PrescQIPP

Unlocking Prescribing Capacity: A Scalable Clinical Mentorship Model for Primary Care Pharmacy

Hywel Dda University Health Board

Project summary

This project addressed a practical challenge within the primary care pharmacy workforce: a gap between independent prescribing (IP) qualification and its use in everyday clinical practice.

Baseline analysis across the Primary care team in Hywel Dda University Health Board showed that although 56% of pharmacists were qualified as IPs, only 44% were actively prescribing. This indicated that the issue was not workforce numbers, but how existing capability was being supported, deployed, and sustained in practice.

Initial scoping, including qualitative interviews with pharmacists, identified consistent barriers influencing this gap. These included limited access to clinical supervision, low confidence to prescribe autonomously, professional isolation, and the absence of structured governance and support. These factors meant that prescribing was often dependent on individual confidence or local circumstance, rather than embedded as routine practice.

In response, a clinical mentorship team was developed and implemented provisions to support a consistent framework for developing and supporting prescribing. The model combined individual mentorship, regular peer forums, case-based learning, and governance-supported clinical pathways. It was deliberately aligned to service priorities and workforce planning, ensuring that development translated directly into clinical activity and patient benefit.

Following implementation, there were clear improvements in workforce capability and utilisation:

  • The proportion of pharmacists qualified as IP increased from 56% to 74%

  • Active prescribing increased from 44% to 83% of qualified IPs

  • The number of pharmacists undertaking IP training increased, alongside development of prescribing supervisors

These changes reflect a shift from qualification alone to active clinical contribution. Importantly, this translated into patient and system-level impact. For example, a targeted 3 month cluster pharmacist frailty project supported through mentorship resulted in 95 patients reviewed, over 1,400 medicines optimised, and nearly 400 clinical interventions. This generated approximately £18,800 in combined savings via medicines optimisation, reduced GP workload, and avoidance of harm.

Qualitative evaluation supported these findings, with pharmacists describing improved confidence, clearer clinical roles, and greater ability to contribute meaningfully to patient care. Mentorship was consistently valued as a mechanism for connection, reflection, and supported decision-making within a complex clinical environment.

This project demonstrates that structured mentorship can act as an enabling infrastructure within primary care, supporting safer prescribing, improving workforce productivity, and strengthening medicines optimisation.