56-day prescribing: barriers, facilitators and interventions for extending periods of treatment (summary)

This report presents findings from a behavioural study commissioned by the Welsh Government to understand behaviours associated with extending periods of treatment, or 56‑day prescribing. The study examined barriers and facilitators to behaviours required for implementing the updated All Wales guidance on prescribing intervals (NHS Wales All Wales Therapeutics and Toxicology Centre), assessed potential interventions and developed recommendations to support behaviour change across the repeat‑prescribing pathway. It engaged with stakeholders including non-dispensing GP practices, community pharmacies and patients. Dispensing doctor GP practices were not in scope. ^{[footnote 1]}

Research questions

• What are the behavioural barriers and facilitators to implementing and maintaining 56-day prescribing policy in Wales?
• What interventions are most likely to influence prescribers in adhering to policy?
• What interventions are most likely to influence the public in being receptive to the change in prescribing practice?

The 2021 Review of Dispensing Volumes (University of South Wales) recommended that reducing the number of prescribing and dispensing events could improve efficiency and release capacity across the system for direct patient care. By supporting a shift from supply towards clinically focused roles for community pharmacists, longer prescribing intervals enable the ambitions of the community pharmacy contractual reforms set out in Presgripsiwn Newydd - A New Prescription and the wider ambitions of A Healthier Wales.

The updated All Wales guidance for prescribing intervals recommends longer prescribing intervals where clinically appropriate, aligning supply with patient needs to reduce unnecessary workload for GP practices and community pharmacies, enhance patient convenience and release clinical capacity. Although seemingly straightforward, the research shows that this change represents a complex behavioural and operational shift requiring coordination across GP practices, community pharmacies, health boards and patients.

The updated guidance recommended extending intervals beyond 28 days where clinically appropriate, primarily via annual medication reviews. It emphasised shared decision‑making, appropriate use of repeat (batch) dispensing and safeguards for groups such as patients prescribed controlled drugs, using multicompartment compliance aids, care home residents and those with cognitive impairment. Health boards were instructed to notify GPs and support adoption, with professional bodies providing further materials to encourage phased or accelerated implementation.

This study applies a behavioural science lens using the Integrated Model of Behaviour (Research Gate), which combines concepts from COM‑B, behavioural economics and psychological theory. The model comprises motivation, choice, execution and outcomes, recognising how these shape actions over time.

Motivation reflects needs, habits and cognitive frameworks, though these can be difficult to shift. The ‘intention–action gap’ highlights how competing demands prevent follow‑through even when motivation exists. The choice stage emphasises perceived costs, benefits and constraints. Execution relates to capability and opportunity to act, acknowledging that practical barriers can undermine well‑designed interventions. Outcomes feed back into future motivation. The model also highlights the ‘options space’: some choices are not considered even when available.

A mixed‑methods design was used across three phases: Define, Diagnose and Solve.

The Define phase framed the behavioural problem, reviewed literature and analysed 2022–2024 prescribing data. Analysis used descriptive statistics, mixed‑effects modelling and ARIMA time‑series to examine differences across health boards and practices. A behavioural journey‑mapping workshop captured insights into decision points along the repeat‑prescription pathway.

The Diagnose phase involved qualitative research with health boards, GP practices, community pharmacies, Digital Health and Care Wales, Primary Care Cluster Leads and patients. Case studies and a supplementary questionnaire provided additional perspectives. Data were analysed thematically and aligned to the Integrated Model of Behaviour.

The Solve phase generated intervention ideas using insight synthesis, the Behaviour Change Wheel and a multidisciplinary APEASE workshop to assess feasibility and system alignment.

Mapping the behavioural journey identified where the guidance can be implemented and which behavioural factors shape adoption. The process begins with patients requesting repeat prescriptions; practice staff review requests and prescribers authorise prescriptions, which are then clinically checked and dispensed by community pharmacies.

GPs were identified as primary decision‑makers, but their decisions were shaped by expectations and capabilities of practice staff, pharmacists, health boards and patients. Adoption points arise during practice processing, reauthorisation and pharmacy checks.

