The requirement for foundation trainee pharmacists to have a ‘nominated prescribing area’ has raised questions among the sector about what this could consist of, as well as fresh concerns about the capacity of the profession to supervise them.

NHS England (NHSE) guidance released this month asks pharmacists undertaking their foundation year from 2025/26 to demonstrate their prescribing competence within a specific area.

A ‘nominated prescribing area’ could include the ongoing management of an existing condition, for instance in a general practice clinic, or medicines optimisation in another setting, NHS England suggested.

And it does not need to be an area in which the trainee pharmacist is actively diagnosing a ‘new’ or undifferentiated condition, NHSE said in its guidance.

The nominated area does will need to be an area in which their designated prescribing practitioner (DPP) is ‘sufficiently knowledgeable, skilled, and experienced to supervise within’.

And the trainee pharmacist must have access to patients within this area, under supervision, in order to conduct consultations and complete prescribing assessment activities.

NHSE said that trainees undertaking their foundation year in 2025/26 will be required to complete ‘some of the Prescribing Assessment Activities, specifically those that require a prescribing consultation with decision making to be demonstrated’ within their nominated prescribing area.

It said: ‘This is so that the trainee pharmacist has a sufficiently focussed area that isn’t too wide or overwhelming.’

But it added that the nominated prescribing area ‘will not limit the future scope of practice for the foundation trainee pharmacist’.

General practice pharmacist Siddiqur Rahman asked in a post on X (formerly known as Twitter): ‘Are there enough DPPs with a specific specialism?’

He added: ‘There’s already shortage of DPPs availability especially in community pharmacies and now they have to be specific to match the specialist scope of practice of the foundation year.’

But another practice pharmacist noted in response that this could be an area which a pharmacist prescriber already works in, such as hypertension, type 2 diabetes, asthma, heart failure, COPD or lipid modification.

Also commenting on the guidance on X, primary care lead at the Guild of Healthcare Pharmacists Laura Buckley said that consideration needed to be given as to how this requirement would be delivered ‘across settings, trainee preference, and DPP areas of competence’.

She added that ‘some clarity’ was needed, and said it ‘feels a bit like we are wading through treacle with realising this properly’.

Along with other pharmacists on X, Ms Buckley also suggested that training foundation year pharmacists in primary care as generalists would be more useful.

Another X user stressed pharmacists’ role as experts in understanding a wide range of medications.

She wrote on X: ‘When patients stop being complex and stop having problems that are “wide and overwhelming” we can stop being generalists. We are often the only professional who knows all the medicines they are on from multiple prescribers.’

But another pharmacist on the platform suggested that the requirement was necessary in order to ensure adequate assessment of trainees.

‘The tutor/DPP need to see they are competent to prescribe,’ they wrote on X, adding: ‘I'm a oncology specialist so would struggle to know if guidelines in asthma or diabetes are being followed’.