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ObjectivesTo support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders’ views on IP in primary care and identify barriers and facilitators influencing implementation.SettingUK primary/community care.ParticipantsInclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors.Primary and secondary outcome measuresN/A.ResultsTwenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) ‘Preparation’, (2) ‘Training’, (3) ‘Transition’ and 4) ‘Sustainment’. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care.ConclusionsIn order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world.PROSPERO registration numberCRD42019124400.

This article examines the role of nurse managers in supporting reflection for professional learning. It aims to enable readers to critically review the role of reflection in nursing and relate this to the Nursing and Midwifery Council (NMC) professional requirements. It also aims to enable readers to consider the purpose of reflection and to help nurse managers explore their role in fostering environments in which to reflect. After reading this article and completing the time outs, you should be able to.

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Paramedic practice is evolving and the number of advanced paramedics in primary care roles in the UK has risen dramatically. Recent legislation granting paramedics independent prescribing rights means UK paramedics are the first worldwide to receive this extension in scope of practice – a significant milestone for the paramedic profession. Paramedic prescribing capability is expected to increase autonomy for independent case management and enhance capacity for service development. However, local and national success is likely to depend on skilful implementation and avoidance of historical barriers. This article aims to raise awareness of potential barriers to early adoption of paramedic independent prescribing in primary care. It identifies common pitfalls prior to training and provides seven practical steps for paramedics considering pursuing non-medical prescribing training.