Analysis of prescribing data for non-dispensing GP practices (2022 to 2024) shows a gradual increase in average prescribing intervals across Wales, with substantial variation between practices. At health board level, Powys Teaching Health Board (tHB) saw the largest rise (of 46%, or 11 days) to 35 days, with notable increases in Betsi Cadwaladr University Health Board (UHB) and Cardiff and Vale UHB. Mixed effects modelling showed most variation occurred at individual GP practice level, not health board level. Practices with a higher proportion of older patients were associated with slightly longer intervals and practices in areas of higher deprivation with shorter intervals. These associations were not explored further to determine whether they meaningfully explain the observed variation. ARIMA modelling confirmed a gradual rather than abrupt change in prescribing intervals.

The primary research identified barriers and facilitators to the behaviours required in implementing the updated All Wales guidance on extending prescribing intervals across the elements of the Integrated Model. A summary of the main findings of the qualitative fieldwork and supplementary questionnaire is described below.

Motivation

Barriers included concerns about waste, confusion, cost, workload, reduced patient contact and GP practice staff viewing interval changes as a low priority task. Some GP practice and community pharmacy staff questioned the policy’s appropriateness and lacked clarity on monitoring arrangements. Facilitators included positive attitudes where benefits were experienced, such as reduced footfall and fewer contacts for stable patients. Patient requests also strengthened motivation.

Choice

Barriers included perceptions of high short‑term resource costs, limited staff capacity and time‑consuming identification of suitable patients. Competing priorities widened the intention–action gap. Facilitators included rapid implementation when resources were available, and targeted payment schemes and health board support.

Execution

Barriers related to clinical complexity, inconsistent communication, training gaps, human error, weak GP–pharmacy collaboration and variable support. Facilitators included dedicated pharmacists, trained administrative teams, strong collaboration, patient‑led approaches, system reminders and standardised processes. Gradual implementation and synchronisation also supported execution.

Outcomes and feedback

Barriers and negative outcomes included synchronisation issues, operational challenges for GP practices and community pharmacies, and patient confusion, all of which fed back into motivation and decision‑making, highlighting the need for aligned processes, incentives and patient‑centred communication. Facilitators and positive outcomes included reduced workload for GP practices, improved patient experience and more sustainable, embedded processes supported by pharmacist input and clearer systems. These benefits helped generate reinforcing feedback loops that strengthened confidence and supported continued implementation.

Selected case studies illustrated the varied approaches and experiences of primary care stakeholders in implementing extended prescribing intervals. Practices with dedicated pharmacists implemented changes safely and systematically, showing the importance of pharmacist support and synchronisation tools. Practices without pharmacists relied on experienced administrative staff and phased adoption, dependent on clear guidance.

Health‑board‑level support influenced consistency of implementation and targets set by health boards accelerated uptake, while limited support slowed implementation. Some community pharmacies faced patient confusion, safety concerns and stock pressures, underscoring the need for shared guidance and communication. Collectively, these cases emphasised that consistent communication, shared guidance and coordinated implementation were essential to realising the intended benefits.

Intervention ideas were generated by mapping barriers and facilitators to behavioural components using the Integrated Model and Behaviour Change Wheel, supported by a targeted evidence review. Ideas were refined during an internal design workshop and presented to primary care and pharmacy stakeholders in an APEASE workshop, where feasibility, effectiveness and system alignment were assessed. Five proposed interventions spanning motivational, capability‑building and system‑level changes were assessed in the APEASE workshop which informed final intervention recommendations.

The evidence across the research demonstrated that implementing the updated All Wales Guidance on prescribing intervals, published in October 2022, was more complex than it first appeared. Determining an appropriate prescription interval sat within a multifaceted institutional landscape and relied heavily on the working relationship between prescribers and community pharmacists, as well as nuanced clinical judgement based on the medication and the patient’s mental and physical condition. A central theme was the distinction between the desired impact, an increase in average prescribing intervals, and the desired behaviour, which was a patient‑centred, individualised process. Where practices focused on achieving the impact rather than encouraging the behaviour, negative outcomes sometimes occurred, including inappropriate intervals and patient confusion.

