This report explores the current and future direction of the independent prescribing workforce in the UK health care system. Independent prescribers are qualified non-medical health care professionals – including nurses, pharmacists and allied health professionals – who can prescribe medications autonomously. They must complete an independent prescribing qualification before becoming annotated on their professional register as an independent prescriber.
Independent prescribers are an important group of the workforce to focus on now.
- There are already nearly 100,000 independent prescribers in the UK, representing almost a quarter of the prescribing workforce as of the beginning of April 2025.
- Prescribing accounts for a significant proportion of NHS spend: in England in 2024/25, nearly £21 billion was spent on issuing medicines, appliances and medical devices, after central rebates. 1
- Independent prescribers are envisaged to play an important role in shifting care from hospitals into community settings and supporting the growing proportion of the population living with long-term conditions – including working as part of multidisciplinary neighbourhood teams and in primary care.
- Rapid change in the independent prescribing workforce is anticipated: from this year, newly qualified pharmacists will be trained independent prescribers, and changes are expected in the range of medicines that allied health professionals can prescribe.
Independent prescribers can play a significant role in patient care – they hold responsibility for assessing patients, including diagnosis, and the clinical management of care. Using the prescribing qualification in practice goes beyond just prescribing medications. It also includes reducing or stopping a patient’s medication (known as ‘de-prescribing’ ), medication reviews and ‘medication reconciliation’ (developing a comprehensive list of a patient’s medications and dosages). All of these are essential for health care professionals when navigating more complex cases, particularly as the prevalence of multiple long-term health conditions (called ‘multi-morbidity’ ) increases in the population.
This report identifies current barriers, issues and opportunities in relation to independent prescribing, and emerging risks to the expansion of the workforce, particularly in community settings. The report draws on research literature, data from regulators and training providers, analysis of policy documents and interviews and focus groups with national and local stakeholders.
What do we know about the independent prescribing workforce?
Nurses form the largest professional group of qualified independent prescribers, accounting for 69% of independent prescribers (68,180 prescribers, 8% of all nurses). More than half of nurses in general practice are active independent prescribers. Data on nurses’ prescribing rates in other settings is limited.
Pharmacists have the greatest proportion of their workforce qualified as independent prescribers and are the fastest-growing group (22,770 prescribers, 33% of all pharmacists). Pharmacists working in general practice are currently most likely to be active prescribers, while those in community pharmacy are least likely to be active prescribers.
Across allied health professionals, 4% of physiotherapists, 7% of paramedics, 7% of chiropodists/podiatrists and 5% of therapeutic radiographers held the independent prescribing annotation in November 2025.
Workforce planning for independent prescribers is lacking
Independent prescribing has developed over time to help improve the capacity of the NHS workforce, in response to both increased workload pressures faced across the health service and a growing need to manage care and medications for patients with multiple long-term conditions.
However, the workforce has developed in a piecemeal way across the professions, resulting in inconsistencies in the training and regulation of independent prescribers (discussed below). In parallel, there is a lack of overall oversight and planning of the independent prescribing workforce, to ensure that it can support policy ambitions for independent prescribing. For example, across the UK, there are initiatives to encourage people to get advice from pharmacists for common health conditions (for example, the Pharmacy First scheme in England), but there are significant challenges for independent prescribers to work in community pharmacy, including access to training and supervision. However, both Scotland and Wales have an ambition to have independent prescribers in every community pharmacy by 2030.
Meanwhile, there are differences in what nurses and allied health professionals can prescribe. Despite often training on the same courses, allied health professionals are comparatively more limited than nurses in their authority to prescribe controlled drugs. This limits the extent to which multidisciplinary community services teams can operate in a consistent way. Although nurses are the largest professional group of independent prescribers, and have greater access to training than allied health professionals, the policy direction for this group of prescribers is unclear, beyond the broader development of advanced clinical practice (which is to bring clarity and consistency to advanced clinical practice across the UK).
The most significant change in the independent prescribing workforce is that, from this year, pharmacists qualifying through the undergraduate Master of Pharmacy (MPharm) degree can act as independent prescribers at the point of registration, as alluded to earlier. The first cohort under these new standards are currently completing their foundation year and will join the register as independent prescribers from September 2026. We estimate this will lead to several thousand more pharmacists joining the register each year, on the basis that over the last four years over 4,000 students have enrolled each year on the MPharm degree. 2 The introduction of these new MPharm graduates into the independent prescribing workforce creates a set of unique challenges. Namely, the cohort will be relatively inexperienced in their chosen area of practice for prescribing, and they will require robust supervision and continuing professional development to bring them to a level to be able to competently prescribe. Challenges with ensuring this cohort have access to structured supervision is a concern at a local level, with varying approaches taken to address these challenges.
Training and supervision
Although there are ambitions to expand the independent prescribing workforce, current training pathways, regulation and assurances may not be fit for purpose. The training pipeline is fragile. It is significantly underfunded in respect to the demand for health care professionals to complete the training and limited consideration has been given to aligning training with available supervisors (with knock-on consequences for local workforce planning). Local leads see increasing the amount of funding available for independent prescribing as a priority for change nationally, but this must be set against evidence that many prescribers cannot use their skills in practice.
