Developing England’s first 13-week foundation trainee pharmacist rotation in substance-use services

As pharmacy training evolves toward a clinical, patient-centred model of care, meaningful learning opportunities across healthcare sectors have become increasingly important. Those completing foundation trainee pharmacist training in 2026 will become the first cohort to qualify as pharmacist independent prescribers. The introduction of prescribing competencies into initial education and training has highlighted the need for rotations that expose trainee pharmacists to complex decision-making, multidisciplinary practice and ongoing patient care.

Waythrough is a registered charity that provides substance-use, mental health and supported-housing services in England. Waythrough — in partnership with Imaan Healthcare — has developed and delivered a 13-week rotation within substance-use services, which is designed as a rotational bolt-on to a community pharmacy training rotation. The rotation broadens trainee pharmacists’ experience by embedding them within specialist multidisciplinary teams (MDTs) supporting people with substance dependence.

Substance-use services provide a unique environment in which trainee pharmacists can develop consultation skills, apply clinical reasoning and gain insight into prescribing governance, safeguarding and holistic patient care. 

Building a new training model

As the only ‘walk-in without appointment’ healthcare professional service, community pharmacy rotations have traditionally provided strong foundations in medicines optimisation, public health interventions and patient-facing care. However, the evolving four-year MPharm programme now requires trainees to understand care pathways that extend beyond the dispensing and clinical checking of medicines. 

This 13-week rotation was designed to complement community pharmacy training through immersive exposure to a specialist clinical setting. Rather than functioning as a standalone experience, it was integrated into the trainee’s existing foundation programme, demonstrating how pharmacists contribute across the wider healthcare system.

This rotation combined supervised clinical practice and prescribing experience, mapped to the Royal College of Pharmacy’s competency framework for all prescribers^​1​, NHS England’s foundation trainee pharmacist assessment activities^​2​ and the General Pharmaceutical Council’s learning outcomes^​3​.

Integrating prescribing competencies into practice

A central aim of the rotation was to provide authentic opportunities for trainees to develop the capabilities required of future pharmacist prescribers. Substance-use services offer exposure to prescribing decisions that require consideration of physical health, mental health, social vulnerabilities and patient readiness for treatment. Prescribing competencies were embedded into day-to-day activities rather than treated as isolated educational exercises.

Trainees participated in consultations involving opioid substitution treatment, alcohol dependence management and associated healthcare interventions, while observing structured assessments, shared decision-making, risk evaluation and treatment planning. The rotation offered a unique opportunity for trainees to experience the relationship between prescribing and psychosocial interventions integral to long-term recovery goals. 

These activities encouraged reflection on prescribing and harm-reduction principles^​4​, including patient assessment, clinical monitoring, documentation, medicine optimisation, safeguarding and safe transitions of care. The rotation also highlighted that effective prescribing extends beyond selecting medicines. Trainees gained an understanding of the governance frameworks that support safe and accountable prescribing.

Learning across the MDT

Working alongside recovery coordinators, nurses, prescribers, health and wellbeing teams and mental health partners enabled trainees to appreciate the collaborative approach required to support people with complex clinical and social needs. Exposure to supervised consumption, medicines reconciliation, harm reduction services and multidisciplinary case discussions demonstrated the pharmacist’s role in improving access to treatment, optimising medicines and reducing stigma.

Trainee experience

Feedback from the two foundation trainee pharmacists, Inshah Hussain and Angel Lim, who completed the pilot rotation was overwhelmingly positive. Both rated the overall experience as ‘excellent’ and felt the rotation provided extensive opportunities to develop their clinical and prescribing skills, increasing their confidence in undertaking patient-centred prescribing activities within their level of competence.

The opportunity to lead supervised consultations, receive structured feedback and work within an MDT was consistently identified as the most valuable aspect of the rotation.

Inshah reflected: “The opportunity to interact with patients, from conducting urine tests to carrying out consultations under the supervision of the prescriber… helped me develop my clinical communication skills and build confidence in patient care.”

Angel highlighted the value of leading consultations under supervision, explaining that it enabled them to identify “my weaknesses and ways to improve it next time”.

Inshah described working alongside nurses, recovery coordinators and prescribers as providing “valuable insight into how different healthcare professionals contribute their expertise to deliver comprehensive, patient-centred care”, while Angel praised the supportive team environment discussions around case management and supporting people throughout recovery.

Angel also noted that substance-use services provide “a niche area where we wouldn’t have experienced [this] in primary care settings”, highlighting the important role pharmacists play in prescribing, medicines optimisation and peer education.

Importantly, both trainees stated they would consider working as pharmacist prescribers within substance-use services following completion of their foundation training programme, suggesting the rotation may positively influence recruitment into this specialist area.

Constructive feedback has informed further refinement of the programme, including greater trainee involvement in developing individual learning plans, improved timetable coordination and enhanced pre-rotation planning.

Looking forward

By integrating prescribing competencies with multidisciplinary learning, governance and direct patient engagement, this new rotation enables trainees to develop confidence, professional identity and a broader understanding of healthcare delivery within this specialist area where pharmacist prescribers remain underrepresented.

As independent prescribing becomes embedded within the profession, innovative cross-sector rotations such as this have the potential to broaden career aspirations, strengthen collaborative working and equip future pharmacists with the knowledge, skills and confidence to deliver person-centred care across increasingly diverse clinical settings. 

Harman Singh Bahra, regional lead pharmacist and pharmacist independent prescriber at Waythrough

Patrick Gorey, regional lead pharmacist and pharmacist independent prescriber at Waythrough