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Xrayser assesses the ‘unsuitable’ GPhC pre-reg exam questions

"The pre-registration exam questions seem to reflect life in community pharmacy perfectly"

Was June’s pre-reg assessment really as hard as some students claim? Xrayser dives into the exam to find out

Over the weekend I read the C+D article about the petition protesting the “unsuitable” June pre-registration exam, which apparently has received more than 900 signatures. Can that really be right? I had to have a look at the question paper myself to find out:

Question 1: You are considering buying a community pharmacy business. Describe the clinical governance and due diligence enquiries you would make to assess its appropriateness.

This is obviously inappropriate. The only way a pre-reg would be able to buy a pharmacy business these days would be if they won the Euromillions lottery or if a relative bequeathed it to them in their will.

Question 2: You are the responsible pharmacist in an average dispensary doing 7,500 items a month. Other than actual dispensing, list the weekly and monthly activities your three dispensers would do to satisfy the General Pharmaceutical Council (GPhC) inspection requirements.

There are a number of problems with this question. Firstly, there’s no way your company would justify three dispensers for that size of business. Secondly, no one would have time to do anything other than dispensing, so you have to pray that you’re given the six weeks’ notice of the inspection so can cram all of the writing of SOPs and governance documents into that time.

Question 3: You receive a prescription for chloramphenicol eye drops and mercaptopurine for an asplenic eight-year-old child with purpura and gluten enteropathy. What is the concentration of mercaptopurine in a solution prepared by mixing 800ml of 40% w/v and 250ml of 30% w/v that would be suitable for this patient?

A perfect question to prepare candidates for the impossible situations they will face in community pharmacy, where we rarely have enough time, enough information, enough support staff, or access to enough online resources. It is also typical of Centre for Pharmacy Postgraduate Education (CPPE) questions, where if you got this one wrong the CPPE “helpful hint” would be: “You achieved 40% in this attempt – try answering the questions more phlegmatically.”

Question 4: List the names and roles of all staff in the local hospital pharmacy department. Grade their abilities with respect to discharge competence, their experience with biologicals, who is most influential on the drug interface group, and what they had for lunch.

This is a perfect example of a community pre-reg student question, as it introduces you to the meaningless priorities of secondary care. You can get extra marks if you present all this information on one sheet of A4 paper and label it “plan on a page”.

Question 5: Your NHS England region drugs budget is £192 million overspent. This equates to an £82,000 cut in prescribing costs for each GP practice. Assuming your clinical commissioning group has already banned scripts for gluten-free products and hayfever remedies, rank the following in order of priority to be cut:

a) broad-spectrum antibiotics

b) emergency hormonal contraception

c) public swimming baths

d) community pharmacy.

Nb. Any answer that didn’t put community pharmacy as the next priority for spending cuts would be an automatic fail.

There you are – these questions seem to reflect life in community pharmacy perfectly, so I honestly don’t know what the students are protesting about.


Adam Miller, Pre-reg Pharmacist

Wrong. I sat the exam in June and none of the above questions were on the paper. I'd love to know which clown was C+D's source on this one.

C A, Community pharmacist

Adam apparently wit, sarcasm and a dry sense of humour were also deemed unsuitable for the syllabus...

Uma Patel, Community pharmacist

Adam in 5 years time you will be the clown asking those questions

Adam, are you seriously saying you didn't realise this was written tongue-in-cheek?

Maybe stick to reading the red tops for now.

Angela Channing, Community pharmacist

I think you mean The Guardian!  lol   paper of the snowflakes and the public sector



J J, Pre-reg Pharmacist

@Adam This is satire. None of those questions were on the exam because hes making the point that, even if the questions reflected real practce, the answers would still all be wrong. I'd like to think any pharmacist that has sat the pre-reg exam would also remember it was MCQ, so none of these could have been in it.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Adam, when you sit an exam, don't you think your job is to answer the questions to the best of your knowledge? If you can't give satisfactory answers, it is usually called 'fail', and not 'the questions are wrong'. Are you aware of this convention? Are you one of those who signed the petition?

Adam Miller, Pre-reg Pharmacist

No, I didn't sign the petition. Less than a third of the candidates signed it. I actually thought the clinical questions on the whole were fair. The only unfair part of the exam were the calculations on the clinical paper. Having to multiply 3.2 x 70 and then divide the answer by 15 can be quite difficult to do without a calculator in a minute. There were around 5 or 6 of questions of this style. They took around 3 or 4 minutes to do each which in turn reduced the time available for other questions. So whilst I don't believe the paper as a whole was unfair I do believe certain elements of it were. There is no real life situation where you would be expected to do such a series of calculations without a calculator.

J J, Pre-reg Pharmacist

@Jonny I sat the exam. I signed the petition. No need to be so patronising to my collegue above - weve been through at least 4 years of exams...we know how they work.

The point is that it wasnt possible to give 'satisfactory' answers - the answer would change depending on how you interpret the question. I could give you an example but I dont want to be accused of 'reproducing exam questions'.

I'm a hospital pre-reg and I put the question to a number of pharmacists and the answer differed between them (as you would expect in real practice). So when answering the question 'to the best of your knowledge' gives you 2 different answers deending on your interpretation (ie, am i in a community pharmacy? Am I recommending this POM or if I put that answer will it be wrong because obviously I cant sell it OTC?) what do you do?

Jonny Johal, Pharmacy Area manager/ Operations Manager

JJ, if you 'know how they work', then what is your beef? What you are saying is the questions are wrong. So typical of some newly qualified pharmacists I came across.

A A, Pre-reg Pharmacist

‘What’s your beef’? Maybe if you took time to read and digest my colleagues reply you would understand what her ‘  beef’ is. And since you want to talk about what’s ‘typical’ of pre reg’s, I’ll tell you what’s typical of you oldies. It’s the constant lack of support and the fear of loosing your jobs to younger, more competent and well rounded pharmacists.

Not-So-Lucky Ex-Locum, Superintendent Pharmacist

There is, in pharmacy, such a thing as 'experience'. That comes with age and is utterly invaluable. Unfortunately, the younger generation seem to think that they know everything straight away. I have been into pharmacies as a customer and on occasion been given totally inappropriate advice from an obviously newly qualified pharmacist who thought they knew it all. Younger pharmacists are NOT more competent nor more well rounded. 

Really? Wow, Superintendent Pharmacist

LOL, that naieveity is the first issue. 

The wisest man of all is the man who knows that he doesn't know everything. 

Keep learning, keep observing, keep picking up things from people that you meet and you will be fine. 

If you keep that attitude, then I am sorry to say that my hopes for you are not so high. 

Best of luck

Stephen B, Manager


Kevin Western, Community pharmacist

i can add another one... how do you get C&D to remember you to save the misbegotten log in process every time... answers on a postcard, I might get to read them...

Leon The Apothecary, Student

Use a password manager.

Kevin Western, Community pharmacist

Superb... paricularly the CPPE one... all absolutely spot on for "pharmacy" today, forget  what its about, get the paperwork right...

Peter Sainsburys, Community pharmacist

These questions just go to show what a complete joke the GPhC has become.

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