On July 17 my social media feed reminded me that 14 years ago to the day a much younger, slimmer version of myself was celebrating after finding out that I’d passed my pre-registration exam. It led me to reflect on how much the profession, and particularly the community pharmacy sector, has changed during that time, and to ask myself – how much have I forgotten and would I even pass the exam now?

My pre-reg year in 2008/09 was in a Co-op Pharmacy branch in the bustling Cardiff suburb of Roath. A full year was spent within community pharmacy except for a brief two weeks in a hospital. Much of it was focused on knowledge of prescription medications and interactions with patients centred around medication counselling or responding to symptoms for over-the-counter (OTC) sales.

While some community pharmacy services existed, they weren’t a large part of the community pharmacy contract at the time. Medicine use reviews (MURs), for example, had been around for a few years and our pharmacy did some needle exchange and supervised administration services.

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In contrast, modern-day community pharmacies across the UK now have significant sums of contractual funding associated with the delivery of clinical services. In Wales, the national clinical community pharmacy service (CCPS) now brings the common ailments service, flu vaccination, emergency medicine supply and access to emergency and Quickstart/bridging contraception into an all-or-nothing suite of services, with almost all pharmacies delivering CCPS services on a monthly basis.

Discharge medicine reviews, sore throat test and treat and the excellent pharmacist independent prescribing service are all nationally commissioned, and an even wider range of additional clinical services are available to deliver where there is a local need.

The landscape in which community pharmacy now operates and the expectations of the role of a community pharmacist are very different to what I experienced, both as an undergraduate and in the first few years of practice post-registration.

Use it or lose it, so the saying goes. The breadth of subjects covered by the undergraduate degree is vast, producing graduates with the underpinning knowledge to pursue any number of careers to which the pharmacy degree opens doors. It is in the foundation training year that you start to apply that knowledge to practice and begin to learn the real-world skills that define everyday practice, and as you pick up new knowledge, your brain inevitably bumps off that which you no longer use – goodbye high-performance liquid chromatography.

Once qualified, and you choose a sector, you lose considerably more of the knowledge that you spent four years gaining at undergraduate level, simply by not using it regularly. It's not that I don’t have an appreciation for the importance of the chemical structure of influenza virus neuraminidase, but it's not what matters when I’m deciding whether a flu vaccination is appropriate for the patient in my consultation room.

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Undergraduate training for pharmacists has of course moved on in line with changes in the profession. University courses now cover much more in the way of clinical consultation skills than mine did. Nowadays, foundation training year places in Wales are multi-sector, with trainees having four-month rotations between hospital, community and GP primary care sectors, meaning that there is a need to demonstrate the application of skills and knowledge to a variety of settings.

The General Pharmaceutical Council's (GPhC) new standards for initial education and training for pharmacists aim to ensure “they are able to play a much greater role in providing clinical care to patients and the public from their first day on the register”. The current cohort of pharmacy students will have undergone undergraduate training with a stronger focus on professional judgement, management of risk, diagnostic and consultation skills than in previous years and will register in 2026 with an independent prescriber (IP) qualification.

Interestingly, in order to provide some of the clinical services that the NHS and patients now require I have found myself having to relearn a number of things over the last five to six years that had otherwise become lost in the depths of my grey matter. Having undertaken a PG Cert in clinical pharmacy in 2018 and my IP qualification in 2021, I was surprised – and quietly ashamed – by the amount of forgotten knowledge which had remained largely untouched in the previous years as a practising community pharmacist.

Now though, I use much of the knowledge gained in my postgraduate studies on almost every locum shift, which shows how much the role has developed in a short time. Certainly when I walked into my first shift as a 'real' pharmacist in July 2009 – clutching my paper copy of the British National Formulary (BNF) – I never thought I would be diagnosing and treating urinary tract infections (UTIs), skin infections or ear, nose and throat complaints within a community pharmacy consultation room. I’ve still never used high-performance liquid chromatography though, and don’t ask me about the structure of neuraminidase.

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Despite changes in pharmacy since I took the registration exam 14 years ago, the underlying principles tested by it remain the same. Can the prospective pharmacist apply learning appropriately to reach the best possible outcome in a variety of situations?

In a time when the community pharmacy sector is increasingly expected to deliver high-quality clinical services it is of course more important than ever to be aware of what you don’t know, recognise when something is beyond your individual competence limits, or know where to find and interpret missing information should you need to. Having these skills is the mark of a pharmacist and it's far more than simple retention and regurgitation of information.

Maybe I could pass the exam after all?

Aled Roberts is a locum pharmacist working in south Wales