Pharmacist Independent Prescribers

1.1 Patients should benefit from access to PIPs in their communities. Structured services need to be in place to enable PIPs to have the capacity to fully utilise their skills depending on the needs of their population.

As community pharmacy practice evolves, the number of patient facing services available continues to increase. A commitment to making community pharmacy the first point of contact for people with common ailments has increased the opportunities for patients to access medicines and advice throughout Great Britain; the introduction of common/minor ailment services has supported this commitment.

A community pharmacist with an IP qualification can deliver beyond a common/ minor ailment service, managing an extended range of common and long term conditions. For example, they could help people access treatment and expertise in a timely manner whilst also supporting the capacity of local GP practices.

1.2 Workforce planning must take into account the new and emerging roles of PIPs. More resources are required for the existing pharmacist workforce to undertake advanced clinical skills training and qualify as PIPs.

Over 1 billion prescription items are written each year in primary care in Great Britain.8 The vast majority are written by GPs. As pharmacists take on ever more clinical roles, the pharmacy workforce will need the right skills to meet these challenges.

Whilst not all existing pharmacists will need to become prescribers, the opportunity should be available to all. For existing pharmacists, accreditation of prior learning, for example, their portfolio, showing completion of the RPS Advanced Practice Framework, should provide evidence of suitability to embark on IP training. Ongoing funding will be essential to ensure wider access to the nonmedical prescribing course for pharmacists. Employers and the NHS will need to resource backfill and protected learning time.

1.3 In the interest of delivering high quality, safe and effective patient care, all PIPs must be able to have appropriate access and be able to input into the patient health record.

Access to relevant sections of the patient health record, including medical history and laboratory test results, will allow pharmacists to make more informed clinical decisions on the use of medicines in partnership with patients and other health and social care professionals. This will support improvements in the safe and effective treatment of individual patients and help the NHS to secure best value from the significant investment it makes in medicines.

All pharmacists, directly involved in providing patient care, must have access to appropriate IT systems that are interoperable with other primary and secondary care IT systems. In order to optimise the use of medicines and deliver more integrated patient care, the ability to access and share essential patient information electronically will reduce risk and improve patient safety across all care sectors.

2. Develop a clear pathway for pharmacists to become qualified PIPs.

Pharmacists’ unique clinical and scientific training in all aspects of medicines and their use equips them to treat people holistically. The pharmacist’s skills are a vital component of healthcare delivery, ensuring new medicines are compatible with existing patient treatment plans, and that inappropriate polypharmacy is avoided. As part of a multidisciplinary approach to care, PIPs can optimise patient medication regimens to ensure the appropriate medicines are used to best effect. This includes de-prescribing and non-pharmacological treatment options for patients.

In order to qualify as an IP, pharmacists must successfully complete a General Pharmaceutical Council (GPhC) accredited IP programme operated by an accredited training institution. Pharmacists must meet the GPhC entry requirements⁹ which include: identifying an area of clinical practice in which to develop their prescribing skills, having clinical or therapeutic knowledge relevant to their intended area of prescribing practice, identifying a supervisor to supervise their learning in practice and sign off on their competency. Finding a suitable practitioner for this role can be problematic and can cause difficulties in eligibility for courses, limiting the entrance numbers.

Once they have demonstrated that they have the knowledge, skills and attributes required of an independent prescriber, they are awarded a practice certificate in independent prescribing which makes them eligible to apply for annotation on the GPhC register.

Expanding the number of PIPs who see patients in a range of care settings, taking responsibility and accountability for their pharmaceutical care, is one way to improve patient access to healthcare. This is already happening in some areas but only 7% of pharmacists were registered as PIPs on the GPhC register in 2015.¹⁰

It is clear that more still needs to be done if we are to have PIPs working universally across Great Britain.

2.1 The underpinning knowledge base for IP must be included in the MPharm undergraduate degree and pre-registration training year.

With healthcare changing and evolving over time there is a requirement for the five year masters level training of undergraduates and pre-registration trainees, which enables individuals to enter into the pharmacy profession, to be continually reviewed and revised to ensure that newly qualified pharmacists are fit to practice in the NHS of today. The underpinning skills and knowledge needed for new roles are incorporated into teaching, learning and assessment. It is therefore logical that the core content of the IP course be incorporated into the MPharm curriculum.

2.2 Pharmacists applying to undertake an IP programme should already have completed the RPS Foundation framework to assess clinical competency.

It is recognised that post registration experience is essential for pharmacists to apply the knowledge and skills they have acquired during their undergraduate and pre-registration education. The behaviours and competence they need to demonstrate during this post registration period can be gained during their Foundation training years where core skills around consultations, clinical assessment, clinical decision making and therapeutic management should be further enhanced and demonstrated, in line with the RPS Foundation Framework¹¹ and under the guidance of a tutor.

All newly qualified pharmacists should have access to Foundation training to enable, guide and quality assure their professional development during their early career. Rather than focusing on a set amount of time before undertaking a prescribing course we believe the focus should be on identifying the right knowledge, skills, experience and level of competence that the individual can work towards during their Foundation training, using the RPS Foundation Framework and then consolidating this post-Foundation training using the Prescribing Competency Framework.¹²

2.3 Experienced non-medical prescribers must be able to fulfil the role of designated practitioner as part of a multidisciplinary team (MDT) approach.

PIPs, like other prescribers, will prescribe within their areas of competence in line with the competency framework for all prescribers. It is important that trainees have access to a suitable prescribing supervisor and therefore regulations should be changed so that the designated prescribing practitioner could be either a medical or non-medical prescriber provided they have the necessary skills and experience. Having a larger number of designated clinical practitioners available would ensure there is an improved supply of IPs.

Ideally the prescribing supervisor should have experience of working in a similar area of practice to that of the PIP in training. It is important however that PIPs have opportunities to develop generalist prescribing competence as well as specialising in a clinical area as it is vital to be able to consider the patients’ needs holistically in practice.

Designated supervision rights for pharmacists would provide additional capacity for more pharmacists to become prescribers. We believe that an increase in the number of pharmacist prescribers is essential to enable pharmacists to contribute more actively, achieving positive patient outcomes, particularly for those individuals with long term conditions.

Additional investment may also be required to support the ongoing development of current PIPs to ensure they are equipped to undertake the role of a designated clinical practitioner for pharmacists and possibly other health care professionals.

2.4. Pharmacists should also receive training and mentoring from medical colleagues and the wider MDT to benefit from a range of professional skills and knowledge.

PIPs in training must continue to have the opportunity to work alongside medical and other healthcare practitioners, particularly when the final sign off for an individual is by a non-medical prescriber. The prescribing supervisor should demonstrate an understanding of and competency in educational supervision to ensure patient safety. In addition, we advocate that trainees should have as much opportunity as possible to gain experience working as a ‘prescriber in training’ within a multidisciplinary team.