Beyond scope of practice: a prescribing autonomy framework to support early-career prescribers

The introduction of pharmacist independent prescribing at the point of registration represents a profound shift in UK pharmacy practice. From 2026, newly qualified pharmacist independent prescribers will begin their careers with prescribing responsibilities but without the experiential consolidation or structured supervision pathways that underpin early prescribing in other professions. Existing governance mechanisms-particularly the concept of scope of practice-were designed for experienced, often specialist, prescribers and therefore fail to capture the dynamic decision-support needs of novice practitioners working across varied clinical contexts. Competency frameworks also provide limited insight into how prescribers negotiate uncertainty, collaborate with colleagues or calibrate clinical oversight in day-to-day practice. This commentary argues that these developments in the UK require an alternative approach to describing, governing and supporting prescribing practice, particularly at transition points. The Prescribing Autonomy Framework (PAF) proposes a context-sensitive framework that categorises prescribing decision-making into three levels of autonomy-low, medium and high-based on the degree of collaboration, protocol use, clinical oversight and digital decision-support required. By focusing on how prescribing decisions are reached rather than solely on what prescribers are authorised to prescribe, the framework offers a structured vocabulary for framing competence, informing support needs and surfacing risks. It also intersects with concepts of clinical complexity, accountability and risk, with the potential to support richer reflection and governance than existing approaches in the UK. While developed in response to changes in UK pharmacy training, the framework may have broader applicability. It offers a mechanism for supporting early-career prescribers across professions, guiding transitions into new areas of practice and strengthening healthcare governance. As prescribing roles expand internationally, the PAF aims to provide a scalable and adaptable approach to supporting safe, contextualised development of prescribing practice. The framework is presented as a theoretical governance lens and has not yet undergone empirical testing or formal validation.