ESCP Best Practice: Clinical Pharmacist Prescriber in General Practice in Slovenia – First National Pilot Trial Outside Anglo-Saxon Countries

In the quiet, often overlooked corner of healthcare where daily prescriptions are written, a quiet revolution has been taking place in a few select nations. For decades, the authority to write a prescription for medicine has rested almost exclusively with doctors. However, in places like the United Kingdom and the United States, a new model has emerged where pharmacists—the experts in medicines who usually stand behind the counter—have been granted the legal power to write prescriptions themselves, either independently or in close partnership with a physician. This shift is not merely about changing who holds the pen; it is about recognizing that managing complex, long-term health conditions often requires a different kind of oversight. When a patient has multiple chronic illnesses, the person who knows the most about how dozens of different drugs interact might be the pharmacist, not the doctor who sees them for a few minutes once a year. The question for the rest of the world has been whether this model, born in English-speaking countries, could work in healthcare systems with different rules, cultures, and histories.

Slovenia has now answered that question with a pioneering national pilot project, becoming the first country outside the Anglo-Saxon world to test this approach in general practice. The story begins not with a sudden leap, but with a foundation built over a decade. For years, Slovenian primary care centers had already employed clinical pharmacists to review patients' medications. These specialists would look at a patient's list of drugs, check for dangerous interactions, and suggest improvements to the family doctor, but they could not change the prescriptions themselves. In 2023, the Ministry of Health decided to take the next logical step: allowing these pharmacists to actually write the prescriptions, provided they did so under a specific agreement with the family doctor. This agreement, known as a collaborative practice agreement, acted as a detailed map, defining exactly which conditions the pharmacist could treat and what steps they must take. The pilot focused on ten specific chronic conditions, such as high blood pressure or diabetes, where the pharmacist could start, stop, or adjust medicines, but only after the family doctor had confirmed the diagnosis and digitally approved the final prescription.

The experiment ran for six months across four primary care centers, involving 119 patients who were referred by their family doctors because their treatment needed adjustment or was not working as well as it should. Five experienced pharmacists, each with more than five years of experience reviewing medications, took on the new role. They met with patients, reviewed their entire medical history, and then, within the boundaries of their agreement, wrote new prescriptions. Every single prescription they wrote had to be digitally signed off by the family doctor before it could be dispensed, ensuring a safety net remained in place. The results were striking. Over the course of the trial, the pharmacists issued 264 prescriptions, and in more than 91 percent of those cases, the family doctors approved them without making changes. This high rate of acceptance suggested that the doctors trusted their pharmacist colleagues and that the system was working smoothly.

Beyond the paperwork, the health of the patients improved significantly. The study measured how well patients were following medical guidelines and whether their health targets were being met. At the start of the trial, only about 30 percent of patients were following the recommended treatment guidelines, and a tiny fraction, just 6 percent, had achieved their specific health goals. By the end of the six months, those numbers had transformed: 91 percent of patients were following the guidelines, and 71 percent had reached their targets. Perhaps most importantly for the patients themselves, their reported quality of life improved noticeably. They felt better, and their health markers showed that the medicines were working more effectively. The researchers also looked at the economics of the project. They found that for every single euro invested in the pilot, the healthcare system saved over 22 euros, a return driven by better health outcomes and more efficient use of resources.

The human side of the story was just as compelling as the numbers. The researchers spoke with the patients, the family doctors, and the pharmacists to understand how the new system felt in practice. The patients appreciated the extra attention and the fact that someone was closely monitoring their treatment over time. The family doctors reported that the collaboration was effective and that they felt comfortable with the pharmacists taking on more responsibility. The pharmacists themselves valued the increased role in managing patient care, though they noted that the system felt a bit like a bridge that was still under construction. While the clinical results were excellent, the participants identified significant hurdles that stood in the way of making this a permanent part of everyday life. The biggest obstacle was the lack of a formal law that would allow pharmacists to prescribe medicines on their own. Currently, the system relies on a pilot agreement, and without new legislation, the pharmacists cannot operate independently in routine practice. There was also a clear need for more structured education to ensure all pharmacists had the necessary clinical skills and for a sustainable way to pay for these services.

Despite these challenges, the pilot has already influenced national policy. In March 2026, the Slovenian Ministry of Health officially included pharmacist prescribing in its future healthcare plans, with a goal to implement the system nationwide starting in January 2027, pending the necessary legal changes. The success of this trial suggests that countries with established relationships between doctors and pharmacists can successfully expand the role of the pharmacist without starting from scratch. It proves that when the right people are given the right tools and the right support, they can improve patient health and save money. The Slovenian experience offers a clear path forward for other nations, showing that the future of healthcare may not be about replacing doctors, but about empowering the entire team to work together more effectively.