The revelation that a proposal for a five-year pharmacist apprenticeship scheme was under consultation was met by responses ranging from support to alarm across community pharmacy.
The 10-day consultation, launched by the Institute for Apprenticeships and Technical Education – an employer-led public body not affiliated with a government department – closed on April 14.
Now the first stage of the consultation has finished, more than 6,000 responses will be reviewed by a “health and science route panel”, along with the proposals themselves.
The proposal is for a level 7 apprenticeship, equivalent to a master’s degree, where pharmacists would train as apprentices on placements hosted by pharmacy companies.
The General Pharmaceutical Council (GPhC) says the apprenticeship would still need to meet its learning outcomes and standards in order to be fully accredited, and trainee pharmacists would still be required to pass the pre-registration exam to join the register.
C+D spoke to high profile pharmacy figures to understand why the proposals have sparked such controversy.
“Eroding the profession”
Hampshire contractor Sultan ‘Sid’ Dajani condemns the proposals, claiming they are part of “a continuing governmental policy to further dumb down and erode the profession”.
“There is nothing wrong with the system, this is regressive change for change’s sake. I’m all for change but this is yet [more] illogical thinking that [should go] onto the compost heap of ideas.”
Mr Dajani – who is also a Royal Pharmaceutical Society (RPS) English board member – believes that an apprenticeship would not prepare pharmacists for the problem-solving required to deliver optimal patient care.
“There are problems you don’t find in a book or on the internet that you have to find yourself. That’s where a university and apprenticeship differ. An apprenticeship won’t teach you how to help patients,” he claims.
“At university you get to learn the basics and strong foundations. If you go straight to practice you’ll never understand theory.” Mr Dajani acknowledges that the apprenticeship would have to be GPhC accredited, but believes the pre-reg exam “would have to change”.
He also believes it’s a “commercial decision, rather than a professional one”. He claims the “multiples would love it”, because it would make pharmacist employees more dependent on their managers, like “robotic beings”.
While there is no evidence the multiples intend to create “robotic” apprentices, Boots, Well, Lloydspharmacy and Superdrug have all confirmed to C+D they are part of the “employer trailblazer group” – a group of at least 10 employers that according to the institute’s website “come together as the creators and early adopters of new apprenticeship standards”.
“Students may welcome the reduced loan burden”
As managing director of 12-branch chain Daleacre Healthcare and chair of the group behind apprenticeships for pharmacy support staff, David Evans is more optimistic about the proposals.
“The pharmacist apprenticeship proposals appear to be all about funding – how employers can tap into the government’s apprenticeship levy to train staff and plug some of the recruitment gaps across the sector, especially in more rural areas of the country,” Mr Evans says. Organisations with a wage bill of over £3 million annually can claim back the cost of apprentice training from this tax, while smaller employers would only pay for 10% of the education costs.
The proposals may be equally attractive for students, Mr Evans says. “I think prospective students might welcome the proposal to be funded and have a reduced student loan burden.”
Mr Evans stresses that pharmacist apprentices would still have to pass the GPhC exam. “If a degree-level pharmacist apprenticeship is the same academic qualification, to the same standards, with a broadly similar structure as the current set up, but the student is employed full-time and is paid during the process, I don’t see the problem.”
He says the use of the term ‘apprentice’ has “clearly created a poor impression” in pharmacy. The aim is to use the government’s levy fund to train staff, which is “common” in other professions, he points out.
“There are already successful healthcare degree apprenticeship schemes, including for physiotherapists, radiographers, occupational therapists, midwives, nurses, paramedics and podiatrists, which result in graduation with a bachelor’s degree.
“There is also the advanced clinical practitioner apprentice qualification, with which an apprentice qualifies with the equivalent of a master’s degree.”
The 10-day length of the initial consultation on the proposals “caused some concern” in the sector due to its brevity, “but unfortunately that’s just how the initial approval process works”.
“Much more detail will become available in the next stages of consultation,” he insists.
“There will be two more consultation stages”
Steve Mosley, chief officer of Lincolnshire local pharmaceutical committee, also stresses that the consultation is only at its first of three stages.
