Selecting an appropriate model of supervision for foundation trainees

According to the General Pharmaceutical Council’s (GPhC) Standards for the Initial Education and Training of Pharmacists, newly qualified pharmacists registering from 2026 onwards will be independent prescribers at the point of registration^​1​. 

NHS England’s workforce, training and education directorate oversees the management and quality assurance of the foundation training year, including prescribing supervision and assessment. A central requirement is that foundation trainee pharmacists in England must complete a minimum of 90 hours of supervised prescribing-related learning, supported by a designated prescribing practitioner (DPP) and a designated supervisor (DS).

Effective models of supervision will be crucial in supporting trainees to meet the required prescribing competencies safely and confidently. This article outlines the different supervision models that may be adopted in foundation training, with guidance on how they function in both single-sector and multi-sector training pathways. It also explores practical strategies for ensuring clear communication, appropriate delegation, and collaborative working between DS and DPP.

The article focuses on supervision models and eligibility requirements as they apply to foundation trainee pharmacists undertaking their training in England, where programmes are managed by NHS England’s workforce, training and education directorate. Different arrangements and requirements exist in the other UK nations, where foundation training is overseen by their respective education bodies:

• Scotland: NHS Education for Scotland;
• Wales: Health Education and Improvement Wales;
• Northern Ireland: Northern Ireland Centre for Pharmacy Learning and Development.

Trainees, supervisor and DPPs in these nations should refer to their national guidance for details specific to foundation training and assessment.

Requirements for being a designated supervisor or prescribing practitioner

While the requirements for a DS remain unchanged from previous years, the introduction of the DPP role and its associated eligibility criteria is a new development within the foundation programme, reflecting the distinct nature of prescribing supervision. Figure 1 summarises the eligibility requirements as outlined by NHS England^​2​.

The requirements for a DPP supervising a foundation trainee are distinct from those for a DPP supporting a qualified pharmacist undertaking an independent prescribing course, reflecting the different levels of prescribing complexity involved^​2,3​. The main difference is that the ‘three-year rule’ — the requirement for at least three years’ recent prescribing experience — does not apply to DPPs supervising foundation trainee pharmacists^​2,3​. This is because prescribing by newly qualified pharmacists, after completing foundation training programme, is expected to be more limited in scope and complexity, carried out with prescribing support and supervision, whereas qualified pharmacists undertaking prescribing training typically manage more complex clinical situations within a broader or specialist scope of practice.

When an individual meets both role specifications, they may act as both DS and DPP; however, the GPhC requires that more than one registrant is involved in the assessment of a trainee pharmacist. Therefore, if the same person acts as both DS and DPP, another prescriber must contribute to the trainee’s assessment.

The trainee must complete at least 90 hours of supervised learning to develop and demonstrate prescribing-related skills. The DPP can enlist the support of other healthcare professionals (known as practice supervisors) to support some of this learning time where appropriate; however, they must personally supervise the trainee enough to ensure that they are able to make an informed decision about their prescribing capability.  

Supervisors are encouraged to complete formal preparation for their roles. DSs may undertake educational supervisor training via e-Learning for Healthcare (eLfH) or other locally accredited courses. For DPPs, the Collaborative of Learning progamme (eight modules) and SCRIPT e-learning are currently recognised options.

Models of supervision

The GPhC and NHS England permit flexible models of supervision, so training sites can choose approaches best suited to their context, staffing and placement design^​2​. Each model has benefits and limitations, meaning that choosing the most effective structure requires careful planning. The ‘best’ model will be dependent on the training programme (e.g. multisector or unisector), nominated prescribing area and availability of supervisors at the training site. 

Both the DS and DPP are responsible for the successful completion of the foundation training by a trainee pharmacist. The DS will make the final sign-off decision for the learning outcomes and the DPP will do the same for the prescribing activities. 

A selection of possible models are summarised below.

