Core advanced credentialing: lessons from a hospital pilot programme

The Royal College of Pharmacy (RCPharm) launched the core advanced curriculum in 2022 to bridge the gap between the post-registration foundation curriculum and the consultant pharmacist curriculum^​1​. The ambition was clear: advanced pharmacists have a pivotal role in delivering future services, while patients with ever more complex healthcare and medicines needs will require pharmacists with advanced-level pharmaceutical expertise to autonomously deliver their care^​2​. Yet, four years on, credentialing rates at core advanced level remain low nationally and are even lower among hospital pharmacists.

RCPharm reported in May 2025 that out of 200 submissions received for core advanced credentialing, around three-quarters have come from pharmacists in primary care settings, which was largely driven through the supported Centre for Pharmacy Postgraduate Education (CPPE) pathway in England. Secondary care accounts for only about 20% of submissions. Pass rates across sectors are broadly comparable, ranging between 50% and 60%.

Why credentialing matters

If credentialing rates remain low, pharmacy risks falling behind other healthcare professions where advanced practice frameworks are already more established. Low uptake risks increasing variation in practice, slowing the development of advanced pharmacy services and reducing the opportunities for a highly skilled workforce to improve patient care. A credentialed pharmacy workforce adds credibility, assures capability, raises the profile of the profession and provides the public with the assurance it deserves.

The case for credentialing is strong, so why have pharmacists practising at an advanced level not yet done it?

Understanding the barriers

The barriers are not primarily about capability: many hospital pharmacists are doing advanced work. What stands in the way is something more subtle.

There is, first, a hidden knowledge gap. Pharmacists are not always aware of what they do not know about building a strong portfolio. Instead, credentialing is often seen as something they will get round to eventually. Building a portfolio is a skill in itself: presenting evidence in a coherent way, deepening reflections and understanding how to triangulate evidence all take support. Doing this retrospectively is harder than building prospectively, so the best time to start is now.

Secondly, getting high-quality feedback in a hospital environment can be difficult. Pharmacists at advanced levels are rarely observed by colleagues in the way already embedded in medicine. When they do seek feedback, collaborators do not always know how to give it well: giving rich, specific, developmental feedback is a skill most people have not been trained in. Without good feedback, portfolios struggle to reach the standard needed.

Thirdly, there is the pressure of clinical life on a hospital ward, where patient-facing responsibilities always take priority over portfolio development.

Without a clear roadmap, the process can feel overwhelming and many pharmacists simply do not start.

Existing credentialing schemes

There are national initiatives to increase credentialing rates at advanced level. The CPPE-supported route has driven most primary care submissions. In Wales, Health Education and Improvement Wales Pharmacy is piloting a national support programme for pharmacists working towards advanced credentialing through 2026–2027. This includes a community of practice that brings pharmacists together for facilitated peer discussion and expert review, helping them to develop and evidence advanced clinical and professional capabilities across the required domains. The programme is aimed at building future mentoring and supervision capacity to support others progressing through the credentialing pathway.

Public Services Delivery (PSD) Scotland provides a formal programme for those based in primary care, consisting of ten monthly sessions covering relevant therapeutic content while linking to appropriate core advanced curriculum learning outcomes. Drop-in sessions are offered, and participants have the opportunity for peer review of their own evidence. PSD Scotland also facilitates a network of core advanced curriculum champions within health boards to support individuals at a more local level.

However, none of these initiatives are led by employing organisations. As a result, there is limited ability to influence organisational culture or embed credentialing as ‘business as usual’ within organisations. In addition, none are specifically focused on hospital pharmacists, where credentialing rates remain low.

The Barts pilot

To address this gap, we designed a pilot at Barts Health NHS Trust: a structured 12-month programme, supporting hospital pharmacists to develop core advanced portfolios aligned with RCPharm’s core advanced curriculum. The central question was whether we could move portfolio development from “something I would like to do one day” to “something I am actively doing today”.

We opened the pilot in January 2026 to post-diploma pharmacists, including pharmacists not yet working at advanced practice but wanting to capture their progression. Eight pharmacists joined, ranging from bands 7 to 8b. Monthly sessions were run via Microsoft Teams, alongside some face-to-face sessions to deepen peer discussion.

A baseline survey identified three perceived barriers: time constraints; difficulty prioritising portfolio work alongside clinical responsibilities; and limited examples of advanced practice evidence. It showed that participants felt most confident in the clinical and education domains, and least confident in research.

Months one to three focused on getting started: learning needs analysis; navigating the portfolio system; and identifying workplace mentors. We asked each participant to create at least one piece of evidence by the end of the third month. This modest deadline proved important, as the extrinsic pressure moved people from thinking about building evidence to doing it and led us to introduce an evidence development timeline for additional structure.

Months four to eight introduced topics aimed at strengthening portfolio development, including deepening reflections, gaining quality feedback from collaborators and avoiding common pitfalls from previous submissions.

Months 9 to 12 focused on peer review across each domain, ending in a summative portfolio review with recommendations for next steps.

Submission for credentialing was not set as a hard endpoint. Our goal was for participants to use the process to identify and address knowledge and skill gaps. We wanted them to become credential-ready to enable credentialing in the future. Credentialing was framed as professional development, not just a finishing line.

We made iterative adjustments along the way: moving session timings to the end of the day; running a catch-up session when clinical commitments clashed; and expanding the programme to accommodate three pharmacists seeking to credential at consultant level, where portfolio development shares many common elements.

What we have found

At our month-4 pulse check, 100% of participants found sessions useful or extremely useful. The cohort has grown from 8 to 11 with no drop-outs. Participants are creating triangulated evidence, and the group has become a source of peer support. One participant said it was “very clear and easy to break down a large piece of work step by step without being overwhelmed”, while another commented that “the pilot has definitely encouraged me to seriously consider completing my advanced portfolio”.

What’s next?

This model could be worth continuing beyond the pilot scaled to a second cohort. Pharmacists who complete the programme will be well-placed to support future participants — having a first-hand understanding of what high-quality evidence looks like is a significant advantage when providing feedback to colleagues.

However, individual pilots are not sufficient on their own, systemic change is needed. An independent review of the post-registration foundation programme commissioned by RCPharm and published in 2025 describes the enabling ecosystem required for successful credentialing^​3​. The principles translate directly to advanced practice: a system-wide vision for the benefits of credentialing, managers who actively support it, and protected learning time for pharmacists and supervisors alike. Without those conditions, even the most motivated pharmacist will struggle to sustain momentum.

Sharing what we have learned at Barts is part of how that ecosystem gets built. The hope is that this will benefit other trusts that are seeking to improve credentialing for pharmacists.

Figure: Conditions for successful credentialing in the Royal College of Pharmacy (RCPharm) post-registration foundation programme (PRF)