Former chief pharmaceutical officer (CPhO) for England Keith Ridge has questioned whether the current model of training independent prescribers is fit for purpose, as increasing numbers of pharmacists look to pursue the qualification.
Currently, each trainee prescriber must be supervised by a Designated Prescribing Practitioner (DPP), with all foundation year trainees requiring a prescribing placement from 2025, plus many within the existing workforce also looking to upskill as independent prescribers (IPs).
During a panel discussion at the Royal Pharmaceutical Society (RPS) Annual Conference last week, pharmacists and clinicians from various settings questioned whether the current DPP model of training was feasible, highlighting issues of capacity among prescribers and training providers.
While as CPhO Mr Ridge had a vision to develop pharmacists' clinical skills he said, as an audience member at the conference, that he was ‘surprised we’re still even talking about DPPs’.
He said that his vision had been that the pharmacy undergraduate course would change such that pharmacist trainees would undertake a prescribing skills assessment similar to that undertaken by medics, ‘and that the need for DPPs would go completely’.
And he suggested that this model of training and assessment could be possible in the future.
Mr Ridge also commented that there was a need to be ‘clear’ about ‘what the HEIs [higher education institutions] have to deliver in order to [make] their proper contribution to this, and not, just, if I might be a bit controversial, washing their hands of the responsibility that comes with producing a different source of clinician’.
His comments followed a panel discussion between MPharm programme director and associate professor of pharmacy at Swansea University Dr Amira Guirguis; North East London ICS chief pharmacist Dr Raliat Onatade; community pharmacist IP and owner Catriona Sinclair; GP Dr Lawrence Brad and University College London (UCL) lecturer and prescribing integration project manager at the Lewisham and Greenwich NHS Foundation Trust William Swain.
The panellists highlighted issues within the current system such as a lack of capacity for existing prescribers, including those from other professions, to supervise the new influx of pharmacy trainees.
Dr Onatade questioned whether the 1:1 model of supervision was the right approach.
Instead of trying to increase the number of DPPs, she suggested that a better approach was to ask how best to train people to be ‘competent and safe’.
And she agreed with Mr Ridge that HEIs ‘do need to step up’ regarding prescribing training.
But Ms Sinclair noted that even if the undergraduate course changed, DPPs would still be required to train those within the existing profession who wanted to become IPs.
As a community pharmacist in a rural part of Scotland, Ms Sinclair noted that it was not always feasible for trainees to work directly alongside their DPP.
Instead, she suggested that effective supervision was about the ‘quality of conversation’, being able to ‘deep dive into the work they’re producing’ and being able to ‘challenge what they're writing’.
And she said that despite the challenges of working out how to supervise a trainee, she had found being a DPP ‘rewarding’ and ‘good to do’.
Dr Guirguis highlighted the value of the Welsh model, which trains students to be ready to take on ‘entrustable professional activities’ as a trainee.
‘As long as we have support mechanisms in place to support them in their first two years of prescribing, I think that will go very well,’ she suggested.
But she highlighted challenges when a DPP did not have expertise in the same area that a trainee wanted to train in, or was only able to train a student in specialist rather than generalist skills.
Mr Swain suggested that it would be useful to ‘move the conversation on’ from ‘silly conversations about scope of practice’.
While he said this may be useful where a pharmacist was delivering a specific service autonomously or semi-autonomously, he suggested: ‘If we're talking about thousands and thousands of people coming through a process at foundation level, where they've done a course that builds up these general skills around communication, and assessing patients and history taking, actually, we need to look at the medical model, where they come into the workplace and they're effectively been able to then work as part of team to come up with a decision collaboratively.
‘And then they can go and do the bit of the management plan that says go and prescribe this.’
He added that that would be where legal changes around prescribing would be ‘very useful’.
‘This idea of having very specific training just on prescribing as a concept is … perhaps not the best way to go in the long term,’ Mr Swain suggested.
And he suggested that the profession needed to come up with an idea of what should be expected from a pharmacist prescriber at a foundation level, which he suggested would make it easier to recruit existing prescribers as DPPs.
‘Then you know what you're trying to produce, once you know what you're trying to produce, you build the experience, once you build experience, you know what supervision looks like,’ he said.