Pharmacists' views on barriers and enablers to the implementation of advanced pharmacist prescribing in Scotland: a qualitative study using normalisation process theory.

Introduction: Healthcare systems need more professionals able to deliver autonomous holistic advanced care. Exploring pharmacists' views on the implementation of advanced pharmacist prescribing (i.e. prescribing autonomously in complex, uncertain, or higher-risk situations) will allow stakeholders to reflect on possible changes that may embed and sustain this work.

Aim: To explore pharmacists' views on barriers and enablers to the implementation of advanced pharmacist prescribing in Scotland.

Method: Semi-structured one-to-one interviews were conducted with National Health Service employed pharmacists from across Scotland, recruited via professional networks using purposive sampling to ensure a range of professional backgrounds, geography and prescribing activity. Interviews were developed and analysed using Normalisation Process Theory (NPT), a sociological framework for understanding how new practices become embedded in routine healthcare and analysed using a hybrid deductive/inductive thematic framework analysis approach.

Results: Thirteen pharmacists from across Scotland participated in the study. Barriers and enablers to advanced pharmacist prescribing were identified in all NPT constructs (Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring). In responses relating to the Coherence construct, enablers included individual understanding of how advanced pharmacist prescribing differs from other advanced pharmacist tasks, as well as the role of an advanced pharmacist prescriber. Lack of shared understanding emerged as a barrier. Cognitive Participation identified barriers including lack of appropriate roles and training as well as a lack of infrastructure to support advanced pharmacist prescribing. In Collective Action, barriers included lack of confidence in consistent delivery of advanced pharmacist prescribing and resource constraints. Reflexive Monitoring revealed strong individual belief in advanced pharmacist prescribing, but barriers included a lack of multidisciplinary evaluation and a need for service reconfiguration.

Conclusion: While individual pharmacists were found to be committed to advanced pharmacist prescribing, widespread implementation is hindered by a lack of shared understanding, inconsistent role structures, and limited strategic alignment. These findings offer valuable insight for those with an interest in embedding and sustaining advanced pharmacist prescribing.