A systematic review of reviews has produced a new Prescribing Implementation Framework that identifies 13 determinants shaping whether non-medical prescribing is implemented successfully, with seven of them concentrated in the preparation phase alone. The research, published in BMC Health Services Research, responds to limited theoretical guidance on how to implement prescribing roles that are increasingly used to support workforce shortages challenging global access to healthcare.
The team conducted a systematic review of reviews, searching six electronic databases for studies published between January 2010 and May 2024 that reported barriers and facilitators to non-medical prescribing. Results were recorded according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the review was registered with PROSPERO under number CRD42024593690.
Informed by principles of meta-ethnography, data from the included reviews were extracted and synthesised following a structured approach. Nineteen reviews fulfilled the inclusion criteria: seven focused specifically on independent prescribing, while twelve covered independent and/or supplementary prescribing.
Across this evidence base, one message came through consistently: non-medical prescribing is largely acceptable both to the service users who receive prescriptions and to the healthcare professionals who deliver them. Acceptability, however, proved to be only one thread in a more complex picture of what determines whether prescribing roles take root in practice.
The synthesised themes were mapped onto four stages of implementation: preparation, training, transition and sustainment. Each theme was then examined for whether it operated at the micro level of individual practitioners and patients, the meso level of teams and organisations, or the macro level of policy and regulation.
The product of this analysis is the Prescribing Implementation Framework, or PIF. It comprises 13 determinants of effective implementation, seven of which sit in the preparation phase. Of the 72 individual macro, meso and micro level factors identified across the synthesis, 36 fell within preparation, 11 in training, 15 in transition and 11 in sustainment.
The authors emphasise that the PIF is a conceptual, multi-professional and systems-wide model that highlights the dynamic nature of determinants, change over time, and the importance of interdependence. In practical terms, the framework is designed to be used by organisations at several points in an implementation journey: it can support preliminary capacity and needs assessments before a prescribing service is launched, help identify potential pinch points where implementation is most likely to stall, and assist in formative evaluations of prescribing processes and outcomes once services are running.
The authors argue that there is a pressing need to advance understanding of non-medical prescribing implementation by developing theoretically informed guidance that supports the planning, execution and sustainability of implementation globally. The framework is offered as a conceptual guide for organisations working in this area, and its use in practice will show how it performs across different health systems and professional groups.
By organising the evidence into a staged, multi-level structure, the PIF provides implementers, educators and policymakers with a structured overview of the factors that influence successful non-medical prescribing implementation, from early preparation through to long-term sustainment of services.
Subject of Research: Implementation determinants of non-medical prescribing synthesised into a staged framework
Article Title: A Prescribing Implementation Framework (PIF) for non-medical prescribing: a review of systematic reviews
Article References: Carey, N., Edwards, J., Liu, N., & Stenner, K. (2026). A Prescribing Implementation Framework (PIF) for non-medical prescribing: a review of systematic reviews. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15406-0
Image Credits: AI Generated
DOI: 10.1186/s12913-026-15406-0
Keywords: non-medical prescribing, systematic review of reviews, implementation science, Prescribing Implementation Framework, health workforce, meta-ethnography, PRISMA, health services research, nurse prescribing, pharmacist prescribing, workforce shortages, BMC Health Services Research
News Source: Ophelia Keating. (October 27, 2026). New Framework Maps 13 Determinants for Successful Non-Medical Prescribing Rollout. Scienmag.
