How we can move advanced practice credentialing into the mainstream

On 3 September 2024, at the Royal Pharmaceutical Society (RPS) headquarters in London, I chaired a summit of pharmacists drawn from the devolved UK nations, from a range of practice settings, in a unique event that examined the system regarding the current status of advanced practice across the UK.

Advanced practice credentialing is essential for the future of pharmacy. Our expanding scope of practice is exciting and opens a range of opportunities for pharmacists. But, without any increased assurance, it could increase risk to the public. As a profession with a duty to ensure patient safety, and as an important part of the wider health system, we must address this.

At the summit, we heard from colleagues at the Nursing and Midwifery Council concerning their journey so far around the regulation of advanced practice and the call for a cross-regulatory approach. Credentialing, based on standardised, broad and robust curricula and assessment, is vital for assuring the quality of the work that we do at agreed levels as pharmacists for the health system, the public and our patients.

So, it is useful to reflect on the event and the lessons that we can take away from it.

First, we saw that credentialing has strong support from system leaders across the UK. We heard from representatives of the four chief pharmaceutical officers, the devolved health education bodies, regulators and, of course, the RPS as the professional leadership body — all of whom spoke about the need to clearly define and assure advanced practice. Community pharmacy representation was noted as being too low and there is a need to start engagement with public representation in this space. We acknowledged that we were among those who were already convinced of the importance of advanced practice credentialling for pharmacists. Additionally, we agreed that these other views need to be actively sought out by the RPS and representatives in the room to ensure a true picture.

Looking across the four UK nations, there were significant differences in how the devolved health systems are promoting advanced practice credentialing and, importantly, supporting their workforces towards this. The event was a valuable opportunity for the UK countries to be able to learn from each other and hear each other’s challenges and perspectives.

Barriers to the uptake of advanced practice credentialing differ between countries and regions but, throughout the day, we heard several recurring general themes. Funding, unsurprisingly, was mentioned. However, there are other factors preventing pharmacists from feeling empowered to engage with advanced credentialing. The confusing jumble of different post-registration training pathways on offer, a lack of confidence in some areas of practice such as research, a legacy of different interpretations of what advanced practice really means and a clear link to career progression are among many factors resulting in some pharmacists and employers asking themselves: ‘Why should I do this?’

First-hand experience

The answer, to me, was most clearly illustrated when we heard from three pharmacists who recently completed their advanced credentialing. They spoke eloquently about the process and the impact it has had on their practice.

They were candid about the challenges of credentialing: it is time consuming and one can feel exposed when you are asking for feedback from a range of collaborators. You must put yourself out there if you want to show that you are operating at an advanced level. One credentialed advanced practitioner said that nothing you do or have done can be presumed — everything must be documented and evidenced — and presenting evidence of practice in a meaningful way can be hard to master. Nevertheless, it is a skill that all professionals must have, with challenges particularly seen for pharmacists looking to meet the research elements of the curriculum. Overall, the first-time pass rate for advanced credentialing is around 60% at the moment, which rises to 91% on the second attempt.

Despite these challenges, those three pharmacists have gained immensely from undergoing the process, particularly building a reflective portfolio and gaining insightful feedback. We heard about the learning that they undertook to develop the breadth of skills needed to pass, the impact on their confidence and the doors it has opened for them professionally. Above all, they made it clear that credentialing had made a demonstrable difference in the care of their patients.

However, it was also notable how the credentialing process is not undertaken alone. We heard from an assessment panel chair, who spoke about the importance placed on the feedback given to unsuccessful candidates and the joy felt when people succeed. We also heard how important it is for candidates to find good supervisors, mentors and coaches — often people they didn’t know before, but who were prepared to act as an adviser, sounding board, critical friend and cheerleader. All of this points to the need for us all as pharmacists to be prepared to help those coming behind us and strengthen our mindset to give back to our profession.

Support from employers

Another vitally important part of this picture is employers. There is much that they can do to support pharmacists to work towards advanced practice credentialing. At an individual level, they can provide opportunities for skills development and enable workplace flexibility to allow people to take time to meet with mentors, learn skills or complete their portfolio. At a systemic level, employers can work to embed credentialing into workforce planning, creating job descriptions that align with the domains of the RPS curricula and linking credentialing with pay and career progression.

Coming away from the meeting, I was struck by the range of voices in support of these developments within the pharmacy profession. On the other hand, it is equally clear that no single organisation can make this happen on its own. We need to coordinate and align work across the whole pharmacy system to make credentialed advanced practice more widespread in the profession — it needs to happen soon.