Scotland’s independent think tank
Scotland’s independent think tank

Pharmacists must be fully integrated into the NHS – Fiona McIntyre

Reform Scotland Blog

Medicines are the most common intervention in healthcare. The creation of the National Health Service (NHS) in 1948 improved access to medicines and prescription numbers leapt from 70 million in 1947 to 250 million in 1949.[1] And it continues to grow with over 1.7 billion prescription items dispensed across the UK[2][3][4] in 2022/23; in Scotland alone, this figure was around 110 million.[5]

The Royal Pharmaceutical Society is the professional leadership body for pharmacists and pharmacy in Great Britain. Our mission is to put pharmacy at the forefront of healthcare. In recent years, pharmacy has been catapulted forward in the public’s eye as the first, or Pharmacy First, point of contact for healthcare in our communities. Accessing a highly trained, regulated, healthcare professional in their local pharmacy who provides high quality care, often without an appointment, has become the norm for many citizens. Pharmacists do not only practice in communities, though the vast majority of pharmacists registered with the General Pharmaceutical Council (GPhC), do. The second largest group practice in hospitals and similar settings; and a growing number, bolstered by the introduction of new roles following the General Medical Services (GMS) Contract implemented in 2018, in general practice. Pharmacists also practice in academia, research and the pharmaceutical industry.

Gone are the days of pharmacists wearing white coats, making up medicines extemporaneously on the dispensing bench, tied to the processes of medicines production and dispensing. White coats have been replaced with appropriate personal protective equipment; skills once used for making the medicinal products now applied to therapeutics and the development of new skills in patient consultations, clinical assessment and prescribing. From 2026, all new pharmacy graduates fulfilling the necessary registration requirements for the GPhC will be qualified to prescribe medicines.

Legislative changes surrounding supervision of activities by the pharmacist are anticipated which will extend the role of registered pharmacy technicians and pharmacy support staff to manage the safe storage, procurement, quality assurance, dispensing and supply of medicines across all sectors of practice. Educational reforms brought about pharmacist prescribing and legislative changes will release the pharmacist from the shackles of supply. So, what will this mean for pharmacists and pharmacy in the future #NHS2048?

Capacity – Access to Care

Patients regularly interact with their local community pharmacy service.  Core NHS services include public health services such as health promotion advice, smoking cessation and access to emergency hormonal contraception; treatment for common clinical conditions through the Pharmacy First service and providing pharmaceutical care and support for those taking medication for long-term conditions. Community pharmacies opt in to deliver a host of other services ranging from stoma care, substance use services, vaccination and support for care homes linked to the needs of their local population and commissioned by local Health Boards.

Community pharmacies are independent contractors like general practitioners (GPs) but are often not seen in the same light as GPs. They are not fully integrated into the NHS and until this is remedied the benefits of the enabling legislation and educational reforms will not be fully realised. To optimise the clinical capacity that prescribing community pharmacists can offer, local health needs of patient populations must be assessed and used as the basis for commissioning appropriate services to address health inequalities.

An essential building block to full integration of community pharmacists into the Scottish healthcare system is access to the Integrated Social Care and Health Record. Many members of the public think that pharmacists can already see their medical notes, however, there is variation across Scotland in terms of which pharmacists can access certain digital systems giving them access to different parts of the health record. In the main, community pharmacists can access the Emergency Care Summary, a centrally held record populated by data from GP practice systems. Limited data available includes a list of repeat medicine prescriptions, latest acute prescriptions and allergies. Inconsistency of pharmacist access to patients’ health records is a missed opportunity to access clinical capacity for care, delivered by capable health professionals who already nurture positive therapeutic relationships with the people in their communities.

The 2018 GMS contract in Scotland introduced a substantial programme of service redesign and transformation of primary care.  One of the fundamental elements was the introduction of a comprehensive pharmacotherapy service that embeds greater numbers of pharmacists, pharmacy technicians, and pharmacy support workers in GP practices to provide pharmacy and prescribing support for patients. [6]

These general practice pharmacy teams are working towards delivering patients a comprehensive service with core and additional elements. Much progress has been made in the last 6 years, with substantial investment in general practice pharmacy teams, however significant challenges remain, and further investment is required in workforce, skill mix and infrastructure to realise the full benefits of the service. These challenges mean a failure to unlock the full potential of the professional role of some pharmacists. These issues need to be addressed urgently to ensure that roles are, and remain attractive, to recruit and retain pharmacists, to provide positive patient care, free up GPs, and build a sustainable pharmacotherapy service that will endure.6 

Pharmacists in primary care should be focused predominantly on patient-facing clinical roles: using pharmaceutical expertise and independent prescribing skills to deliver clinical medication review, support safer use of high-risk medicines, and improve complex pharmaceutical care.6 To properly support clinical pharmacists in this complex role it is vital that the appropriate number of pharmacy technicians and pharmacy support workers are available.  At present, shortages of these roles in many areas necessitates pharmacists having to provide services that could be provided effectively by other members of the pharmacy team: addressing this gap would markedly improve efficiency and release pharmacists’ clinical capacity.

