Nuffield Trust Warns Training Gaps Threaten NHS Community Care
- A new report from the Nuffield Trust warns that the NHS may struggle to realize its goals of shifting healthcare into community settings due to critical gaps in...
- Independent prescribing is considered a central component of NHS strategies to move care closer to home and provide better support for patients managing multiple long-term conditions.
- As of the start of April 2025, over 98,000 non-medical clinicians in the UK are qualified as independent prescribers.
A new report from the Nuffield Trust warns that the NHS may struggle to realize its goals of shifting healthcare into community settings due to critical gaps in supervision, training, and workforce planning. The analysis specifically highlights risks associated with a rapid expansion of pharmacist independent prescribers entering the workforce.
Independent prescribing is considered a central component of NHS strategies to move care closer to home and provide better support for patients managing multiple long-term conditions. However, the Nuffield Trust indicates that the system supporting these prescribers may be insufficient to handle the current pace of change.
Expansion of the Prescribing Workforce
As of the start of April 2025, over 98,000 non-medical clinicians in the UK are qualified as independent prescribers. This group includes pharmacists, nurses, and various allied health professions, collectively representing nearly a quarter of the prescribing workforce.
The number of pharmacist prescribers is expected to increase significantly starting in 2026. For the first time, pharmacists graduating from the Master of Pharmacy (MPharm) programme will qualify as independent prescribers at the point of registration.
The first cohort of these graduates is expected to join the professional register in September 2026. Based on enrollment data from the previous four years, where over 4,000 students enrolled in the MPharm degree annually, the report estimates that several thousand more pharmacists will join the register each year.
Risks to Patient Safety and Professional Development
The Nuffield Trust warns that these newly qualified prescribers will often lack experience in their chosen clinical areas. To prescribe safely and confidently, they will require robust supervision and ongoing professional development.
Researchers found that access to necessary supervision is already limited, particularly within community pharmacy settings. Without adequate oversight, the expansion of the prescribing workforce could be undermined, potentially jeopardizing the broader plan to shift care into the community.
Broader Community Care Challenges
The difficulties facing pharmacist prescribers are part of a wider struggle within community healthcare. A separate Nuffield Trust report published on October 31, 2025, highlighted a crisis in district nursing that further threatens the goal of moving care out of hospitals.
The report found that an estimated one in four district nurses left the workforce in the year ending September 2024. This decline is characterized by a plummeting supply of nurses despite rising demand for care.
- Between 2009/10 and 2023/24, the number of district nurses fell by 43%.
- When accounting for growing patient needs, this decline is estimated at 55%.
- During the same period, the need for district nursing services rose by 24%.
- Demand is projected to increase by another 34% by 2040 as the population ages and health needs become more complex.
The Nuffield Trust estimated that restoring district nursing services to 2009 levels, relative to the current population, would cost £376 million.
Regional Disparities in Access
The analysis of district nursing also revealed significant regional variations in patient access to services across the UK. The number of staff in district nurse roles per 100,000 needs-weighted population varied widely:
- North West: 13.7 nurses
- South West: 4.4 nurses
- South East: 3.3 nurses
- East: 2.8 nurses
These workforce shortages have led to a decrease in service delivery, with 2.8 million fewer recorded district nursing contacts—including telephone and face-to-face appointments—in 2023/24.
Collectively, the gaps in pharmacist supervision and the attrition of district nurses represent systemic weaknesses that may hinder the NHS’s ability to transition care from hospitals to community settings.