Model 1: Pharmacist DS with a medical DPP

This model has been widely used in independent prescribing (IP) training for qualified pharmacists. In this model, the DS is a pharmacist and the DPP is a doctor — often a general practitioner or secondary-care consultant. The medical DPP may be based in the same workplace as the trainee or outside the main training place.

The following case examples illustrates how this model can be deployed in practice.

Model 2: Pharmacist DS with nurse or allied healthcare professional DPP

In this model, the DPP is a nurse or allied health professional with an independent prescribing annotation. While less commonly used in IP training for pharmacists, it may offer practical advantages, particularly in settings where a non-medical prescriber is the clinical lead in a nominated prescribing area.

Model 3: Pharmacist DS with a pharmacist DPP (two individuals)

This model may be increasingly common as more pharmacists become prescribers. Here, the DS and DPP are different pharmacists — potentially in the same or different organisations. This model can be an option when the DS is a pharmacist but may not yet meet the criteria to act as a DPP, with another pharmacist who does meet the criteria acting as the DPP. This model also could work well in multisector rotations, where focused prescribing activities are completed during multisector rotation with DPP provision. 

Model 4: Pharmacist DS and DPP (same person)

When a pharmacist meets the criteria for both roles, they may act as both DS and DPP. This model may become more prevalent over time as more pharmacists qualify as prescribers and integrated training models become established.

Considerations for multisector training programmes 

As multisector training programmes are increasing in popularity and will become a mandatory requirement going forward, foundation trainee pharmacists will have multiple DSs^​4​. According to GPhC guidance, DSs should be in place for placements lasting longer than 13 weeks; however, only one DPP may be nominated per trainee. Where trainees are undertaking their foundation training year across multiple sectors, it will be important to ensure that the DPP is in the sector where most of the prescribing experience is likely to occur, and also that there are clear lines of communication so that evidence generated in a different sector can be taken into account when considering sign-off for the trainee.

Trainees completing a sandwich or practice-intercalated course will need to consider any supervision requirements specific to that programme. For example, the five-year sandwich MPharm programme at the University of Bradford includes two six-month placements either side of the fourth year of academic study enabling students to undertake foundation training as part of the programme.  This means students will need to have a different DS and DPP for each of their six-month placements. This may also be necessary when a supervisor leaves the host organisation or is absent, such as on parental or sick leave. It will be very important in these cases to ensure that communication between the different supervisors is clear, timely and well documented, so that trainees don’t have to unnecessarily repeat activities and supervised practice hours. 

Fostering strong supervision and communication

It is important to ensure effective communication and collaborative planning between the trainee, all DSs and the DPP. Trainees are more likely to successfully demonstrate prescribing competence when early meetings are held to assess learning needs, required actions and jointly plan how the 90 hours of supervised learning in practice will be used^​5​. These regular, three-way progress meetings should be scheduled to continue throughout the foundation training year to ensure that everyone involved is aware of how the trainee is progressing allowing any remedial action to be taken if required.

It is important to take the time to consider and agree on which methods of three-way communication will work best for each specific supervision arrangement. A range of digital tools is available to support collaboration, even when supervisors are based in different locations or organisations; for example, video conferencing, shared editable documents (e.g. Google Docs), messaging apps and email. However, when using these tools, it is essential to ensure compliance with privacy, data protection and local organisational policies. Clear expectations and boundaries should be established from the outset to maintain professional standards and ensure all parties are aligned. 

Troubleshooting

Even if communication is established well from the beginning, some issues may arise over the course of the foundation training programme. The table below provides some examples of possible challenges and how they can be approached based on learnings from the NHS England independent prescribing  pilot programme^​3​. 

Summary

A successful prescribing supervision model is grounded in shared goals, role clarity and adaptability to the training context. Whether within a single site or across sectors, the choice of supervision model should prioritise the trainee’s learning experience, regulatory requirements and feasibility of sustained collaboration between supervisors. As the prescribing landscape in pharmacy evolves and greater emphasis is placed on pharmacist-led training and interprofessional collaboration, these models will continue to adapt.