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The current cohort of trainee pharmacists are now well into their pharmacy foundation training year, which replaced the former pre-registration year as part of major reforms to the initial education and training of pharmacists.
Although headline changes such as integrated independent prescriber training will be introduced gradually, pharmacy owners, supervisors and trainee pharmacists have been getting to grips with the different requirements since the GPhC published a revised set of standards for the initial education and training of pharmacists in January 2021.
Perhaps reassuringly for trainee pharmacists and their employers, there was little immediate change. In the main, the foundation year uses the same progress reports and assessment summaries that were in place for previous pre-registration trainees. Neither do any previously approved training plans need to be immediately replaced. Instead, new interim learning outcomes from the GPhC and, in England, Health Education England supports the assessment of trainees against these markers. There’s no need to panic.
“The hardest part is learning the new terminology!” says Babir Malik, foundation and pharmacy student training lead at Weldricks Pharmacy, who is responsible for interviewing and placing trainee pharmacists across the group’s 60 branches. “But in essence it is still one year of training before registration – it has just had a name change. The tutors are now called supervisors and the pre-regs are trainee pharmacists, while performance standards have become learning outcomes.”
New standards
The new standards for education and training leading to registration came into force in October 2021. Interim learning outcomes bridge the gap between the old performance standards and the introduction of new learning outcomes that will run across years one to five of pharmacist undergraduate and pre-registration training in England, Scotland and Wales.
It is important to note that this is just the first step in a five-year phased plan that will ultimately introduce new learning outcomes for the education and training of all new pharmacists, and for those who supervise and educate them – whether they are supervisors in a pharmacy or those responsible for the MPharm degree at the various schools of pharmacy.
A key distinction between the old and new education and training standards is the inclusion of those relating to pharmacist independent prescribing, a major step forward for the profession. However, the GPhC recognises that these cannot be introduced immediately and instead will be implemented over time for both trainees and existing pharmacists.
Nevertheless, prescribing is becoming an essential clinical skill for pharmacists and this is why, after extensive discussions with the statutory education bodies (SEBs), schools of pharmacy, employers and other stakeholders, the GPhC will include the requirement for independent prescribing in later iterations of the transitional learning outcomes.
Why change?
It has been over ten years since the last set of standards for pharmacist education and training were introduced and it goes without saying that a lot has happened in pharmacy and, indeed, the health service since then. The new standards document from the GPhC explains that both the NHS and the society that pharmacy serves have changed considerably in recent times, and that the educational standards for pharmacists need to reflect this.
Citing factors like increasing life expectancy, polypharmacy and the integration of health and social care in the UK, the regulator says that this calls for a more person-centred approach when training pharmacists of the future.
The revised standards document specifically cites “ambitious healthcare strategies in Great Britain and Northern Ireland” and points out that “all of these refer to the role pharmacists and pharmacies can play in bringing about change, and the skills they will need to do this – including prescribing.”
The Covid-19 pandemic only served to emphasise the need for these reforms, says the GPhC, adding: “The global pandemic highlighted why these changes are so important and need to be brought in quickly. We need to make sure future pharmacists have the necessary skills and knowledge to play a bigger part in delivering care to patients and members of the public.”
“Shared decision making will provide better outcomes and is more realistic of current training sites, where trainees can have healthcare professionals other than their designated supervisor involved in their training”
Foundation year: the key elements
First, let’s consider what has stayed the same from the old system. Pharmacy students will still study for four years at university on the MPharm course and spend a year gaining experience in practice before they register as a pharmacist. So no surprises there.
However, the new learning outcomes will cover the full five years of a pharmacist’s training, from their first day at university, through to the GPhC registration assessment. Many of the changes are actually more applicable to those responsible for delivering the education and training, rather than the trainees receiving it.
To reflect this, the learning outcomes are split into two. There are those for trainee pharmacists, and also for the tutors teaching and supervising them.
Pharmacy foundation year trainees will now have more than one person signing them off at the end of their pre-registration experience. The final declaration must include confirmation that the views of a named second registrant or other healthcare professional have been obtained before sign-off at the end of the training year.
Noma Al-Ahmad, a visiting lecturer at King’s College London and managing director of ProPharmace, which delivers training for foundation year pharmacists, thinks this is a positive move. “This shared decision making will provide a better outcome and is more realistic of current training sites, where trainees can have healthcare professionals other than their designated supervisor involved in their training,” she says.
The changes make the four-year degree course and one year of foundation training more flexible in approach, but with clear learning outcomes for the full five years of training. It is expected that the schools of pharmacy and statutory education bodies will play more of a role in setting standards and supporting foundation trainee placements alongside employers.
Standard 9.5 states, for example, that all supervisors must be trained and appropriately overseen to act in this capacity and that they are competent to assess trainees. However, there still appears to be a degree of variability in the quality of supervision that foundation trainees receive.
