxfordshire have already been able to get prescription medicines in this way for uncomplicated urinary tract infections, and antibiotics for infected insect bites have been available in Cambridge and Peterborough, and in Norfolk and Waveney.
A spokesperson for the Royal Pharmaceutical Society (RPS) told Full Fact that pharmacists prescribing for the seven conditions “was happening in a limited number of pharmacies in certain areas. But it wasn’t routinely done, and wasn’t for all seven conditions in a single pharmacy.”
The RPS spokesperson added: “This is the first time that all these services have all been available in every pharmacy doing all these services in England […] As far as we are aware there are no pharmacist independent prescribers in England operating in community pharmacies providing all of these services on the NHS.”
High street prescriptions may become the norm
Recent years have seen a large increase in the number of pharmacists who can prescribe. The Pharmaceutical Journal reported that the number of IP pharmacists in England more than tripled between 2016 and 2020, and that the numbers in Wales and Scotland rose too.
Apart from the Pharmacy First scheme, NHS England is also launching a pilot scheme to commission prescriptions from IP pharmacists.
Prescribing is also becoming part of pharmacists’ training, and every new pharmacy graduate who registers with the GPC will be able to prescribe from 2026 onwards.
The President of the Primary Care Pharmacy Association, Graham Stretch, told Full Fact: “A small minority of community pharmacists can at present work as independent prescriber [...] All the legal mechanisms such as patient group directives can be utilised to provide prescription only medicines to groups of patients in specific circumstances and can be used to action the plan as described by NHS England[…]”
What does the NHS say?
An NHS spokesperson told us: “The NHS has been crystal clear that this is the first time community pharmacists across England will be able to supply NHS prescription medicines for these seven common health conditions.
“As the plan states, because this is a new national initiative, it is subject to consultation.”
NHS England has committed to a national campaign to help the public understand the planned changes in primary care, including Pharmacy First.
Image courtesy of National Cancer Institute