Antibiotic prescribing by non-medical healthcare professionals in primary care: a systematic review of effects on antibiotic use, patient experience, interprofessional relationships and job satisfaction.

Background: Demand for primary care services has increased significantly in the last decade, with substantial pressure placed on general practitioners (GPs), such as in the English Pharmacy First programme. Developing a more diverse skill mix to include other healthcare professionals (HCPs), such as nurses and pharmacists in the management of common, acute, self-limiting infections is considered part of the solution to this issue in many countries. Aim/objectives: This study aims to review the evidence available on the effects of expanding antibiotic prescribing to include HCPs other than doctors in primary care with a focus on antibiotic use, patient experience, interprofessional relationships and job satisfaction. Methods: Five databases were searched; EMBASE, Policy Commons, Web of Science, Scopus and Overton. The search covered the period 2010-2025. In total, 20 studies from nine countries were included. Data extraction followed PRISMA 2020 guidance, and risk of bias was assessed using the CASP (2024) qualitative checklist. Owing to heterogeneity, findings were synthesized using narrative synthesis following SWiM guidelines. Results: Antibiotic prescribing by non-medical HCPs is increasing but remains a small proportion of total prescribing (e.g. 6.5% in England, 3.2% in Australia), with nurse prescribers providing a notable proportion of antibiotic prescriptions (56% in New Zealand). Public awareness of HCP antibiotic prescribing is limited but patient satisfaction with HCP prescribing is favourable (e.g. 75% in England). Job satisfaction improved where supervision and role recognition were strong, but decreased when workload increased without support. Conclusions: Continuing professional development and supportive work environments improve prescribing confidence, promote safer practices and support longer-term HCP retention. To maximize the benefits of non-medical prescribing, clearer role definitions, stronger interprofessional collaboration and integration within antimicrobial stewardship programmes are needed. Future research should assess prescribing appropriateness and the wider system-level impact on antibiotic use and antimicrobial resistance.