Duncan Craig/UCL
On a summer’s day in central London, Duncan Craig is sat in an impossibly tidy and modern-looking office.
Recently appointed the chair of the Pharmacy Schools Council (PhSC), he has the job of representing all the pharmacy schools across the UK at a time of great upheaval in pharmacy education and training.
Looking at his impressive CV, it is clear why he was given this job. Craig is currently director of the School of Pharmacy at UCL; before that, he set up a new school of pharmacy at the University of East Anglia in 2003, after spending four years as chair of biophysical pharmacy at Queen’s University, Belfast, from 1999 to 2003.
But he is going to need more than academic prowess to navigate the PhSC through the next few years after the General Pharmaceutical Council (GPhC) signalled that it would like to move ahead with proposals to have an integrated five-year pharmacy degree programme in England, following similar plans in Scotland and Wales, to boost clinical and communication skills in graduates.
This is despite pharmacy schools being under pressure with falling student numbers and considerable variation between schools in terms of preregistration pass rates for their former students.
Craig is careful with his words, and often points the finger elsewhere, but he is clearly aware that pharmacy schools are going to have to adapt quickly in order to keep pace with the rate of change in today’s healthcare service.
The 2019 preregistration exam pass rate was the lowest since 2011. Do pharmacy schools bear some responsibility for this?
We’ve got to be careful of assuming a causal relationship between the pharmacy school a student studied at and the pass rate. I’m not saying that there isn’t a relationship, but there’s also the small matter of preregistration experience.
It’s down to individual schools — including my own — to look at what their practices are
Also, what’s the relationship between the preregistration exam and the accreditation process? The assumption is that if a school passes accreditation, the students coming out should be able to pass the exam. So, either it means something might be going wrong in the preregistration year, or that there’s a misalignment between the accreditation process and the GPhC exam.
But it would be incorrect to say the experience a student had at a university has no relevance at all to the preregistration exam. It’s down to individual schools — including my own — to look at what their practices are and [ask], could we be giving the students more support during the degree?
Do you have any concerns about the accreditation process?
I believe that the GPhC will look at the accreditation process, and we are keen to have constructive discussions with them about the way it’s conducted.
The GPhC, over the years, has got much more right than it’s got wrong. I’m a big fan of its emphasis on integrating science and practice, [but] some of the aspects of the current visit format probably have served their purpose, and it’s time to look at new ways of doing things. I am concerned that the scientific acumen of the students is more or less completely ignored.
I’m also concerned that some of the conditions and recommendations that schools are getting seem to be on aspects of their portfolio that do not appear to have a direct relationship with patient safety. A conversation needs to be had, in a constructive way, with the GPhC to make sure that what those accreditation visits are actually examining is relevant to patient safety and best professional practice.
Do you think the 140% increase in the number of students accepted onto MPharm courses through clearing is affecting the variation in pass rates for the preregistration exam?
There is evidence that the quality of the students that pharmacy schools take in has a huge effect, not only on performance during the degree but also after. It doesn’t matter how well you educate somebody: if they are not capable of fulfilling the degree’s requirements, or the GPhC’s expectations, it’s difficult to see how they’re going to flourish.
It’s in everybody’s interest that pharmacy is seen as an exciting, vigorous career with a great future
One of the things that I have talked to the Royal Pharmaceutical Society (RPS) about is the idea of working together to raise the profile of pharmacy. At the moment, the individual schools have their own strategies for recruitment and marketing, with varying degrees of success. We don’t have a coordinated approach throughout the whole profession.
It’s in everybody’s interest that pharmacy is seen as an exciting, vigorous career with a great future. That’s going to lead to a more positive public perception, and a greater influence at decision-maker level.
Have you received any reassurance on how the training element of the GPhC’s proposed five-year integrated pharmacy degree would be funded?
The GPhC wants to work with us to develop something that’s going to work. Discussions about a more integrated degree have been on the cards for years now. We already have one example in the sector at the University of Nottingham and the University of East Anglia, and it seems to be equivalent to the current ‘four plus one’ model.
Quality assurance of the preregistration experience is a matter of concern
I would be interested in meeting with the GPhC, and other stakeholders such as the RPS and Health Education England, to ask: what problems are we trying to solve? Can you identify where the weak points are? We can use that to work out how we can work with them to come to a solution. A fully integrated degree isn’t the only way that we can look at this.
Quality assurance of the preregistration experience is a matter of concern. One solution is to fit it into the undergraduate degree, and say to universities: it’s now your responsibility to quality assure it. We are not intrinsically opposed to that, but it’s got to be properly resourced. As it stands, we spend a lot of our budgets on clinical placements. There’s no problem with that — it benefits the students and, ultimately, the profession and the public — but we don’t get any extra funding for this.
If we have this final year as part of the degree, employers would have to be remunerated, plus there would be an enormous amount of work involved in that quality assurance process. It can be done, but we need to talk about how it can happen.
What is your position on pharmacy degree apprenticeships?
The thinking is at a very early stage and the logistics must be looked at very carefully. How would you expand the degree to take into account all the things that students usually do, absolutely full-on, full-time for four years, in an apprentice scheme? What purpose would it fulfil that is not currently being served? It’s not as though there is a deluge of people who have got the intellectual capacity but who are not, currently, able to get into pharmacy.
But could they attract people who do not want to get into debt?
Possibly — but on the other hand, the funding has got to come from somewhere. The devil is going to be in the detail. I think our view at the moment is to wait and see. I know it’s been a controversial topic, and some of the ways in which the ideas have been communicated have probably fuelled the controversy. But again, it’s the same answer I’m giving all the time: at the end of the day, it’s about sitting down and talking to people, and finding out what it is that they would like to achieve, and whether there is a way in which schools can work with them to do that in a manner that is practically acceptable.
Is academic pharmacy research well-funded enough to be a viable career option?
There is a real push from students who don’t want their career choices to be binary: that is, community or hospital. A significant number want to come back for research projects and PhDs, and would like an academic career.
Many students want science-based careers and we should provide them with those opportunities
Generally speaking, the number of PhD places available is not too bad. But there’s something else that needs to be explored: we’re structuring our degrees now — with a big push from the GPhC — to focus on patient-facing roles. But what about those people who don’t want a patient-facing role?
I’m a little bit nervous about assuming that everybody has to study pharmacy for a patient-facing role. I want to discuss the science content with the GPhC. If we lose the science, we lose our unique selling point. Many students want science-based careers, and we should provide them with those opportunities.
Are you worried about the impact of Brexit on schools of pharmacy?
The PhSC doesn’t have an official position on this, so this is my view.
Irrespective of where one stands on the desirability of Brexit, the potential disruption is a major source of worry. Certainly, in my own institution there have been worries about retaining staff and huge worries over the supply of medicines.
At my pharmacy school, we’re keeping a very close eye on the situation. One of the worries is research funding. Many of us, including myself, have EU grants; we absolutely value our colleagues in Europe, who we collaborate with on research. I hope that if Brexit does go ahead, the government will prioritise finding means by which we can continue to work in these networks. It could be devastating if we don’t.
