Pharmacists carried out half of non-medical prescribing in 2021

This represents a 20% increase from 2020, the Care Quality Commission (CQC) says in its report, with 2,361,921 items prescribed by pharmacists last year compared to 1,962,615 in 2020. 

'This trend of pharmacist prescribing is likely to continue as all newly-qualified pharmacists will be independent prescribers by 2026,' the CQC said in its Safer management of controlled drugs: Annual update 2021. 

In 2017, pharmacists accounted for only 29% of non-medical prescribing (487,036 items), the report says, but 'pharmacist prescribers are increasingly working in GP practices and primary care networks'. 

The CQC's analysis found prescribing of controlled drugs by non-medical prescribers increased for all professional groups by 14% - from 4,215,881 items prescribed in 2020 to 4,799,328 items in 2021. 

Prescribing by nurses, including nurse independent prescribers and community practitioner nurses, accounted for 51% of all non-medical prescribing in 2021 (2,427,897 items), it found.

In addition, in 2021, the report found that hospital prescribing that can be dispensed in a community pharmacy was’ broadly in line’ with 2020, the health and social care regulator said, with an increase of less than 0.5%.

The data also showed small numbers of non-medical prescriptions by paramedics (up to 153%), podiatrists (up by 152%), radiographers (up by 140%) and physiotherapist (up by 26%) - although these did not show in the overall percentages when rounded.

Last year saw an increase from 2020 in the hospital prescribing of some Schedule 5 controlled drugs for community pharmacy dispensing, the CQC said, including Dihydrocodeine - up 26% from 2,654 to 3,341, Co-codamol - up 23% from 28,905 to 35,447, Morphine Sulfate - up 14% from 11,702 to 13,355, and Codeine - up 14% from 23,050 to 26,162. 

The most commonly supplied controlled drugs issued through the national NHS Community Pharmacist Consultation Service were clonazepam, co-codamol, codeine, co-dydramol, diazepam, dihydrocodeine, morphine sulphate and zopiclone, the regulator said. 

The service, launched in October 2019, 'aims to reduce pressure on primary and urgent care services, including emergency departments and out-of-hours GP services, by referring people to community pharmacies for advice, treatment and urgent repeat prescriptions,' the CQC explained. 'The service may supply certain controlled drugs in specific circumstances for a limited period.' 

Controlled drugs 

The report also presents some 'key findings and learning' in relation to controlled drugs, gained from analysis of Prevention of Future Death reports between 2017 and 2021, which the CQC says are 'an important source of information about controlled drug-related deaths'. 

Themes raised in these reports include collecting controlled drugs from community pharmacies, and poor communication between health and social care providers in local systems, the regulator said. 

'In one example, a pharmacy had allowed multiple different patients to collect each other’s prescriptions interchangeably,' the CQC said. 'The coroner raised the concern that this meant people could stockpile medicines, which would lead to a raised risk of harm and/or death.' 

In another example, medical professionals treating a young person had not told a community pharmacy about a safety plan. 

'The plan was in place because a young person had a mental health condition that put them at risk of deliberate overdose,' the regulator explained. 

'Because the pharmacy was not aware of the safety plan, this meant that the pharmacy supplied medicines directly to this person when it was not safe to do so.' 

The report also highlights an Opioid Prescribing Comparators dashboard that was released in May, aiming to help prescribers improve care and reduce harm for patients taking opioids to manage chronic non-cancer pain. 

The benefits of the dashboard include that it will 'enable GPs, pharmacy professionals and other healthcare professionals to identify problematic opioid prescribing issues in a locality, and understand more about these issues, including how many patients are taking opioids, enabling a more targeted response,' the CQC said. 

Independent prescribing first evolved as an add-on qualification that pharmacists could undertake in their own time, often with their own money, but it is now a more widely funded qualification for pharmacists taking up new roles in general practice through the Additional Roles Reimbursement scheme. 

In December 2020, the General Pharmaceutical Council (GPhC) approved new standards for the initial education and training of pharmacists, which will make prescribing skills an integral part of pharmacists’ training and mean all MPharm graduates will be independent prescribers from 2026. 

In addition, in November 2021, Health Education England announced investment of up to £15.9m from NHS England and NHS Improvement to support the expansion of frontline pharmacy professionals in primary care over the next four years. This includes giving registered pharmacy professionals the opportunity to access further clinical training, such as independent prescribing skills. 

It is in 'everyone’s interests to ensure that there are enough pharmacists progressing to become PIPs,' the Pharmacists’ Defence Association said, as they offer care and services to professions and can help train designated prescribing practitioners in subsequent cohorts. 

Last year, a Government-commissioned review concluded that the clinical skills of pharmacists and pharmacy technicians need to be upgraded to tackle overprescribing.   

Community Pharmacy Wales has previously urged the Welsh Government to ensure there is at least one independent prescriber in each pharmacy across the country by 2030, while RPS Wales called for further integration of pharmacist independent prescribing into ‘routine NHS care’.   

Meanwhile, in August 2020, the Scottish Government announced it would launch a formal career pathway designed to boost independent prescriber numbers in community pharmacy.