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Pharmacist apprenticeships: It’s going to take some convincing

"I can see both sides of the argument on the pharmacist apprenticeship proposal"

Proposals for a pharmacist apprenticeship may have been kicked into the long grass for now, but pharmacists’ concerns will have to be addressed if they come back, says Toni Hazell

Apprenticeships are not a new way to learn your trade; they can be traced back to the Middle Ages, when the first national system of apprenticeship was introduced in 1563.

By the 1960s, a third of school-leaving boys became apprentices, but there was a decline in numbers from the 1960s to the 1990s, with a clear political shift to university education. Who remembers the famous 1999 policy aim that 50% of young people should go to university?

Many degrees do not hugely increase graduates’ earning power, and with the advent of tuition fees and increasing costs of living, the debt incurred by students can be large. It is no wonder that earning while you learn has become more popular in recent years; until the COVID-19 pandemic, numbers had been growing year on year.

Can every career be accessed via the apprenticeship route, or are there some – such as a career in healthcare – for which university is essential?

If apprenticeships don’t work for everything, then it would make sense that healthcare careers might be one area in which a university degree is still needed. There are a lot of facts to learn – a lack of understanding of which could be dangerous – and set regulations about the exams that must be passed.

The direction of travel for nursing has been away from the apprenticeship model, with the 2009 change to an all-degree profession, and the recent announcement of a possible apprenticeship route to medicine was not greeted with widespread enthusiasm.

So what about an apprenticeship route to being a pharmacist? It was first proposed in April 2019, but work on it was paused a month later, restarted in October that year and paused again in December. We all know what happened next – the pandemic hit, life as we know it was turned upside down and the apprenticeship scheme for pharmacists is still in limbo.

I can see both sides of the argument for this proposal. Going to university is a big financial commitment, which can feel like a massive hurdle, particularly for those from low income backgrounds. If we want to say that we encourage social mobility in the UK, then surely something needs to be done about access to higher education.

Earning while you learn seems an obvious answer to that, but it isn’t the only one. Means tested bursaries are one way forward, although those currently available seem unlikely to touch the sides of the cost of living; anyone who has a child will laugh at the idea of a £2,000 annual allowance for childcare while studying, as in many areas that would barely cover two months of full-time nursery. More innovative ideas might include subsidising housing for students, or even reducing or waiving fees for courses that produce the healthcare professionals this country so badly needs.

The argument against pharmacist apprenticeships comes down to quality and reliability. Will such schemes produce pharmacists who are of equal quality to their university educated colleagues? Could they instead reduce the esteem in which the profession is held? Comments on a recent online article would suggest not, with apprenticeships being compared to a “McJob”, apprentice pharmacists being described as a “laughing stock” and the idea being called a “dumbing down” of the profession. My colleagues in medicine have similar concerns about the apprenticeship route to being a doctor.

It remains to be seen whether this scheme will practically get off the ground. The recovery from COVID-19 is going to take such a long time that maybe no-one will have the headspace for such a massive change to training programmes. If the proposal does go forward, then surely the changes will need to bring the existing workforce along with them to ensure confidence in apprenticed healthcare professionals. At the moment, that would seem like a big hill to be climbed.

Toni Hazell is a GP based in a practice in London

11 Comments

William Johnson,

In the sixties I was in the last year of the old PhC "apprenticeship" course at Liverpool, where you could do the practical year either before college or afterwards. I did it before, with Boots, and it helped enormously at college as I knew what pharmacy actually entailed. In practical dispensing I always finished long before the others and usually left to go to the cinema.

R A, Community pharmacist

Apprenticeships only work when you have a respectable body that regulates the training standard, an actual demand at reasonable wage exists for the trade and employers commited to take on apprentice.

Now in the Victorian era the trade body regulated the profession to maintain standard but protect the livelihood of individuals. Apprenticeships worked in the past because we did not have multiples. People either bought ownership of existing business or built a new business from scratch.