‘Designated prescribing practitioners’ (qualified and experienced prescribers) supervise trainee independent prescribers throughout their training. But limited access to suitable designated prescribing practitioners is a significant barrier to accessing independent prescribing training. A lack of access to designated prescribing practitioners in the community is a challenge for pharmacists in particular, and we heard from local leads that workable solutions are often difficult to implement. This has significant implications for achieving the ambitions to expand independent prescribing in the community.
Prescribing in practice
Problems with a lack of supervision also affect recently qualified independent prescribers. Significant barriers exist to accessing supervision, all of which are particularly pronounced in the community setting. This issue will be exacerbated for the cohort of new pharmacists who will be qualifying as independent prescribers in September 2026. Limited supervision can have substantial impacts, including demotivating staff from working in the community and risking a more vulnerable workforce.
Continuing professional development (CPD) is essential to maintaining the knowledge and competency to safely prescribe. However, there are limited opportunities for independent prescribers to upskill and access CPD. Workload pressures and a lack of protected time to pursue CPD compound this. CPD opportunities are also not tailored to specific needs.
The extent to which independent prescribers are using their prescribing abilities in practice is difficult to determine. Where professionals are not actively prescribing, there is a significant risk that they will lose their prescribing skills and confidence, or seek prescribing roles outside NHS-funded services.
Governance and assurance
Professional regulators have all adopted the Royal Pharmaceutical Society’s competency framework for prescribers. 3 Regulators are responsible for revalidation (the process that all health professionals must complete to maintain their registration with their regulator), but currently this does not include any additional requirements for independent prescribers. There are emerging risks around safety assurances, such as prescribers becoming deskilled when not prescribing within their current job role. Regulators are best placed to address these risks through the revalidation process.
Integrated care boards, health boards and NHS trusts have their own independent prescribing policies. Integrated care board policies are aimed at independent prescribers working in GP surgeries, community pharmacy or other providers linked to the integrated care board’s prescribing budget. An NHS trust’s policies are aimed at independent prescribers working across the trust. As such, all independent prescribers are encompassed by the same policy, regardless of professional group or specialty. We heard that implementing and maintaining strong governance structures is more difficult for large trusts and integrated care boards that encompass a number of different specialist providers.
Looking outside NHS-funded services, independent prescribing is also growing in the private sector (as part of a growth in prescribing in the private sector overall). This comes with challenges, including rising competition to recruit and retain independent prescribers for NHS-funded services. It also represents a significant emerging risk, with concerns about the strength of governance in providers of private prescriptions, where prescribing activity is not visible. Again, this reinforces the argument that regulators need to play a more significant role in ensuring the safe practice of independent prescribers.
Data, monitoring and evaluation
Data for oversight of the independent prescribing workforce and their activity is limited. Regulators record who is annotated on the register, but not whether they are prescribing within their current role. This is a significant data gap. In primary care there is data on prescribing activity, but there is no data on the proportion of staff who are independent prescribers at an employer level in the health sector.
There is significant scope to improve the monitoring of prescribing practice, such as extending the current monitoring of antibiotic prescribing in primary care. Improving the monitoring of workforce activity and prescribing patterns would provide greater assurance that independent prescribing is working well, and it would support wider use of prescribing skills.
More broadly, while independent prescribing has become embedded in the NHS workforce, and is seen as core to the intended shift from hospital care to community and neighbourhood care, there is little evaluation of the quality, effectiveness or cost-effectiveness of independent prescribing roles.
Recommendations
Independent prescribing is not well addressed in national policies and plans on its own. Instead, it sits alongside a number of different workforce and other policies, including Pharmacy First, the Additional Roles Reimbursement Scheme, advanced clinical practice and wider policies such as the shift to community. Furthermore, there are gaps and inconsistencies between policies and across settings, which can create challenges when implementing in practice.
It will be essential that further iterations of the NHS Long-Term Workforce
Plan, first published in 2023,
4
address the future of independent prescribing. This should include detailing what roles independent prescribers can be expected to undertake in neighbourhood health teams and taking steps
to better integrate independent prescribing across multiple settings. The plan should consider providing evidenced modelling on the new MPharm graduates pipeline into the workforce, making sure to consider the requirement for stronger supervision.
Our recommendations are also targeted at regional workforce leads, ensuring that local workforce planning is underpinned by population need and considers how independent prescribing can help meet current and future demands. This includes ensuring that independent prescribers are working in services that can use their prescribing skills and incorporating supervision into regional planning.
A number of recommendations are centred around establishing consistent and robust assurances on the governance and regulation of independent prescribing. This includes addressing the limited consideration given to providing evidence of independent prescribing skills and competence within the revalidation process.
Our recommendations also aim to address the lack of data, monitoring and evaluation of independent prescribing in practice.
This Nuffield Trust project was funded by the Association of the British Pharmaceutical Industry (ABPI).