Using freedom of information responses, Leela Barham digs into data on the scale, location and fees being claimed by independent prescribing (IP) pathfinders in community pharmacy across England

More than 180 sites have signed up to be an IP pathfinder across England, just short of the expectation of 210. NHS Humber and North Yorkshire leads with 11 sites, but three other ICBs have just two sites in their patches. More than 350 sites would have liked to participate but weren’t selected, missing out on funding with sites claiming more than £330,000 for participating in the last two months of 2023. Lessons from IP pathfinders should emerge from an evaluation due to be completed in December 2024. 

Planning ahead

When the NHS wants to try something out, it conducts a pathfinder. Community pharmacy is no exception, with independent prescribing (IP) having its own pathfinder programme as part of prep for IP in community pharmacy hitting the big time by September 2026. By then, all newly qualified pharmacists will be IPs on the day of registration.

NHSE opened an expression of interest process for IP pathfinders in January 2023. It was anticipated that up to 210 sites could take part across 42 integrated care boards (ICB).

Fast forward to April 2024 and data from the NHS Business Services Authority (NHSBSA) revealed that 181 sites had registered across 37 ICBs (fig. 1). NHSBSA registrations of 181 compares to an NHSE figure of 178 sites. The five ICBs not on either NHSBSA or NHSE’s responses – NHS Norfolk and Waveney, NHS Suffolk and North East Essex, NHS North West London, NHS Cambridgeshire and Peterborough and NHS Surrey Heartlands – would add a further 15 sites based on their responses to direct freedom of information requests.

The fact that numbers differ according to who you ask is likely a reflection of things changing on the ground over time. NHSBSA data reveals that registrations have ebbed and flowed, with just four in November 2023, hitting a peak of 83 in December 2023, before falling to 66 in January 2024 and 14 in February and March. It’s unlikely there will be many more given the expectation of 210 sites.

More than 350 left out

Freedom of information responses from ICBs have shed light not just on how many IP pathfinders each has, but also on the level of interest locally. Based on 38 ICBs who responded to the requests, 357 sites expressed an interest but weren’t selected. For some, the prospect of taking part wasn’t attractive at all; in one ICB there were 12 sites with an IP already in place but five of those didn’t want to take part in the programme.

ICB responses also highlight how the situation varies across the country when it comes to availability of IPs. Availability of IPs was a criterion frequently used to select from those interested in the programme; sometimes it was the only criterion used.

NHSE influence

NHSE has described how the scope for IP pathfinders would be “determined by ICBs”. It would also be for ICBs to “work with community pharmacy teams to identify the pharmacies and local pharmacists that will deliver the service”. That doesn’t resonate with all the responses from the ICBs though.

One ICB said its pathfinder sites were “allocated to…[the] ICB”. Another said “NHSE has allocated five pathfinder sites to our area”, and a third said NHSE had “commissioned the ICB to permit up to six pharmacies to participate”.

Whether that means NHSE stepped in to limit the number of pathfinders or went further in playing a role to select them is open to interpretation.

Reaping some rewards

IP pathfinders are entitled to a £1,500 set up fee and can claim for up to 24 sessions a month at a total of £198.

The most up-to-date data on claims for pathfinder activity from NHSBSA covers November and December 2023, when claims were made by IP sites in 29 ICBs. The inference is that the sites in the other eight ICBs were not in a position to claim. Those that were, claimed over £330,000. That includes both the set-up fee and delivery of the service as NHSBSA data doesn’t split these out.

The average per site across the ICBs varied from £750 to more than £5,500 for the last two months of 2023.

Evaluation planned

NHSE has commissioned the University of Manchester to evaluate the IP pathfinders. That contract is due to end in December 2024.

NHSBSA describes the intention for “appropriate local and national quantitative and qualitative evaluation and research, including patient experience and the experience of community pharmacy, general practice, community services and secondary care teams”.

What that means is that we’ll have to wait and see.