Unfortunately Pharmacy is going extinct and remaining operators are multiples who do not care. This will end up in tears. 

M. Rx(n), Student

To stop this in its tracks is why I've gone with the first-year MPharm "technician" angle.

It also means an organic supply of technicians to steadily shore up the Profession itself and an arrest of Pharmacists qualifying and then wanting to be discount doctors.

Paul Dishman, Pharmaceutical Adviser

Having an apprenticeship scheme in pharmacy in the 21st century is a joke, and a sick one at that. Cheap labour for the multiples with the approval of senior DoH officials, none of who have the professions interests at heart. The idea should be strangled at birth.

mark straughton, Pharmaceutical Adviser

I don't see the problem with the idea of apprenticeships in Pharmacy. It works in engineering in which students can apply for memebership to the Engineering Council and provide evidence to support a portfolio for admission. This can be up to a level 7 (Masters). Indeed, often they're required to attend university and complete modules. 

The apprenticeship aspect mostly focuses on the levy and the funding involved.

I think it's the pride and ego of pharmacy that's the problem here, and the reputation of apprenticeships from many decades ago.

Kevin Western, Community pharmacist

Or it could just be a deeply placed mistrust of the motives of the people pushing the idea, generally with a long established track record of running down the role, importance and even necessity of Pharmacists in a Pharmacy.
Given a properly structured, in depth course and payment for teaching it, and extra resources to do it , I'm sure it's doable but it isn't going to be like training a counter.
assistant. If the proper resources were to be put in, and the training course we're good enough, then I suspect the option would disappear as too costly, what they are relying on is replacing an existing staff member with a trainee, paying the tutor pharmacist nothing or peanuts with no extra cover to do the reaching and a quick and easy course like the current tech course. High on bumpf low in content.
Now that will have them rubbing their hands!

mark straughton, Pharmaceutical Adviser

Because you mistrust the motives is not a reason to dismiss the idea and any benefits to students and the wider public.

A 4th year pharmacy student who has only had maybe a summer placement in community, for example, who at one moment is writing a research dissertation on colloidial dispersions is not ready to be thrusted as an RP in a 10000 item community pharmacy.

Kevin Western, Community pharmacist

I wasn't aware that I had dismissed it, simply pointed out the likely direction of travel, the motives and why it would probably end up being unsatisfactory.
Do Pharmaceutical advisors have egos?
Maybe not!

M. Rx(n), Student

It is absolutely fine to dismiss it and then some, Kevin!

Anyone with a working head on their shoulders could see this gambit for what it is.....from a mile out.

But don't worry, it's all about"modernising" Pharmacy. What's more, Pharmacists don't want to be Pharmacists, and they abdicate their responsibilities to "technicians" and ex-chainstore managers who weren't stupid enough to spend all that time studying and passing tall exams and training, and who end up even getting assigned as line managers of Pharmacists.

I bet the bureaucrats don't even believe how easy it's been for Pharmacists themselves to come crawling over with the keys to the locks.

I remember many years ago attending a "Pharmacy Managers" meeting with my tutor and the area manager (who, to be fair to him, realised his limits) having co-opted a painfully ambitious young Pharmacist to lecture the other Pharmacists on "stuff". Shakespearean!

Pear Tree, Community pharmacist

You've pretty much summarized this debate. 

M. Rx(n), Student

Hmmm...the very notion lacks any rigour.

By the very nature of the Profession, a Pharmacist, in their practice, must be free of any undue influences. So how does the apprentice, over the course of a 5-year (?) apprenticeship, develop such a free-thinking ethos?

Rather than be cynical, I'll offer an alternative in keeping with the fundamentals of the Profession: each student must complete a fast-track 'technician' program within the first year of Pharmacy education and accrue a certain number of hours of 'technician' practice over the following years of education -- culminating in the final Pre-registration Pharmacist training.

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