Exploring prescribing volume among pharmacist independent prescribers in community pharmacies across Wales
Authors: Alshakmobarak N , Deslandes R , Hodson K 
Published: April 2024

Abstract

Introduction
In a 2019 document titled ‘Delivering a Healthier Wales’, the Welsh Government presented a transformative vision for healthcare that emphasises a shift from hospital-centred healthcare to community-based care.[1] As part of this vision, independent prescribing (IP) is to be implemented in every community pharmacy by 2030.[1] Recently, the independent prescribing service (IPS) has allowed pharmacists to manage and treat patient conditions within the community pharmacy, offering a potential solution to the increasing demand for general practitioners (GPs). A substantial increase in IP consultations is evident, with 16,005 consultations recorded across 33 out of the 713 community pharmacies in Wales since 2016.[2]

Aim
This study aimed to explore, for the first time, the number of items prescribed by community pharmacists across Wales and in each of the seven local health boards (LHBs), as well as determining from which British National Formulary (BNF) chapter the medicines were prescribed.

Methods
A retrospective secondary data analysis of community pharmacy prescription data was conducted. Monthly prescription data of prescribed items were obtained from the Comparative Analysis System for Prescribing Audit (CASPA) from January 2020 to December 2022 and analysed on a three-monthly basis. To compare changes in prescribing volume across LHBs, the number of items per 100,000 population was calculated. The CASPA data were categorised into BNF chapters, and a Pareto analysis was performed to determine the most prescribed therapeutic areas. These accounted for 80% of total prescribing, which was used for further analysis. LHBs were coded as LHB1, LHB2, etc., to ensure anonymity.

Results
There were considerable variations in prescribed items across LHBs. Despite LHB 1 having the largest number of prescribed items in the overall population (n=13,982), it ranked third (n=1,988) in the number of prescribed items according to the number of items per 100,000 population, LHB 2 (n=2,542) and LHB 3 (n=2,659) ranked first and second, respectively. LHB 7 had the lowest number of prescribed items in the overall population (n=51) and per 100,000 (n=38). Based on the Pareto analysis, 80% of the items prescribed during the study period fell into the following six BNF chapters: Infection; Eye, Ear–Nose–Oropharynx; Skin; Obstetrics–Gynaecology–Urinary Tract Disorders; Appliances; and Central Nervous System. The infection chapter had the highest number of prescribed items (n=20,107), with most of the items being antibacterial (n=19,583, 96%). Nitrofurantoin was the most prescribed antibacterial agent (n=5,682).

Conclusion
This study explored the increase in prescribed items in community pharmacies across Wales, aligning with the 2030 vision for a healthier Wales. IPS plays a crucial role in pharmacist-led care for conditions such as urinary tract infections, potentially alleviating some of the burden facing GPs. While CASPA data captured prescribed and dispensed items specifically for community pharmacies, items prescribed but not dispensed are not accounted for in the data analyses. This study lacks information regarding the appropriateness of consultations. Further research is needed to examine prescribing appropriateness and patient outcomes.

References
1. Welsh Pharmaceutical Committee. Pharmacy: Delivering a healthier Wales. 2019. Available from: https://www.rpharms.com/wales/pharmacy-delivering-&#x2028;a-healthier-wales
2. Burns C. Independent prescribing pharmacists deliver 16,000 consultations since 2016. Pharm J. 2021;306.