Last month saw the publication of the results of a freedom of information request by the Guild of Healthcare Pharmacists (GHP), which examined entry grades to MPharm courses, the proportion of pharmacy students accepted through the ‘clearing’ process and pass rates in the GPhC’s registration assessments. This generated quite a furore, with claims that universities are ‘endangering the future of the profession’; understandable when the GHP’s press release used phrases such as “a conveyor belt of pharmacy students” and “a pharmacy crisis about maintaining professional standards”.

The press release goes on to state that the figures show “a clear association over each of the last five years between entry criteria, the number taken through clearing and the final exam entry success”. This assumes that, as entry grades have been lowered and the proportion of students accepted via clearing have increased, so the proportion of candidates passing the GPhC’s registration assessment has decreased. This statement, perhaps not unreasonably, was aped pretty much parrot-fashion by all those who covered the story. I’m not saying the correlation highlighted does not exist – it does – but I do not believe that the analyses conducted were optimal.

 

Digging through the data

First, a minor criticism. Cardiff University is included. It really shouldn’t be because universities in Wales have completely different funding arrangements to those in England. More importantly – and I have to express some surprise that nobody has picked up on this – even if there is a link between entry grades or the proportion of students accepted through clearing in 2014 and the registration assessment pass rate in 2014, so what?

The vast majority of candidates sitting the registration assessment in 2014 would have enrolled on an MPharm programme in 2009. Of the data published by the GHP (and it should be commended for getting this out in the open), it really only makes sense to establish if there are any associations between entry grades in 2008 and 2009 and registration assessment pass rates in 2013 and 2014 respectively.

Now, don’t all rush and open a spreadsheet – as it happens, I have examined the specific subset of the data outlined above. The associations suggested by the GHP do exist – both entry grades and the proportion of students accepted through clearing in 2008 and 2009 are associated with the registration assessment pass rates in both 2013 and 2014. The correlations all reach the level of statistical significance but both of these are based on a fairly small number of data points: 16 in 2008 and 18 in 2009 (I have excluded Cardiff from these analyses and I have used the median A-level tariff for entry). These data are certainly worthy of longitudinal monitoring.

 

The media reaction

Much of the coverage appeared to lay the blame for the decrease in the pass rate of the registration assessment to 74% squarely at the door of ‘greedy’ universities.This obviously ignores the fact the MPharm graduates undertake a year of pre-registration training prior to the registration assessment.

I’m not looking to point the finger of blame in either direction here, but it is plausible that the quality of pre-registration training may have an impact on pass rates in the registration assessment. It seems to me that those who have commented on these issues thus far have been too eager to point the finger of blame and too simplistic in their narrative.

The ‘greedy’ universities narrative may appear superficially attractive. I am going to make no attempt to defend the decisions of university vice-chancellors (VCs) as to which courses their institutions are going to provide. Perhaps some ‘bottom-line focused’ VCs have viewed the provision of an MPharm as a means of boosting the incomes of their institutions but you cannot expect them to make altruistic decisions on behalf of the pharmacy profession. Like so much else in the public realm, higher education has been marketised and, in that context, some people may commend such VCs for developing new revenue streams and helping to protect the future of their institutions.

 

Supply and demand

And while we are on the subject of ‘the market’, let’s talk about supply and demand once more. The supply of pharmacy graduates is beginning to outstrip the supply of pharmacist positions (most pertinently, pre-registration positions). We know this. There are those who believe we are going to be able to stimulate the demand side of the equation by role extension such as GP-based pharmacists and bring the equation back to somewhere near equilibrium. I think they’re wrong (unfortunately) and recently advertised full-time pharmacist positions at around the £20,000 per annum mark suggest that oversupply is starting to bite.

The point of these apparent economic asides is to highlight that universities are far from exempt from the vagaries of the market. Downwards pressure on pharmacist terms and conditions make it increasingly likely that the most able students will steer away from pharmacy towards other degrees that offer a better return on investment. Universities find themselves in a competitive market where, to a large extent, they are dependent on the income from student fees to survive and thrive.

Expecting senior university managers to voluntary disadvantage themselves in that market by specifying entry grades to MPharm courses that will result in them recruiting smaller cohorts of students is perverse. If the most able students are being deterred from pursuing a career in pharmacy, universities will lower entry grades and/or recruit students through clearing to ensure that they meet their targets for student numbers. As Ice-T once famously remarked, “don’t hate the player, hate the game”.

 

Continuing worries

All of this is not to say that I do not share some of the same concerns expressed by the GHP – I do. I worry that the quality of entrants to the MPharm degree is, and may well continue to be, decreasing. I worry that, given universities’ dependence on fees for income, students who may previously have been ejected from degrees for poor academic performance may be allowed to continue through to graduation and then hit the buffer of the registration assessment or ram through that buffer and prove to be poor pharmacists (I’d like to make it clear that I’ve seen no evidence of this happening).

I worry that some schools of pharmacy appear to have registration assessment pass rates that are clearly outside the limits of random variation. To be frank, at times I worry about the future viability of our whole profession. Universities certainly have an important role in inculcating and maintaining professional standards, but to single out universities for blame in the face of much larger social, political, economic and technological changes seems – from this particular ivory tower at least – a tad unfair.

Joseph Bush is a senior lecturer in pharmacy practice at Aston Pharmacy School. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official views of Aston University or its school of pharmacy.

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