IntroductionAs of 2015, as part of the implementation of the Welsh Government primary care plan and primary care clusters, the Welsh Government has encouraged non-medical healthcare professionals working in primary care to train as independent prescribers (IPs).ObjectivesThis research aimed to identify the number of NMIPs in primary care in Wales and describe their prescribing trend of items between 2011 and 2018, in order to compare their prescribing pattern before and after the implementation of primary care clusters for Wales.DesignRetrospective secondary data analysis and interrupted time series analysis in order to compare prescribing by non-medical independent prescribers (NMIPs) preimplementation and postimplementation of primary care clusters across Wales.ResultsOver the study period, 600 NMIPs (nurses n=474 and pharmacists n=104) had prescribed at least one item. The number of nurse IPs increased by 108% and pharmacists by 325% (pharmacists had the largest increase between July 2015 and March 2018). The number of items prescribed by NMIPs increased over time by an average of 1380 per month (95% CI 904 to 1855, p<0.001) after the implementation of primary care clusters compared with 496 (95% CI 445 to 548, p<0.001) prior its implementation. Approximately one-third of the items prescribed by NMIPs was within Betsi Cadwaladr University Health Board (HB) with only 4% in Powys Teaching HB.ConclusionThe number of NMIPs and their volume of prescribing in primary care in Wales has increased following the implementation of primary care clusters in 2015. This suggests that the Government’s recommendations of using NMIPs in primary care have been implemented. Future studies should focus on efficiency and quality of prescribing by NMIPs in primary care.

Introduction Since 2019, the role of independent pharmacist prescribers (IPPs) in primary care has extended to community pharmacies in Wales [1]. This was in response to a Welsh Pharmaceutical Committee report in 2019 that outlined a plan to include an IPP in each community pharmacy in Wales by 2030. This aimed to relieve pressure on general practices, enhance patient care and reduce referral and admission rates to secondary care [2]. As funding was provided by the Government, the number of community pharmacists completing the independent prescribing course increased and many have implemented their prescribing role. Aim To explore the views of community IPPs regarding their prescribing role within community pharmacies in Wales. Methods Semi-structured face-to-face and telephone interviews were conducted with community IPPs from all seven health boards (HBs) in Wales. Ethical approval was obtained from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University and the School of Pharmacy and Bioengineering at Keele University. Purposive sampling was used to identify potential participants. Gatekeepers (HB community pharmacy leads and directors of IPP courses in Wales) sent invitation emails, participant information sheet and consent form to potential participants. Written consent was obtained. Interviews were audio-recorded and transcribed ad verbatim. Thematic analysis was used to analyse the data. Results Thirteen community IPPs across Wales participated. Six themes were identified, including the utilisation of their role as community IPPs, their experiences with their independent prescribing training, motivation to obtain their prescribing qualification and utilise it, the impact, barriers and facilitators to implement and utilise their role. Participants practised as IPPs in the management of minor ailments and some other conditions, such as respiratory and sexual health. The course and training for community IPPs was helpful, but there was a need to focus more on therapeutic and clinical examination skills. The main impact of the role was that it helped to improve communication between community pharmacies and general practices and relieved some pressure on general practices. The main barriers were the lack of appropriate funding by the Government to develop the role, lack of access to patients’ medical records, lack of support and high workload. “One of the areas identified as high risk is for pharmacy prescribers is the lack of access to clinical records. How can you [as community IPPs] make any sensible decisions with half the information?” IPP6 Facilitators included that some services were already in place and the drive from the 2030 vision. Conclusion This is the first study that explored the views of community IPPs regarding their prescribing role in community pharmacies in Wales. It provided an insight into this new role that can be considered by the Welsh Government to achieve the 2030 vision for this role. A limitation to this study was that the role is still new in community pharmacies, which may affect the views of the community IPPs. Many of them have obtained their prescribing qualification but have not started to utilise it yet. Further work is needed to explore a wider population of community IPPs’ experiences as the role develops. References 1. Wickware, C. 2019. All community pharmacies in Wales to have an independent prescriber as part of long-term plan for Welsh pharmacy. Available at: https://www.pharmaceutical-journal.com/news-and-analysis/news/all-community-pharmacies. 2. Welsh Pharmaceutical Committee. 2019. Pharmacy: Delivering a Healthier Wales. Available at: https://www.rpharms.com/Portals/0/RPS%2.