Half of pharmacists unable to support new independent prescriber graduates, survey finds

Almost half (47%) of pharmacists say they would be unable to support a new prescriber when they qualify next year, a survey by The Pharmacist has found.

The poll of 329 pharmacists revealed that, of those who could not support a newly qualified pharmacist with independent prescribing status, 41% said they don’t feel they have sufficient experience themselves, and 36% said they don’t have the time. One quarter (23%) said there is inadequate funding available.

Reshma Ravindran, a clinical rotational pharmacist at East Surrey Hospital, said that until she has completed the independent prescribing course herself and gained sufficient prescribing experience, she would be inadequately prepared to support a graduate.

‘I've been qualified almost five years and I'm not sure I'd be confident to prescribe right now post-IP. I definitely wouldn't be confident to prescribe straight out of university,’ she said.

‘The newly qualified pharmacists coming out of university as IPs will require a lot of training before they are allowed to prescribe, I think.’

She added that more experienced pharmacists with independent prescribing status are needed to be able to support graduate prescribers and ensure safety in prescribing.

‘We still have to have the minimum two years of working experience to do the course and they will be prescribing fresh out of university. Lots of measures need to be put in place to prevent errors.’

A superintendent community pharmacist based in East Sussex echoed this point and questioned whether new prescribers fresh out of university would have the skill to be able to prescribe straight away.

‘A few years ago, I was a newly qualified IP but with 15 years’ community experience to draw upon,’ he said. ‘I would have concerns about the transfer of knowledge from classroom to the hands-on experience that you only gain in the job role.’

He added that dedicated funding streams to enable pharmacies to support placements for newly qualified prescribers would be required ‘so we can work shoulder to shoulder, building their experience and knowledge in a safe way’.

The survey follows changes to pharmacy education from 2021, which now includes independent prescribing. The first cohort of newly registered independent prescribing pharmacists will qualify next year.

In August 2023, the government launched a pathfinder project to test how different models of pharmacist independent prescribing could work, and made available a share of £12m funding for up to 210 community pharmacies.

A year later, NHS England rolled out a system enabling pathfinders to ‘start delivering their clinical services’, including giving community pharmacists the ability to generate prescriptions.

By May, the community pharmacist prescribing pathfinders had delivered more than 17,000 consultations, with more than 600 medicines stopped, 2,000 changed, and more than 800 new medicines started.

Without the community pharmacist prescribing pathfinders, these would all have needed a referral from a GP.

Respondents to The Pharmacist’s recent survey were broadly in favour of newly qualified pharmacists being able to prescribe, with 55% saying they agree strongly or somewhat with the changes.

One pharmacist said: ‘I 100% believe the new [prescribing] pharmacists can add value. It has the potential to allow patients quicker access to essential care and will improve patient quality of life.’

Another added: ‘I think it’s a good thing that they are getting the training alongside their degree, but I think it’s unfair on previous graduates who have to pay extra for it.’

A recently retired pharmacist who had practised in Brighton said that, although newly qualified independent prescribing pharmacists can add value, there needs to be more ‘good role models’ to support them.

‘I learnt all my prescribing skills and ethics from my boss in my one-year training placement during my degree in Switzerland, where prescribing is a normal role of the pharmacist,’ she commented.

‘We are missing the experienced pharmacy prescribers as role models, particularly in community where prescribing is desperately needed.

‘The profession is trying to create these practitioners, but it will take time, and we need to ensure that our new prescribers understand clearly the ethical remit and have the confidence to take on the responsibility including risks of prescribing.’

Matthew Upward, an advanced specialist aseptic services pharmacist, is unable to support a newly qualified prescriber because of the nature of his job, but he believes there is a use for them.

He pointed out, however, that increasing the focus on pharmacists having the scope to prescribe could mean fewer pharmacists going into non-clinical specialisms.

‘I have no problem per-se with prescribing pharmacists, as long as there are sufficient “pharmacist pharmacists” left to undergo the clinical check of that prescription,’ he said.

‘As a passionate technical services pharmacist I see my sector as more under threat, not from prescribing pharmacists, but from the lack of exposure that pharmacy students, foundation pharmacists and then junior pharmacists get to this vital aspect of pharmacy.

‘With all new pharmacists inevitably going into clinical roles – they’ll have to or their prescribing qualification will be wasted – there will be no pharmacists to fill roles such as mine.’

One-third (33%) of pharmacists answering the survey said they do not agree that all new graduates should be independent prescribers – 18.5% saying the somewhat disagree and 15%, strongly disagree.

Most cited new graduate pharmacists’ lack of real-world experience in the workplace to be able to safely undertake prescribing.

One respondent commented that graduates ‘do not deserve to become IPs until two years after qualifying as a pharmacist’, as is required currently.

‘They are inexperienced and have an unfair advantage when compared to existing pharmacists trying to become IPs.’

Another pharmacist said that newly qualified prescribers were at risk of ‘being taken advantage of’. ‘Whilst it is upskilling pharmacists and allowing an increased scope of resource within healthcare, it is being used to enforce a new baseline of skilled working for lower salaries, undermining the profession,’ they said.

‘Employers are using this to force pharmacists to take on complex and higher-risk prescribing from medics to provide cheaper alternatives at lower salaries, as there are no regulations to ensure fair pay for higher-skilled working.’