Foundation trainees to train in limited clinical areas for independent prescribing

Foundation trainee pharmacists will need to specialise in a clinical area to complete their independent prescribing training from 2025/2026, according to new NHS England guidance.

In ‘Prescribing supervision and assessment in the foundation trainee pharmacist programme from 2025/26‘, published on 12 January 2024, NHS England has set out the requirement for foundation trainees to have a “nominated prescribing area” to complete some prescribing assessment activities and within which they can demonstrate generic prescribing skills.

The guidance is intended to help foundation training sites understand how they need to prepare for the 2025/2026 training year, which is the first year when all newly qualified pharmacists will be independent prescribers at the point of registration.

The guidance says that the nominated prescribing area will ensure that the trainee pharmacists have a focused clinical area that “isn’t too wide or overwhelming”.

“To put it another way, the nominated prescribing area gives the foundation trainee pharmacist a setting in which to demonstrate the generic skills of a prescriber,” it adds.

The nominated prescribing area will not limit the future scope of practice for the foundation trainee pharmacist and a pharmacist prescriber can develop and widen their scope of practice when registered, supporting this with effective CPD, the guidance states.

NHS England’s guidance does not specify a list of nominated prescribing areas for a foundation trainee pharmacist in the foundation training year, but it says that the nominated prescribing area must be:

• A clinical area relating to the provision of healthcare (i.e. it cannot be a non-healthcare area such as aesthetics);
• An area that the trainee’s designated prescribing practitioner (DPP) is sufficiently knowledgeable, skilled and experienced to supervise;
• An area within which the foundation trainee pharmacist is able to access patients with whom they can conduct consultations and complete the prescribing assessment activities with.

Commenting on the guidance, Graham Stretch, president of the Primary Care Pharmacy Association, told The Pharmaceutical Journal that limiting trainees to a specific scope of practice could “make it hard to deploy them in general practice”.

“I think that we need to turn the guidance on its head and concentrate on providing a baseline of generic skills to be a prescriber,” he added.

“What we should be doing is providing general training so people know how to monitor medicines appropriately and then allow specialisms that can be expanded upon as they get more experience.”

Responding to publication of the new guidance, Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, told The Pharmaceutical Journal that the increase in clinical services being provided by community pharmacies and the start of the Pharmacy First service would allow foundation trainees “to develop many of the prescribing-related skills, including history taking, physical examinations and consultation skills”.

“Whilst we recognise these changes are happening at pace and causing concern across all training sectors, including hospital and general practice, this guidance around prescribing assessment activities clearly demonstrates that many of the prescribing competencies can be met in a community pharmacy setting,” she said.

At the Pharmacy Show, held at the NEC in Birmingham, West Midlands, in October 2023, Atif Shamim, pharmacy dean at NHS England, announced that employers wishing to take on a pharmacist trainee in 2025/2026 would need to confirm that they can provide access to a DPP and a “prescribing learning setting” by March 2024.

Speaking at the same session, Nick Haddington, pharmacy dean for south west England at NHS England’s workforce, training and education directorate, announced that DPPs would no longer be required to have three years’ experience in prescribing.