Al-Ahmad says: “Unfortunately there are designated supervisors currently undertaking this role without the necessary skills to carry it out effectively, which is one of the reasons why we see a huge disparity in training between various sites. Although the GPhC does not accredit supervisor training programmes, the message needs to be consistent with the new standards – namely, that proper supervisor training is essential to enable them to develop those skills.” In addition, supervisors need to be supported and resourced to carry out their roles effectively, she adds.
Independent prescribing
As already mentioned, the biggest change in the standards concerns the introduction of pharmacist independent prescribing. While details regarding timings and funding for prescriber training placements are yet to be finalised, the aim is to have all pharmacy graduates trained as independent prescribers by 2026/27. Prescriber training will take place across 90 hours of the foundation training year, but related skills will be taught throughout the entire five-year training period.
One of the biggest challenges is that relatively few current supervisors or even existing pharmacists are qualified and practising independent prescribers, so are currently unable to deliver this training. Most of the prescriber training will need to be delivered instead by local GPs, which poses logistical and financial challenges.
Babir Malik says he is concerned that some pharmacies may initially struggle to sort out GP placements for their foundation trainees to do this. “It is going to be hard for pharmacies across the country to arrange 90 hours of supervised practice for their trainees in general practice,” he believes.
Health Education England will need to be involved as well, says Malik, as some GP practices will not take part unless they are remunerated. “A lot of community pharmacists may need help to arrange these placements.”
It should also be noted that England, Scotland and Wales are at different points in their pharmacist independent prescriber journey, including having the necessary training requirements in place. However, everyone is working towards a common prescribing goal.
Scotland and Wales are further advanced, where work has already been done on achieving closer integration and connections between the foundation year and the MPharm degree. This is easier to do when working with different stakeholders in a smaller geographical area, with a clearer focus on clinical placements.
Having said that, more details are emerging about funding for independent prescriber training in England through the Pharmacy Integration Programme.
It is hoped that the financial arrangements will eventually include a tariff that would part-fund some of that educational supervision. In England there is a tariff that is associated with non-medical placements and pharmacy is not included in that scheme at the moment, although this may change in the future. Additional funding is also needed to get the right infrastructure and support in place.
A spokesperson for the GPhC said: ‘‘[We] will engage with the statutory education bodies through an accreditation process, so it can be assured that there is sufficient capacity of independent prescribers in the system who can act as designated prescribing practitioners for trainees to ensure that independent prescribing can be delivered as part of [pharmacists’] foundation training.”
Identify knowledge gaps
Pharmacist trainees taking up placements this year at least won’t – hopefully – have their foundation training year disrupted due to Covid. However, as with any unexpected event, it is important to spend some time thinking about how it might affect your learning and to identify any gaps in your knowledge as a result.
Make sure you have an open discussion with your designated supervisor about whether you have any learning gaps you want to address during your training year. If you talk about it as soon as you can, it is easier to plan things in than if you identify any gaps later on. Don’t sit on things. Be proactive.
Get off to a good start
Foundation year pharmacists need to get off to a good start by making sure everybody in their organisation knows who they are because of the name changes. “For 30-odd years it has been ‘pre-reg pharmacist’, so when you say ‘trainee pharmacist’ you might need to remind people what that means,” warns Babir Malik.
He also suggests quickly getting to grips with the practical requirements of the foundation year. “Speak to your supervisor about how they want your evidence submissions,” he advises.
“A lot of trainees use the online e-portfolio from the Royal Pharmaceutical Society. Prior to this, trainees often used to record their evidence in hard copy form unless their employer had a specific recording platform. It is not compulsory yet to use the RPS platform but it might be in the future, which would mean all trainees recording their evidence using the same platform.”
Malik is also keen to reassure this year’s cohort of trainee pharmacists that, like last year, they shouldn’t worry about being ‘guinea pigs’ for the new arrangements. “Many aspects of the year’s experience are very similar to before. Mainly it is just the names that have changed,” he emphasises.
Foundation year trainee pharmacists should also take heart in the fact that they are among the first cohorts to be following the new standards and so there is plenty of support available. They only have to ask for it. Buddying up with a mentor who has recently completed their own foundation training year is also a really good idea.
Conclusion
In summary, the foundation training year replaced the pre-registration year from July 2021. Pre-registration trainees are now known as trainee pharmacists and tutors are called designated supervisors. Learning outcomes replaced performance standards. These changes are part of the implementation programme for the new standards for the initial education and training of pharmacists published by the GPhC in 2021.
All training delivered for 2022/23 is based on the new interim learning outcomes, but these will not require individuals to train as independent prescribers during their foundation training year. The requirements for prescriber training after 2023 have yet to be finalised.
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In Learning
This is your ultimate guide to pharmacy learning. Here you can find modules, articles, scenarios and more to improve your knowledge and support your learning in the pharmacy.