Emeka Onwudiwe: ‘The prescribing qualification is a landmark for pharmacy students’

It is clear that Emeka Onwudiwe, president of the British Pharmaceutical Students’ Association (BPSA), is passionate about making sure pharmacy students find confidence as they progress through the MPharm programme to become fully qualified pharmacists. Having joined the BPSA in 2022 as its eastern area coordinator, he later took on the role of treasurer, before being elected president for the 2024/2025 year. 

Currently in his fourth year of the MPharm programme at University of East Anglia, Onwudiwe is part of the first cohort of pharmacy students who will be qualified independent prescribers when they join the register in 2026. While Onwudiwe describes this as a “landmark” moment for the profession and for pharmacy students, he also highlights the lack of information available to students as they approach their foundation training year. 

The Pharmaceutical Journal spoke with Onwudiwe at The Pharmacy Show in Birmingham earlier in October 2024 to discuss what questions pharmacy students still have around their prescribing training, what the changes to initial education and training have meant for their pharmacy education so far and how he hopes the independent prescribing qualification will impact career opportunities for him and his peers.

Why did you want to take on the role of president at the BPSA?

With the BPSA, everyone in the room wants one thing, which is a change in pharmacy. That’s why I ran for the eastern area coordinator position in 2022 and then from then on, I feel like I was just building my connections. After eastern area coordinator, I went on to become treasurer. 

Two days before the election at the annual conference, I thought: ‘You know what? Let me go for the presidency.’ Because it was either go for president or take a step back and focus on other things. So I went for the presidency. Obviously, every position is very important when you’re working with a team and the team really looks up to you as president. If you’re strong-minded, the team’s going to be strong-minded. So that responsibility and pressure is really something I wanted to do, and it felt like something I wanted to strive for. 

Have pharmacy schools adequately changed their curriculum to prepare students for independent prescribing from day one?

I can speak from my university experience at the University of East Anglia. I would say they prepared us from the beginning. There’s more of an onus on you being a clinical specialist. 

They changed the format of exams. So before, we were just doing long-answer questions. But that doesn’t really test our clinical abilities. We’d do multiple choice questions (MCQs) outside of an exam setting, but you could just speak with friends — you could do that as a team. It doesn’t really test individual knowledge. So now, they split it: 50% MCQs based on the clinical knowledge and 50% based on the long-answer questions. Now, you’re able to test both because as an independent prescriber, you need to be very good on clinical knowledge to really prepare for how the clinical world is going to be working in pharmacy.

How much have placements changed from previous years with the introduction of entrustable professional activities?  

It’s changed a lot because, as a pharmacy student, when we go into placement, some students are very much by themselves and some are very much around the team. Those activities have allowed us to have a broader understanding of what we’re going to embark on when we become pharmacists. These activities show us difficult areas in pharmacy and they show us the positive areas in pharmacy. So, they allow us to see the different pathways. 

Can you give an example of the entrustable activities that you would be doing while on placement?

On my most recent placement, I was given a list of medications to check, and I had to check if there were any mistakes. I had to go through 100 of them, but if I made a mistake, I had to do another 100. That was never the case before. Normally, they’ll just say do the first ten and then leave the rest for the accuracy checking technicians and the other people in the team that have more experience. But now they really put that onus on you, especially from third year onwards — they see you as pharmacists already.

Is the NHS ready to welcome you as an independent prescriber?

Not yet — there’s still a lot of work to do. I think certain parts of the NHS are getting to grips with it, such as doctors, for example, that are already prescribers. But to talk about the whole NHS in general, I don’t think they’re ready. There’s still a lot of information they need to figure out from all the regulatory bodies that are implementing the new prescribing elements within the 2025/2026 trainee year. 

I don’t believe the NHS should be 100% ready right now because all the information is not even out there yet. There are still grey areas. But within the next six months to a year, those grey areas will be clarified and will allow the NHS to have a full understanding of what’s going on. They need to see the impact that pharmacists as prescribers are going to have on the industry. Once they can see the impact, they’ll be more open.

What are some of the grey areas that you would like to see clarified?

