In July, 2,077 preregistration trainees in the UK earned the right to sign their names on the General Pharmaceutical Council (GPhC) register, having passed the registration assessment. Although there was a dip in the pass rate overall, from 85% in June 2014 to 74%, candidates who completed their preregistration training in hospital excelled, with 91% passing compared with 71% of their community counterparts.
This is not a new phenomenon; since the GPhC started recording this information, hospital trainees have outperformed those from the community. Perhaps the hospital candidates are simply stronger — obtaining a preregistration position in a hospital is competitive so hospitals can select the best candidates.
However, other factors may be at play. In the GPhC’s 2013 survey of preregistration trainees, those from the community sector were more likely to be dissatisfied with their training compared with their peers in hospital. One of the reasons for this dissatisfaction was the quality of support they received, in particular from their preregistration tutors. Because tutors are not currently accredited, it is not possible to ensure that trainees are given consistent support, neither between individuals nor across sectors, so community pharmacy trainees may well be at a disadvantage.
Following the registration assessment, the British Pharmaceutical Students’ Association claimed that some questions demanded an inappropriately high level of clinical knowledge. In general, hospital is a more clinical environment for budding pharmacists than community pharmacy and trainees are more likely to meet patients with a range of unusual and complex problems on the ward than the high street. With a new, more clinical registration assessment set to debut in 2016, trainees in community pharmacy may have legitimate concerns that their practice will not prepare them for the exam.
The new style of registration assessment has been designed to reflect changes to practice, so says the GPhC. Certainly, many pharmacists in every sector have aspirations to be more clinical. However, perhaps this is not yet playing out at the coalface in community pharmacy across the board. Pharmacy owners, both independents and multiples, must be profitable to survive — their businesses, staff and patients depend on it. The business model for delivering pharmacy-based clinical services is developing, but far from widespread. The reality for most pharmacies is that revenue comes from dispensing drugs and selling over-the-counter medicines. If trainees are expected to pick up their clinical skills mainly from practice, then those in a community setting may still be at a disadvantage.
Whatever the hopes and plans for the future, today’s community pharmacy trainees cannot be expected to gain the clinical knowledge from a model of care that is not yet established in practice.