In Analysis

Follow this topic

Bookmark

Record learning outcomes

Leela Barham investigates the status of national economic evaluation of independent prescribing in England, just as ICBs must make decisions on what is next for Pathfinders in their patch

It’s less than a year until all newly qualified pharmacists will be independent prescribers on the day of their registration from September 2026. To prepare for this change, NHS England (NHSE) launched its Independent Prescribing in Community Pharmacy Pathfinder Programme.

The programme included three models:

• Existing services like acute minor illness and contraception
• Long-term conditions such as prescribing statins, anticoagulation in atrial fibrillation, inhaler optimisation and rescue therapy for respiratorydisease
• And novel services including deprescribing, reviewing antidepressants and menopause services. 

Alongside the Pathfinders, a clinical system – CLEO SOLO - was also rolled out to allow community pharmacists to generate prescriptions via the NHS Electronic Prescription Service (EPS). Pathfinders could access CLEO SOLO from August 2024. The first Pathfinder pharmacy went live on CLEO on 16 December 2024. 

Slow implementation

A previous P3pharmacy investigation found that more than 180 sites signed up to be pathfinders back in May 2024, falling short of the plan for 210 sites.

Minutes from a Community Pharmacy England (CPE) service development subcommittee meeting held on 24 September 2025 noted that “almost all sites had been able to commence prescribing” but “a lot of the sites” had only started prescribing in July.  NHSE opened its expression of interest for pathfinders in January 2023, suggesting it took over two years to move from idea to prescribing for most pathfinders. 

Yet even given this, Hammaad Patel, national pharmacy integration lead at NHSE, revealed in October that the pathfinders had delivered over 33,000 consultations. He also said more than 59 per cent of those consultations led to prescriptions for people who would “otherwise need to have been seen elsewhere in primary or secondary care”.

It’s likely that there’s been variation in what’s being done within pathfinders. Ghulam Haydar, a senior policy lead at NHSE, has highlighted that integrated care boards (ICBs) have “utilised the pathfinder to run a number of different clinical services based on local needs”.

National evaluation 

NHSE commissioned a national evaluation from the University of Manchester and ICF International. The aim is to help “develop a framework which will support the commissioning of independent prescribing as part of clinical services in community pharmacy.” 

The benefits of this should be that the research will be up to date and reflect today’s community pharmacy context in England, rather than trying to learn from other countries.

The evaluation effectively started on 1 April 2024, according to the University of Manchester’s project website. The contract was awarded on 1 January 2024 with a contract value of £202,000.

An abstract on the evaluation was published on the realist evaluation by University of Manchester researchers on 7 November 2025 in the International Journal of Pharmacy Practice. The original submission was sent on 31 December 2024 and revised on 8 September 2025, so it only reflects what was known by then. Preliminary insights highlighted the importance of close collaboration with general practice as well as the need for support for independent prescribers, plus the need to embed independent prescribing into community pharmacy. 

Publication too late? 

It would have been useful to have the national evaluation ready as ICBs have to make decisions about their pathfinders. NHSE asked ICBs to “agree locally which pathfinder sites they wish to continue after 31 December 2025, as well as which clinical models will be maintained” in its 30 October letter. Presumably, the national evaluation puts more substance behind the preliminary insights offered by the university researchers. 

NHSE did not respond when asked about discrepancies with the published contract end date (11 January 2025) and the University of Manchester’s project end date (30 September 2025). Sister publication Pharmacy Magazine had understood that the report was “expected anytime now” when reporting on progress in March 2025. 

The University of Manchester told us on 11 November that “the draft report is with NHS England, and we are working with them to plan its publication.” They didn’t say when it went to NHSE.

Lessons from previous research will also come from the National Institute for Health and Care Research (NIHR) Integrate research programme looking at ‘what works for whom, why and in what circumstances’ when it comes to independent prescribing. Aston University was also awarded £248,495.47 for a literature review. That work started in July 2024 and was due to end in December 2025. 

It seems likely that these pieces of research won’t change the direction of travel; NHSE already told ICBs that they must introduce prescribing-based services into community pharmacies during 2026/2027 in the Medium-Term Planning Framework for 2026/2027 to 2028/2029 published on 24 October.

NHSE’s timeline for next steps for the pathfinders includes completion of the national evaluation between October to December 2025. They have committed to publishing the evaluation and sharing other learning gleaned from focus groups. NHSE told P3 that the final report “will be published in due course.”

Whatever the national evaluation comes up with, it risks being too late to be useful to ICBs but could still help as CPE negotiations on future contracts. Better late than never?