Why are increasing numbers of students dropping out of pharmacy education?

To meet growing patient demand for pharmacy services, NHS England has built an overarching plan to increase the pharmacy workforce, while upskilling it at the same time.

NHS England’s long-term workforce plan, published in June 2023, says that “education and training places for pharmacists are estimated to need to grow by 31–55% to meet the demand for pharmacy services”, setting out its ambition “to increase training places for pharmacists by nearly 50% to around 5,000 places by 2031/2032”. It adds that NHS England plans to start with initial growth in 2026/2027, “when places will increase by 15%”. ^​1​

The plan, coupled with reforms from the General Pharmaceutical Council (GPhC) to its ‘Standards for the initial education and training of pharmacists’ in 2021 — meaning pharmacists will become independent prescribers at the point of registration from 2026 — is intended to reduce pressure on the NHS and improve patient access to care ^​2​.

However, data provided to The Pharmaceutical Journal by the GPhC in August 2024 revealed that pharmacy students are leaving the MPharm programme at increasing rates. In 2021/2022, 889 students (20%) of the 4,505 new students who began the first year of the MPharm that year did not progress to the second year. This was a 47% increase on the number of students who withdrew the previous year, when 604 students opted not to progress from the first year in 2020/2021 to the second year.  

The MPharm programme is a four-year university degree that is the first step toward becoming a qualified pharmacist in the UK. After graduating, trainee pharmacists will undertake a year of foundation training before taking a registration assessment set by the GPhC.

The issue is not limited to first-year pharmacy students. The number of students across all years of all programmes who withdrew from university has trended upwards since the pandemic year of 2020/2021.

Data published by the Student Loans Company (SLC), which is overseen by the Department of Education, show that, while the number of students who withdrew from university in England, Wales and Northern Ireland dropped in 2020/2021, it sharply increased beyond pre-pandemic levels in the two subsequent years (see Figure 1). 

This number, which does not include students from Scotland as their finance is managed by Student Awards Agency Scotland, is on the decline again in 2023/2024, but it is still higher than it was before COVID-19.

Impact of COVID-19

The reasons that students have for leaving their university course “are multifactorial and, very often, individual”, says a spokesperson for the University of Sunderland — adding that these reasons could include “deferrals, leave of absences and students who repeat a year following a failed module or modules”.

Data show that 10% of MPharm students at the University of Sunderland (n=13/129) did not progress to the second year in 2019/2020. This increased to 28% (n=32/116) in 2022/2023. 

The university was one of 19 pharmacy schools that responded to a freedom of information request from The Pharmaceutical Journal, asking for data on the number of students who began the first year of the MPharm programme and progressed to the second year for the four academic years from 2019/2020 to 2022/2023. The figures provided by the GPhC and schools of pharmacy do not include those retaking the year for any reason (Figure 2).

“The time period in this dataset was significantly influenced by COVID, where restrictions, including on travel, and other personal impacts led to deferrals, which very much affected individual student progression between years of study,” the spokesperson says.

The University of East Anglia (UEA) faced a similar issue during the pandemic. Since 2019/2020, the proportion of students who did not progress to the second year increased from 42% (n=57/135) to 53% in 2020/2021 (n=85/161), and then to 62% (n=101/163) in 2021/2022. Similar to the national picture, for the 2022/2023 cohort, the percentage of students who withdrew after the first year then fell to 54% (n=94/173) — still above pre-pandemic levels.

 “Students choose to leave their course for different reasons, whether related to their university experience or for other external reasons,” says a spokesperson for UEA.

“The COVID pandemic has undoubtedly had a detrimental impact on progression rates, and our School of Chemistry, Pharmacy and Pharmacology has invested more resource in recent years into earlier intervention by ensuring student advisors are proactively contacting students who may be struggling or not attending lectures.”

Emeka Onwudiwe, president of the British Pharmaceutical Students’ Association and a fourth year MPharm student at UEA, says that online learning as a result of the pandemic meant students were unable to ease into the course as they usually would in person.

“A lot of people didn’t have that easing-in period, because it was all online. So, we had to take a step back,” he says. 

“That easing-in period allows you to learn your revision techniques, allows you to understand your exam preparation … and how you get your mindset into doing the exam.” 

Speaking from his own experience, Onwudiwe adds: “The way the in-person exams hit me was a big shock, and I really had to adjust myself to different learning habits and different revision techniques.”

Onwudiwe warns that the effects of the pandemic are continuing to have a “detrimental effect” on students and that it will take “a couple of years” for progression rates to recover.

