Community Pharmacy Independent Prescribing Pathfinder Programme

Background

In 2023, Pharmacy First was launched in Community Pharmacy as part of a wider strategy in England to increase primary care access for patients. A shift to more clinical services is often hampered by the limited mechanisms for how patients can access medicines. Enabling independent prescribing will allow further clinical services from community pharmacy. The changes in pharmacist education and training will mean that all new pharmacists leaving university will have independent prescribing capability from 2025. NHS England has implemented a pathfinder programme to develop a commissioning framework for Independent Prescribing in future clinical services from community pharmacy.

NHS England commissioned NHS Midlands and Lancashire (NHSML) to support the programme operationally from September 1, 2023, to November 31, 2025, to develop a national dashboard and a standalone cardiovascular disease lipids management dashboard for data analysis to inform a national commissioning model.

Action

In collaboration,  NHS England and NHSML developed a suite of tools to support operational implementation. This includes:

• A Readiness Checklist for Integrated Care Boards (ICB) and Community Pharmacy Pathfinder sites to help governance assurance with the go-live process.
• A dashboard summarising ICB progress towards go live status. This was updated monthly.
• An overall national dashboard and a cardiovascular disease - lipids management dashboard to analyse data, capturing clinical and prescribing activity (e.g., clinical models, consultation length, medicines prescribed, changed, or stopped)
• A customised reimbursement Microsoft claim form, enabling Pathfinder sites to record activity and submit claims, supporting ICB teams with reimbursement processes.
• Ongoing in-depth analysis of the results to help inform future strategy development

Impact

NHS ML worked with ICB Community Pharmacy Integrations Leads (CPCLs) within each Region to capture monthly pre-go live dashboard reporting data for NHS England. This helped NHS England understand what was working well and not so well at each ICB level and how the Pathfinder was progressing.

NHS ML also developed checklists for ICBs and Pathfinder sites which could be iterated locally, as well as setting up Communities of Practice with NHS England Regional Leads supporting ICBs who were doing the same clinical models to share learning.

NHS ML developed the Independent Prescribing (IP) Pathfinder Site Post-Consultation and Sessional Claim form for community pharmacists. This recorded data for community pharmacy payments and enabled NHS England to understand the activity at pathfinder sites. This post-consultation data was also utilised to produce a national dashboard for the national implementation team as well as regional and ICB pharmacy teams. NHS ML hold and manage this data for the majority of the sites.

Analysis shows that to date, there have been a total of 20,188 consultations, with 19,061 completed to date (94.4%). 8,792 consultations (43.6%) resulted in 9,771 new medicines being prescribed, 1,585 consultations (7.9%) led to 2,189 medicines being changed, and 673 consultations (3.3%) resulted in 731 medicines being stopped. A variety of clinical models are being implemented, the most common is the minor ailments service, with hypertension, prescription management, anticoagulation and lipid reviews also frequently selected.