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Reform could 'aim' for new pharmacists to be independent prescribers

Independent prescribing would be "one aim" of the foundation year

Newly registered pharmacists could qualify as independent prescribers when completing the one-year foundation training expected to replace the pre-reg year in 2021.

Under proposals outlined by NHS England and Improvement and Health Education England (HEE) last week (July 23), the pre-registration year could be replaced by a one-year foundation training from July 2021.

Through this reform, which would apply across the UK, the General Pharmaceutical Council (GPhC), Pharmaceutical Society of Northern Ireland (PSNI) and the four UK chief pharmaceutical officers (CPOs) envisage “new registrants to be independent prescribers”, they wrote in a letter published yesterday (July 28).

This would be “one aim” of the foundation year, which will be “be subject to appropriate consultation” and will consider “each country’s circumstances”, they added.

Demand for pharmacist practitioners

Pharmacists’ roles have “evolved quickly” in the last 10 years and there is a “significant and growing” demand for “clinical, patient-facing pharmacist practitioners”, GPhC CEO Duncan Rudkin, PSNI CEO Trevor Patterson, Scotland CPO Rose Marie Parr, Wales CPO Andrew Evans, England CPO Keith Ridge and Northern Ireland CPO Cathy Harrison wrote in the letter.

The reform to introduce a one-year foundation training scheme will support pharmacists at the beginning of their careers “through a structured work-based approach that embeds knowledge, skills, abilities, values, attitudes and beliefs in their practice”, they added.

The training will equip new pharmacists with the skills necessary to “take on extended clinical roles” and work across different sectors and with other healthcare professionals, they said

The GPhC is finalising the revised standards for the initial education and training of pharmacists in Great Britain and PSNI is carrying out parallel work in Northern Ireland, the letter explained

“Once the standards are finalised”, the reforms for a “continuum of five years of education and training” will be introduced in July 2021, with a “phased approach to implementation”, the regulators said.

In England only, provisionally registered pharmacists and pre-regs who are signed off as eligible for provisional registration will complete an interim foundation pharmacist programme, starting in September this year.

This is a “vocational training programme”, during which provisionally registered pharmacists will “use work-based experiences and reflection to identify areas of good practice and further development opportunities”, HEE director of national transformational programmes Alan Ryan told C+D today (July 29).

Provisionally registered pharmacists will not be asked to take “hours out of practice for training” and there will be a focus on online resources to “enable a flexible delivery and access to content” and help pre-regs “balance personal development while working”, Mr Ryan added.

What do you make of the regulators' proposals?

Ronald Trump, Pharmaceutical Adviser

Valeria, would be interesting to know your thoughts on the proposals? I assume you read the comments? I think people probably sick of hearing me and LEL now.

Ronald Trump, Pharmaceutical Adviser

This is defnitely the right way forward, as the pharmacist role continues to evolve over the decades in line with the healthcare needs of the population.

However I have a few questions/ concerns:

1) Are we aiming to get pharmacy students who are currently in there 2/3/4 year of study to become IPs after 5 years of study/ training? Or will the cirriculum be redesigned from year one to allow students who will be starting a pharmacy course now or in near future to come out with IP after 5 years? I worry that if this is rushed through for pharmacy students already near the end of there course then they will not have the competency, experience, skills and experience to be able to prescribe safely.

2) There is going to be a disparity between newly graduated pharmacists and most pharmacists in the community pharmacy profession without IP or clinical knowledge required to carry out the new services of a new contract. How do you plan to bridge this difference? There will need to be funding for training and for pharmacists to be released from their work to do diplomas and IP. Also there will be pharmacists who think I dont want do be a prescriber or I dont want to do anymore study- do we just leave these behind? Or pay them less because they have less clinical skills? Or do they just 'like it or lump it'

3)At the moment, most prescribers would have 5 years training until qualification, then 2/3 years of diploma and IP- so it takes them minimum of 7/8 years to become an independent prescriber. I have concerns that pharmacy students, unless there is a massive overhaul of the undergraduate cirriculum, would have all of the skills, confidence and knowledge to prescribe safely at the 5 year point. Also, will they specialise in a therapeutic area or be a generalist? Will they have to choose early on in their pharmacy degree/ foudation year what area they will prescribe in? Or will they be limited to start? How can you expect all of this training and knowedge to be squeazed into 1 year of foundation?

This feels as if it is being rushed through for political reasons. We cannot rush it as patients will end up dying from incompetent pharmacist practictioners. This will then tarnish the pharmacist profession forever.

My preferred option as shared by Roisin O’Hare, vice president of the Guild of Healthcare Pharmacists:

Either way this is huge news! Again, my advice to any pharmacist: further educate yourself now to futureproof your job and prospects. Otherwise you will be left behind/ paid less/ left with the crap jobs

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

If you're going to continue talking good sense like this, you'll have to change your username!

