A qualitative study to understand pharmacists’ application of prescribing scope of practice when working in generalist roles in primary care

Abstract Introduction Prescribing Scope of Practice (SOP) is defined as ‘prescribing activities a healthcare professional carries out within their professional role.’[1] This vague definition contributes to uncertainty regarding professional practice boundaries, which could potentially impact on efficient access to medicines.[2] All newly qualified pharmacists will be prescribers from 2026. There is a timely need to understand how pharmacists working in primary care interpret prescribing SOP to inform future practice and their role within the multidisciplinary team. Aim To understand how pharmacists interpret and apply the concept of prescribing SOP when working in generalist roles in primary care. Methods A qualitative semi-structured interview study was conducted with purposive sampling, using university prescribing course providers as gatekeepers. Inclusion criteria—three years minimum experience as a prescriber; currently employed in UK general practice. Exclusion criteria -pharmacist prescribers not currently prescribing. Topics explored were prescribing SOP and the patient, professional, educational and/or organisational factors that influence prescribing SOP. Data were collected between 2022 and 2024. Deidentified verbatim transcripts were analysed using Braun and Clarke’s reflexive thematic analysis. Results Twenty-six participants were interviewed, 19 females and 7 males, with practice experience from 8 to 30 years. Participants’ backgrounds included community, hospital, primary care, military, legal, education and policy sectors. Three overarching themes were identified (i) ‘Making sense of prescribing SOP,’ (ii) ‘Influences on prescribing SOP’ and (iii) ‘Prescribing competence.’ ‘Making sense of prescribing SOP’ sub themes included defining a prescribing SOP, initial prescribing SOP, expanding prescribing SOP, prescribing SOP boundaries, evidencing prescribing SOP and application of prescribing SOP in practice. Within this theme, the conventions for defining, interpreting and applying prescribing SOP varied. Participants expressed uncertainty in applying this concept due to the broad nature of the prescribing tasks they were involved in. Several influences such as pharmacist background and experience, the prescribing course studied, and prescribing tasks were found to influence all sub-themes. The perceived lack of prescribing policy, clinical supervision and mentorship negatively affected participants prescribing confidence which impacted on their perceived competence. Within the prescribing competence theme, participants felt they could prescribe to ‘manage and maintain’ medicines in primary care without the need to upskill their diagnostic competence as part of their prescribing SOP. Conclusion Primary care pharmacists are moving away from the traditional model of prescribing in a specialist area and adopting broader and less defined approaches to prescribing to meet patient and workforce needs. This is causing ambiguity and challenges when trying to apply a defined prescribing SOP. The study found that there needs to be greater understanding, recognition and acceptance within policy of the requirement to prescribe broadly in primary care. This is required to set the future vision for pharmacist prescribers in primary care. Practice experience in all four UK nations is represented in this work which is a key strength. Participants were restricted to having three years’ minimum prescribing experience, which gave rich experience to draw upon but means a limit to this work is the lack of representation of the voices of newly qualified pharmacist prescribers.