The research also highlighted that, although community pharmacists were foregrounded in policy documentation, the key decision‑makers were GPs and GP practices. GPs generally understood and supported the rationale for the policy, but perceived limited direct benefit for practices, while the time and effort costs of implementation were immediate and substantial. Rapid, poorly coordinated rollouts created synchronisation problems, tensions with community pharmacists and operational burdens.

Despite these challenges, examples of successful implementation showed that modest incentives, embedded pharmacist support and structured, team‑based approaches mitigated many barriers. Eleven intervention recommendations are proposed (below), with short-term incentives for GP practices identified as having the greatest potential impact. The report recommended piloting and evaluating the interventions to ensure they operate effectively in practice.

Targets, funding and dashboards for General Practice

This intervention aims to encourage GP practices to extend prescribing intervals by introducing incentives and performance measures within existing contractual frameworks.

Establishing a collaboration approach between GP practices and community pharmacies

This initiative seeks to strengthen routine communication and shared planning between GP practices and community pharmacies to support coordinated implementation of the guidance.

Enhanced incentives for community pharmacies

This measure embeds new incentive components into the Community Pharmacy Contractual Framework to support longer prescribing intervals, linking financial rewards to decreased prescription volumes, short‑term implementation costs and long‑term assurances that protect pharmacy viability if expected policy benefits are not realised.

Expanded role for community pharmacies

This approach equips community pharmacies with training and guidance so they can help extend prescribing intervals by identifying suitable patients and making recommendations to GP practices.

Implementation roadmap

This action creates a collaboratively developed, phased roadmap that provides GP practices and community pharmacies with coordinated timelines and clear guidance to support consistent, low‑disruption adoption of changes to prescribing intervals.

Communications to patients and protocols for self-advocacy

This intervention works by providing clear, tailored information that empowers patients to make informed, active choices about their treatment and promotes a flexible, patient‑led approach to implementing changes to prescribing intervals.

Decision-aids

This proposal equips GP practices and community pharmacies to make consistent clinical decisions by providing decision aids and clear protocols, including guidance for handling synchronisation of medicines and defined responsibilities for each stakeholder.

How-to Guides (technical)

This intervention strengthens GP and prescribing‑team confidence in adjusting prescribing intervals by providing a practical how‑to guide with step‑by‑step instructions and clear guidance on updating prescription settings within IT systems.

New launch / framing of policy (e.g., via Welsh Health Circular)

This initiative frames national guidance to refocus prescribing-interval policy to clinically appropriate, personalised decision-making, and strengthening expectations for patient engagement, collaboration and the consistent, structured implementation of extended periods of treatment to benefit patients, GP practices and community pharmacies.

Success stories and education

This intervention promotes the business case for extended prescribing intervals by sharing case studies and proof‑of‑concept examples that highlight real‑world benefits, including time savings for practices and improved outcomes for patients.

Waste management

This measure establishes a formal feedback mechanism between GP practices and community pharmacies to monitor and address any medication waste arising from the policy’s implementation.

[1] Dispensing doctors are general practitioners (GPs) who, at the request of a patient, are permitted to dispense the medicines they prescribe for patients due to the rurality of the practice. There are around 70 dispensing doctor practices in Wales.

Report author: Matt Barnard, Iranzu Monreal, Rhydian Cleaver, Alice Diaz, Ellie Kettle

Views expressed in this report are those of the researchers and not necessarily those of the Welsh Government.

For further information please contact:

Pharmacy and Prescribing Branch
Primary and Community Care Division
Welsh Government
Cathays Park
Cardiff
CF10 3NQ

Email: Pharmacyand.PrescribingBranch@gov.wales

Social research number: 48/2026
Digital ISBN: 978-1-80633-867-2