I don't really think this is aimed at the likes of me though, with too many miles on the clock. If this comes to fruition, what's going to happen is that your traditional pharmacy will still exist but be run by techs, ACTs etc, while the pharmacist will move to their prescribing role, either within the pharmacy premises, nominally as RP, or else with a dedicated consulting room at a GP practice (probably seeing all of the awkward/smelly/hypochondriac patients the GPs don't want) but either way, the likes of me will be on the scrap heap. Not that I care. I'm out at the end of this year at the latest.


Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Hmmmm....I wonder if this is shaking the Ivory Towers in GP-land? The filthy unwashed hordes of Pharmacists ready to take over your role for significantly less money! Maybe pharmacists (young ones anyway) have a future after all. This sounds like the death knell for the old stagers like me though. A further erosion of the traditional pharmacist role, and as Benie said, a way to drive down pharmacist wages.

Ronald Trump, Pharmaceutical Adviser

I think GP's bums have been twitching for a long time. I think that in the long run though it will mean more money for pharmacists and we are now able to compete better with GP for clinical services and work more autonomously with the public.

Yes traditional role has been eroded but this has been happening for years- it is a natural evolution in line with the health of the human race and technology etc  Change isnt always a bad thing :)

This is the biggest change to the pharmacy profession since the 19th century when it went from apprenticeship to degree.

My two pence worth: I think eventually pharmacy will become a sub-specialty of medicine. A five year intergrated degree- call it a PharmD as in the states and raise the entry standards. This will both raise the profile of the profession to the public and attract better students who will be willing to pay the extra fees. Pharmacists should have advanced clinical skills to cope with the demands of a modernised NHS, but also retain core expertise in medication.

Upon 5 year qualification- give them IP rights, but then set them up with pathways to training in specialties...diplomas etc

Exciting times for the pharmacy profession! Not so exciting for community pharmacy business owners unfortunately as will be a lot of change and adaptation to come if they want to make decent profits.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

This is very odd Ronald. We've disagreed strongly on other topics, but this time, I agree with you entirely. Frankly, if I was a 15ish year qualified pharmacist with a big mortgage and kids, having to work stupid hours just to make ends meet, I would be very worried about being left behind BUT I've just downsized to get mortgage free and am not renewing at the end of this year after 30 years at the grind. I'm going to do things I enjoy from now on.

Ronald Trump, Pharmaceutical Adviser

haha good for you LEL, I mean that sincerely

Life is for enjoying

Enjoying the journey too

Im loving the positivity in your post :)

I hope these new plans and opportunities for pharmacists will raise the profile of the profession and show what we can do to help the health of our nation...It makes me feel proud to be a pharmacist (yes I am a pharmacist not just an advisor) when I think we are a profession that is not afraid to shy away from the challenges of pandemics and future healthcare needs ...and is adaptable and evolutionary in its approach...rather than sticking to our old models and battening down the hatches...we are taking the profession forward

...right I  better stop now before you give me some grief

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

No I won't! I've seen the error of my ways. I'm going to stop being a grumpy old sod now (the 50 grand in the bank from the downsize helps!!). I REALLY hope, for the sake of all the youngsters, that your vision for pharmacy comes true. It's a thing that could be magnificent but has been spoiled by the multiples in my opinion, purely for monetary gain.

I, like you, have a very positive opinion of the capabilities of Pharmacists. I think we are and have been a great untapped reserve for public healthcare but have been ground down by YEARS of drudgery. Maybe things will change for the better. I hope so. I'm done with the pessimism. It doesn't do me or anyone else any good.

Friends now?

Joan Richardson, Locum pharmacist

Proposal will certsinly need some work.  As I understand it at present you have to choose an area of interest in which you would like to become an IP - eg anticoagulants -  and then the local health authority decides if there is a need for a pharmacist to become qualified in that area before you are allowed to train.


Benie Locum, Locum pharmacist

With Boots and GPhC running the show as a partnership all that protocol can be thrown out the window. 

Getting Shorter, Community pharmacist

If either part of this is done to anywhere close to the current standards for pre-reg or IP, there is absolutely zero chance they can safely and successfully combined into one year.

If the standards/requirements/experience are significantly lowered however....

Benie Locum, Locum pharmacist

 Read btw the lines. This is presented as gift for pharmacists but will turn out to be the same old s*** sandwich. The only beneficiaries will be the likes of Pessina and some contractors. The vast majority of pharmacists will be forced to grin and pretend to enjoy it.

Adam Hall, Community pharmacist

BTW I know you can complete an IP course but it appears incredibly arduous, especially if you are already holding down a demanding full-time job

Ronald Trump, Pharmaceutical Adviser

It is arduous and I do sympathize. But unfortunately science hasnt evolved yet where we can artificially implant knowledge and skills into your brain. Until that point, you have to put the work in yourself. You have to make sacrifices if you want something. Im not saying that it is your fault- I think some of the fault lies with the employing and regulatory organisations in the profession, that community pharmacists are generally overworled, understaffed, and have been allowed to reach a state of knowledge inertia over the last few decades. It has never been a problem until the last few years as pharmacies have always been propped up by decent'ish remuneration for mass volume-based item dispensing. This has changed due to advances in automation, a change in the healthcare needs of our population and expectation of the NHS paymaster. 