The lack of designated prescribing practitioners (DPPs) is a big issue and is something that the regulatory bodies in pharmacy are really working on because they know time is of the essence. We just finished our Oriel preferencing two weeks ago. Within the next six, seven or eight months, we’re going to be graduating, and a lot of people will be starting their training at the beginning of July 2025. 

These issues should have been ironed out before we went into our preferencing because now a lot of people are sceptical when they’re doing their Oriel preferences — they don’t know what to expect. 

A lot of people are picking places that are closer to their home, but they don’t understand fully what the actual placement is. There should be more information out there about the different prescribing areas that are offered. But as there’s a lack of DPPs, some of the organisations can’t provide that because they’re still looking for DPPs to train pharmacists.

Is that going to cause a problem if people do not know what clinical areas they are choosing?

For me, I’m very open-minded. I’m not passionate in a particular area to say I want to prescribe in that area and nothing else. 

There are some people that really want to specialise in prescribing in one area and having that knowledge of what certain institutions will be offering, in what they believe is an area they want to prescribe in, will factor into changing people’s Oriel preferences. But, unfortunately, that information is not out there.

Is there enough awareness within universities about the awarding gap? Are they doing enough to close that gap?

Yes, there’s a lot of awareness. In 2013, the awarding gap between black Africans and white people becoming a pharmacist was very big, and so you have to ask the question: why is that happening? I feel like universities are now answering that ‘why’ quite a lot. 

They’re really trying to implement different things. When we’re doing case studies, we’re now focusing not just on things that affect white people and white skin conditions. They’re now looking at black skin conditions. When we’re using diagrams, it’s not just white people. Before, it would just be white people, such as, ‘this white female called Julie did this and this’. But now we’re saying, ‘this black person called Naomi did this and this’. And that’s a big change. It might be little to some people, but it makes a big difference because now you’re seeing people that are not all from the same race, and it allows black people to see that they’re being represented here. 

It allows people to improve their academics as well. When you’re seeing stuff that’s related to you, it helps you to want to know more about it. When you’re seeing things that are not of your race, obviously you’re still going to want to learn it, but you’re asking the questions: why am I always seeing this, why is it always of a particular race and why am I not seeing my race being portrayed the same way as another race? And that can demoralise people. 

The latest statistics that I looked at — from the Royal Pharmaceutical Society — was a 23% gap so I feel like it’s coming down. But there’s still a lot to happen. 

What needs to happen next? 

We need to portray all races in leadership positions. Even with the BPSA, we were not getting a lot of people from ethnic minorities, but then there was a tide change. Once those people put themselves forward, we started seeing more people from ethnic minorities coming to leadership positions. And now you see people, they gain confidence. I wish the BPSA was not just 20 people — I wish we could open a spot to everyone because I would love people to experience what we experience day in, day out, being involved in such a team, and the courage and encouragement and the drive that you get. 

Because I’m telling you it will make a difference once you get to the preregistration exam, the confidence alone, the motivation alone, to study to get to that point, it will definitely decrease the gap. 

Is there anything else you wanted to raise on behalf of pharmacy students?

I wanted to talk about the prescribing qualification and training. It’s a landmark for pharmacy, for pharmacy students. And one of the biggest reasons why is because it’s going to increase our career opportunities, going to allow us to become more involved in more clinical roles from the early stages of our pharmacy career. It’s added more innovative ideas in pharmacy education and allows us to have more direct patient contact. It allows us to have more impact on patient care and allows us to build more of a rapport with patients.

But there’s one more thing I want to say. From the positive side, we’re going to get more clinical depth, but on the flip side, there’s a stress element to it because now you’re adding another component to the preregistration year. There’s a lot of things you have to do, from self-reflection to completing booklets to be signed off and then to do your exam. But now you’re throwing in an element of prescribing where you’re not only going to be signed off for your prescribing year, you’re going to have to be signed off for your preregistration year. So the worry is — let’s say I do very well in my preregistration year, but I don’t get signed off on the prescribing — does that mean I can’t do the exam? What is the pass mark for becoming a prescriber? These are the questions that students are asking us right now. They really want more clarity.