Pharmacists now offer increasing levels and ranges of clinical, diagnostic and public health services, which may require a pharmacist to be absent from the pharmacy premises. Currently, in the UK, many pharmacy activities legally require the direct supervision and physical presence of the pharmacist. This study aimed to explore the potential for changes to supervision, allowing pharmacist absence, and greater utilisation of pharmacy support staff. Four nominal group discussions were conducted in May 2012 with community pharmacists (CPs), community pharmacy support staff, hospital pharmacists and hospital pharmacy support staff, involving 21 participants. Participants were asked to generate pharmacy activities, which they felt could/could not be safely performed by support staff in the absence of a pharmacist, followed by a discussion of these items and voting using an agreement scale. A written record of the items generated and voting scores was made and the group discussion elements were audio-recorded, transcribed verbatim and analysed thematically. The selling of general sales list medicines, assembly of prescriptions and provision of public health services received a high level of agreement between groups, as activities that could be performed. There was greater disagreement about the safety of support staff selling pharmacy medicines and handing out checked and bagged prescription items to patients. Group discussion revealed some of the main challenges to supervision changes, including CPs' perceptions about their presence being critical to patient safety, reluctance to relinquish control, concerns about knowing and trusting the competencies of support staff, and reluctance by support staff to take greater professional responsibility. The findings of this study aim to inform a future consultation on changes to pharmacy supervision in the UK. The empowerment of pharmacy technicians as a professional group may be key to any future change; this may require clarity of their professional responsibilities, enhanced career progression and appropriate remuneration to match greater responsibility. © 2013 John Wiley & Sons Ltd.