This also reminds me of the chicken and egg.

We need pharmacists with the skills to perform the new roles and services.

But we dont quite yet have the roles, services or money in community pharmacy.

Therefore we need to start with a change in the initial education of undergraduate pharmacists- and that is what Ridge et al are rubber-stamping in their letter.

The already qualified pharmacists will have to play 'catch-up to keep-up' with the best paid jobs and opportunities. Hopefully CPOs have a plan for this too.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I looked into it a while ago - totally unfeasible for someone with a full time job. It would leave you with precisely NO down time at all. Non-starter for the likes of you and me and anyone who is already qualified with a family and a life I'm afraid.

Adam Hall, Community pharmacist

A friendly, pro-Pharmacy GP asked me several years ago why all new pharmacists weren't independent prescribers from the outset. I didn't have an answer but think it is a good idea. My one concern would be - what about all those qualified 1,2,3...10..20 years? Can they undergo some brief training course to become independent prescribers, to avoid being disadvantaged by this progress? Always be aware of unintended consequences

Ronald Trump, Pharmaceutical Adviser

'Can they undergo some brief training course to become independent prescribers, to avoid being disadvantaged by this progress?'

Ofcourse not. You cannot compromise clinical standards or patient safety just for convenience. Shortening the course will make it unlikely you would achieve satisfactory competence. Plus achieving IP status is just the started of learning- you need to continue to develop and learn, ideally surrounded by more experienced clinicians to refer to for guidance if needed- this is another problem in community pharmacy- very isolated.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Ronald, I humbly apologise for the criticism I have sent your way previously. You are talking so much good sense on this subject. If I was even twenty years younger I would be inspired to really have a crack at this thing, improve myself and above all else, ENJOY myself. Unfortunately, the mid-fifties have taken me and my enthusiasm for the job, but I'm going to throw myself into things that I wish I'd done years ago, enjoy the life I have left and start smiling again.

Thanks, mate!

Ronald Trump, Pharmaceutical Adviser

LEL I think you should give it a go because as an experienced pharmacist you could offer so much and put your skills and knowledge to even more use to benefit act as a mentor for less experienced pharmacists. You might even get a pay rise or charge more for your services- then you can work less! You're only 50 odd mate Im sure there's plenty of life left in the old dog yet! ;) That's great to hear that you're going to do new things outside of pharmacy which will make you smile :) Maybe that will give you a new perspective on your job that will be easier on the soul. It's so easy to get caught on the hamster wheel that is community pharmacy, and it can be so stressful/ demoralising that it removes the enjoyment from the job. I was lucky I got out a few years ago. Well I wasnt really lucky- I made my own luck by investing in my education and learning, and applying for new jobs outside of community pharmacy. I had a couple of rejections from jobs but I suppose I had a stroke of luck and landed a job that I really wanted, because I think there were lots of equally good pharmacists applying. But you've gotta have a ticket to win the raffle! I took a big pay cut for a little while which was hard, and I had to sacrifice most of my social life for a little while. But I enjoyed the journey and now I am in a job I love and it has transformed my life (sounds cheesy but its true). I feel real value in my job now. When I was a community pharmacist I felt so constrained by the demands of the job, pressure from management to complete services that I didnt believe offered true benefit to patients or value for money for taxpayers. I felt stripped of my autonomy and that most of what I had learned in university was  going to waste as I was checking boxes all day. Plus it was very difficult to gain investment to have my own bricks and mortar pharmacy business- at least by owning your own business you may feel more of a sense of value. I would consider going back to work as a community pharmacist if the contract was changed so I could use my skills fully, it was better paid and you were guaranteed adequate staffing can only dream!

Anyway, great debate about our beloved profession. We may rant but at least it shows we care! Only wish more pharmacists would speak up and let us know their struggles and never know who might be reading these forums. In the words of Delia Smith 'Where are yewwwwww?!'




Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I think I feel now exactly how you used to feel. I need a break from pharmacy for sure, but I've a feeling I won't be back. I'm genuinely glad to hear that someone has found their place though. Happiness is more important than anything else - I'd rather be a happy tramp than living in a mansion and being unhappy.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

'A friendly, pro-Pharmacy GP' - isn't that also known as a Unicorn? I would file it under mythical beasts anyway.

Freelance Chemist, Pre-reg Pharmacist

Don't you need to be qualified for 2 years before IP?

so bending the rules, moving the goal posts at their pleasure?

Benie Locum, Locum pharmacist

probably implemented by Boots and co with GPhC support to drive down pharmacist earnings.

Leon The Apothecary, Student

I imagine they would want to make more use of expensive services such as Lloyd's recently announced Weight Loss Clinic.

Freelance Chemist, Pre-reg Pharmacist

Spot on again

Leon The Apothecary, Student

I like the idea. I think it is important if pharmacist prescribing is to be utilised more mainstream, especially in any minor ailments services such as how CPCS is being directed as being, that prescriber training is included as standard.

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