There is potential for community pharmacists to take on some aspects of the pharmacotherapy service and this should be explored. This may include some aspects of prescription management being undertaken in community pharmacy through extension of the Medicines Care and Review service. The knowledge and skills of community pharmacists already exists; however, funding and contractual arrangements require to be adapted to enable these new models of care. As a minimum, stronger links between pharmacists in GP practices and community pharmacy practice should be achieved to deliver seamless care for patients.6

The linkages between each sector of practice at the interfaces of health and social care has never been more necessary as we look to the future of an integrated NHS. A shift in the balance of care is vital so that patients accessing scheduled care services for the management of a long-term condition that has been traditionally managed in outpatient clinics need to be able to interact with their local community pharmacist or general practice pharmacy team for more conditions. In the immediate future, this will be enabled by emerging digital technology i.e. wearable devices and apps for patient reported outcomes and monitoring. E.g., a patient prescribed an oral cancer therapy has a remote consultation with a specialist cancer care pharmacist who accesses the data from the app, confirms the clinical picture with the patient and approves the release of the medication supply from their local community pharmacy via ePrescribing.

Expanding healthcare capacity in the community, alongside technology advances in automation, will enable hospital pharmacy transformation and a shift in the clinical practice of hospital pharmacists and pharmacy teams. Pharmacy teams ensure the medicines necessary for patients requiring both hospital inpatient and outpatient services are prescribed, optimised and administered, or taken, in a way that maximises their positive outcomes while reducing avoidable harm. Pharmacy teams in hospitals oversee the safe and effective procurement, storage, handling, distribution and dispensing of medicines, undertaking the oversight of the governance aspects of the introduction of new medicines, production and quality assurance of medicines and support for the growing number of non-medical prescribers practicing within the system.  Achieving these diverse aims in the context of a national health service in recovery from a global pandemic is challenging but provides an opportunity to make the changes necessary to secure a sustainable future.

In the future, algorithms and artificial intelligence embedded in electronic prescribing systems will support safe and effective multiprofessional prescribing under the leadership of pharmacists.  Prescribing pharmacists will have a blended job plan where they work in new clinical environments to increase access to care and contribute to avoiding hospital admission wherever possible. In some areas, pharmacists already manage a caseload of patients in scheduled care clinics, in-reaching to review complex inpatients or work across the interface providing care for patients being managed at home to prevent hospital admission or directly reviewing patients in unscheduled care settings. Pharmacy teams will harness the skills of pharmacy technicians and pharmacy support staff to provide leadership in the safe and effective use of medicines, responding to hospital demand and patient flow, releasing pharmacists to optimise the impact of advanced medicinal therapies, pharmacogenomics and the application of precision medicine.

The Chief Pharmaceutical Officer committed to publishing a strategy for hospital pharmacy transformation and this is eagerly awaited by the pharmacy community.


Imagining the healthcare landscape for #NHS2048 can feel somewhat out of reach. However, there is certainty that medicines will remain a critical aspect of healthcare. Pharmacy teams are pivotal in the healthcare system, supporting professionals and patients alike, to optimise the best outcomes from medicines and preventing harm. To fully optimise the impact of legislative and education reforms in pharmacy, pharmacists in all settings must be fully integrated into the NHS. When planning future developments, it is essential that pharmacy teams are included from concept to delivery, with co-production in models of care and digital systems designed to support the safe and effective use of medicines and delivery of health and social care.

Fiona McIntyre is the Policy & Practice Lead at the Royal Pharmaceutical Society Scotland

[1] A History of Pharmacy in Great Britain. S Anderson. BSHP – British Society for the History of Pharmacy. Accessed 4th July 2024
[2] NHS Business Services Authority. Prescription Cost Analysis – England – 2022-23 | NHSBSA. Accessed 27th February 2024
[3] Welsh Government. Primary care prescriptions: April 2022 to March 2023. Primary care prescriptions: April 2022 to March 2023 | GOV.WALES Accessed 27th February 2024
[4] Family Practice Services Practitioner Unit. General Pharmaceutical Services Annual Publication 2022/23 ( Accessed 27th February 2024
[5] Public Health Scotland. Dispenser Payments and prescription cost analysis. Dispenser payments and prescription cost analysis – Financial year 2022 to 2023 – Dispenser payments and prescription cost analysis – Publications – Public Health Scotland. Accessed 4th July 2024
[6] Joint RPS and BMA Scottish GP Committee statement on the Pharmacotherapy Service. Joint BMA-RPS pharmacotherapy service 13 Jan 2023_1.pdf ( Accessed 27th February 2024

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