MPharm content

Onwudiwe also attributes high non-continuation rates to the “content heavy” programme, likening it to a medical degree. 

“Pharmacy is on par with medicine,” he says. “I have a lot of medical students that are friends of mine, and I see the workload that they do, and they even say, ‘You know what, pharmacy is probably harder than medicine’.”

He explains that MPharm exams are also difficult because “we only have multiple choice for 50% [of the exams]; the other 50%, it’s all from your brain”.

“If you don’t have the content in your head, unfortunately, in the exam, you can’t make it up,” he says. “In an MCQ … you can do process of elimination; you kind of find your way through it and … hopefully pick the best [answer].” But with the long-form answer questions, he says, “you have to have the knowledge”.

This is a new exam format, says Onwudiwe, which was introduced at UEA to better test student’s clinical knowledge before becoming qualified as independent prescribers at the point of registration from 2026.

At the University of Brighton, a spokesperson says that MPharm students in particular face challenging progression requirements as they “are only allowed to progress after they have completed and passed all assessments and modules for that year of their course”.

They add that trailing — where students can progress to the next year of a course and retake a module they failed in the previous year — or compensation of mandatory modules — where students can earn credit for a module they did not pass based on their overall academic performance — “is not allowed on the MPharm course, which also affects progression rates compared with other courses”.

At the University of Brighton, the proportion of students who did not progress to the second year of the MPharm programme almost doubled in four years from 21% (n=29/141) in 2019/2020 to 41% (n=47/116) in 2022/2023. 

“The lower progression rates for 2022 and 2023 reflect the effects of students returning to in-person and face-to-face assessments after COVID, which we know many students found challenging,” says a spokesperson for the university.

However, it is taking steps to improve progression rates across all MPharm years. “Measures put in place have included: a dedicated member of MPharm staff responsible for overseeing the academic progress of part-time repeating students; attendance and engagement monitoring of all students; and provision of extra support via our Student Skills Hub,” the spokesperson adds.

As a result, the university says the first-year progression rate has increased from 59% in 2022/2023 to 74% in 2023/2024 and non-progression rates have now returned to pre-COVID levels. 

Mental health support

In addition to COVID-19 and the rigorousness of the MPharm, mental health difficulties are also a significant driving force behind dropout rates. An analysis of data from surveys of students between 2016/2017 and 2022/2023 by the Policy Institute at King’s College London and the Centre for Transforming Access and Student Outcomes in Higher Education found in September 2023 that mental health is “by far the most common main reason someone considered dropping out of university”, with financial difficulties also being a significant factor that is “interlinked” with mental health^​3​.

The Policy Institute’s analysis found that between the 2016/2017 and 2022/2023 academic years, the proportion of undergraduate students at universities across the UK who said they had experienced mental health difficulties rose from 6% to 16%^​3​.

“Although some of this increase occurs around the time of the pandemic, and there is a large (32%) rise in the past 12 months focused around the point of the cost of living crisis,” the analysis said.  

“We must ensure that students receive the necessary academic, financial and mental health support throughout their studies, including access to the learning support fund alongside other healthcare professionals,” says Claire Anderson, president of the Royal Pharmaceutical Society and professor of social pharmacy at the University of Nottingham’s school of pharmacy.

Through the NHS Learning Support Fund, provided by the NHS Business Services Authority, students can apply for a training grant of up to £5,000 per academic year, claim money back for travel and accommodation costs on placements, and claim up to £3,000 if they are experiencing financial hardship. The fund is available to eligible students studying certain healthcare courses, such as dentistry, midwifery and nursing, at a university in England. However, pharmacy students are not currently eligible for the funding. 

In response to the rising dropout rates, a spokesperson at the GPhC said that this was something the organisation is monitoring. “We collect data from the pharmacy schools on the progression rates for MPharm students on an annual basis, along with a wide range of other information, and carefully examine this data,” they said. 

“We will then follow up with any schools where we have identified any concerns relating to significant trends within the data, as part of our ongoing quality assurance of the schools of pharmacy.”

A spokesperson for NHS England said it is “continuing to work closely with the Pharmacy Schools Council to understand and monitor student numbers and their progression, including supporting progression through the foundation training programme”.

The Pharmacy Schools Council declined to provide a comment.

Without a fix, increasing rates of pharmacy students dropping out of the MPharm programme run the risk of affecting healthcare provision in the UK, impacting an already-stretched NHS. If NHS England is to realise its plan of expanding pharmacy training places to meet increasing demand for pharmacy services, universities will need to work hard to keep students enrolled in pharmacy schools.