Opinion: Professional revolution or damp squib?

In a recent blog for the King’s Fund, Keith Ridge, former chief pharmaceutical officer for England, outlines how pharmacist prescribing could revolutionise patient care but fears that the move may fail without proper strategic planning by the NHS.

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. And from 2026, pharmacists will all automatically become prescribers. For those not associated with pharmacy, the response might be – so what? 

After all, who can’t prescribe these days? However, 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 three, 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.

Radical changes

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 financial support.  

Why are pharmacists prescribing different from, say, nurses or physiotherapists prescribing, or indeed doctors? Medicines are still the most common therapeutic intervention in healthcare. 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 – £17.2bn in 2021/22 (about a 50:50 split between hospitals and primary care), the biggest NHS spend after staff. 

As my overprescribing review for the Government demonstrated, too many medicines are used too often. Fifteen per cent of adults in England are taking five or more medicines a day; 7 per cent are taking eight 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 a 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 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.