Stakeholders' views of the implementation of pharmacist prescribing in the community pharmacy setting: a mixed-methods systematic review

Background: Pharmacist prescribing in community pharmacies is gaining traction globally as a strategy to enhance medication access. However, uptake remains inconsistent, making it essential to understand stakeholder perspectives to identify factors shaping successful implementation. Aim: To synthesise the views, experiences, perceived benefits, concerns, and contextual influences of key stakeholders regarding pharmacist prescribing in community pharmacies across implementation stages. Method: A mixed-methods systematic review using a convergent integrated approach was conducted. Five databases were searched from inception to March 2025. Primary research studies were included where ≥1 key study focus was on stakeholders' views of pharmacist prescribing in community pharmacies. Thematic synthesis was used to generate themes. Results: Five analytical themes explained variation in implementation: (1) support, motivation, and clinical readiness; (2) structural, policy, and organisational conditions shaping feasibility; (3) patient-centred access, continuity, and therapeutic relationships; (4) moral responsibility, risk, and safe practice boundaries; and (5) professional identity, autonomy, and legitimacy. Overall, the literature reflected support for pharmacist prescribing, particularly for low-risk, protocol-driven conditions and collaborative care models, although views varied across stakeholder groups and contexts. Perceived benefits included improved medication access, adherence, convenience, and patient satisfaction. Concerns remained regarding accountability, medico-legal risk, care fragmentation, workload, reimbursement, and commercial conflicts of interest. Confidence, training, interprofessional collaboration, and access to records strongly influenced implementation. Conclusion: Pharmacist prescribing is shaped by interacting individual, organisational and system-level factors. Sustainable implementation requires integrated care models, workforce development, governance frameworks, and supportive policy. This review offers actionable insights for policymakers and healthcare systems seeking to integrate pharmacist prescribing into routine care.