“There will be two further, much more detailed and rigorous, stages of consultation”, he says. He interprets the consultation as asking two primary questions: whether the sector “needs more pharmacists?” and “is pharmacy hard?”.
The consultation response document asked seven questions, including “do you support the development of the apprenticeship standard set out in the proposal?” and “do you recognise this occupation?”.
Criticism of the proposals “weren’t relevant at this stage”, Mr Mosley claims, though they will be at the next two stages.
“Our voices shouted too loud, too early. Calm down, look at what the process is,” he tells concerned pharmacists.
Mr Mosley draws attention to the time required in the proposals for on-the-job training (445 days), which he says equates to around two days a week over five years. “It’s for the trailblazer group to demonstrate how this meets the [GPhC standards] at stage two and three of the consultation. At the end of the day it would be the GPhC who will determine whether it has legs.”
However, he does question whether the government would want to fund the apprenticeship scheme through the tax levy, as it “sounds a lot more expensive than five years of private loans”.
“Creating a one-dimensional pharmacist?”
Professor Reem Kayyali, head of pharmacy at Kingston University in London, says the proposals need to be reconsidered to include the varied role of pharmacists.
“Pharmacists are now recognised as part of the multi-disciplinary team, with careers in community, hospitals, GP surgeries, care homes, NHS 111 and urgent care,” she says. “Many of these roles have been established recently, due to the recognition that pharmacists are healthcare professionals who can meet the increased pressure on the NHS, especially with Brexit looming.
“Their training makes them unique in that they are the only scientist as part of the healthcare team with a syllabus that includes: physiology, pharmacology, therapeutics, chemistry, microbiology and pharmaceutical formulation.
“Their versatility makes them able to have careers in public health, industry and academia, and many now are prescribers and run their own specialist clinics.
“So how would the apprenticeship ensure this versatility and ensure the growth of this workforce to fill the pressure in the NHS?” she asks. “Is the apprenticeship trying to generate a pharmacist who is one dimensional and thus indirectly challenge the sustainability of this profession? Is it planning to grow one sector or one approach?”
“Apprentices would be prepared for the role”
Team PreReg directors left to right: Jay Modhvadia, Fawzia Lokat, Harvinder Mann and Mital Thakrar
Mital Thakrar, co-founder of pre-reg support provider Team PreReg, also has concerns about the quality of the training apprentices would receive.
University courses offer experiences such as “group learning, presenting, lateral thinking and the time to think”. As pharmacy moves away from dispensing towards a more services-oriented approach, pharmacists need to have “an embedded foundation of knowledge” from university, he says.
He acknowledges that this is just the first stage of the process of creating apprenticeships. “There’s a lot of steps involved to get it where it needs to get to. Once we can see the clear framework, the competencies and the plan, then employers can look at it.”
There are benefits to training in a pharmacy, Mr Thakrar says. “Having a long-term position where you’re working every day can develop you. You’d be prepared for the role.”
His Team PreReg co-founder Harvinder Mann says there is potentially a “wide opportunity” for the sector for students who can’t afford university fees.
However, hearing about the scheme was “a bit of a surprise” and the “industry is quite unsure” about it, he admits. He raises a concern about apprenticeships creating an inconsistency in the kinds of pharmacists produced, by offering an alternative route. In addition, he worries it could reduce pharmacists’ wages and damage their workplace rights.
“Change the narrative”
Ade Williams (pictured above, centre), superintendent pharmacist at the C+D Award-winning Bedminster Pharmacy in Bristol, says the apprenticeship proposal provides an opportunity for the profession to do some soul-searching. Community pharmacy needs to understand why it has materialised and ensure that it does not damage the sector, he says.
“If you haven’t identified the right problem, you will most likely come up with the wrong solution. We need to come together – what are the challenges?”
The “outrage” the proposals triggered means the sector needs to “build some consensus” to “change the narrative”, Mr Williams says.
Whether the proposals could present an attractive opportunity for students who can't afford university loans or threaten to erode the profession is still up for debate. How the Institute for Apprenticeships and Technical Education reacts to the 6,000 responses it has already received to its consultation will determine whether it progresses to the next stage, coming one step closer to making pharmacist apprenticeships a reality.
Read everything C+D knows about the pharmacist apprenticeship proposals