Mixed feelings about prescribing studies for pharmacy undergraduates

In July 2020, the General Pharmaceutical Council (GPhC) proposed major reforms to the initial education and training for pharmacists, which included replacing the pre-registration year with foundation training and subsequent plans to integrate prescribing training.

Unsurprisingly, Twitter was hot with debate, and the prescribing aspect clearly divided opinion. And additional concerns were raised about the short timeframe for implementing these proposals.

As a pharmacist with 20 years’ experience, in hospital and academia, I have mixed feelings about these changes. The demands of modern healthcare continue to change rapidly, and the COVID-19 pandemic has highlighted further the value of pharmacists.

As the experts in medicines, there is a compelling case for pharmacists to have a key role in prescribing. However, these changes need to be explored carefully to ensure that newly qualified pharmacists do not end up making the same mistakes as newly qualified doctors. The EQUIP study demonstrated that doctors in their foundation years had the highest prescribing error rates, and there is a strong argument that it is the ‘junior’, not the ‘doctor’, aspect that explains these findings.

Currently, the shortest time from commencing pharmacy undergraduate studies to achieving a prescribing qualification is 7.5 years, and these proposals would reduce this by one third, to 5 years.

The two years’ post-registration experience currently required before commencing a prescribing qualification provides valuable time for pharmacists to become confident in challenging prescribing decisions and develop their decision-making skills. The Pharmacy Schools Council’s position statement, ‘The science-based therapeutic practitioner’, published in July 2020, argues why the science aspect of pharmacists’ training needs to be retained. Therefore, the integration between science and practice will become even more important to ensure that science is not taught just for the sake of it when the undergraduate curriculum is reformed.

Pharmacists need to be able to learn from their mistakes without fear of failing a programme of study (which I feel is not possible under the current GPhC standards for the education and training of pharmacist independent prescribers), although this will need to be balanced carefully against maintaining patient safety.

Reflecting on my own journey to becoming a prescriber, I think that the partnership between myself and my designated medical practitioner benefited from a mutual respect, which we had developed by working together for almost three years before my training. The changes implemented in pharmacy education must ensure that this dynamic in the trainer–trainee relationship is not compromised. Finding suitable designated prescribing practitioners for more than 2,000 trainees each year will also be challenging.

Gareth Nickless, programme leader, postgraduate diploma in clinical pharmacy for secondary and tertiary care, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University