Phasing in multi-sector placements offers another chance to review foundation training 

In December 2024, NHS England announced that plans to mandate pharmacy employers to offer multi-sector rotations in the foundation pharmacist training programme from 2026/2027 would be delayed by one year^​1​.

This delay means that the foundation training programme will now introduce multi-sector rotations in a phased approach. Employers can still submit single-sector rotations for recruitment in 2026/2027, although most are expected to be multi-sector. However, single sector programmes will not be accepted for rotations starting in 2027/2028.

A clear benefit to multi-sector foundation training is that it provides trainees with a basic understanding of more than one sector, aiding cross-sector relationships post-registration^​2​. There will be a greater appreciation of colleagues’ roles in other sectors, both in the value added to patient care but also the challenges and limitations^​3​.

Such a model opens greater opportunity for portfolio careers for the pharmacists of the future to experience time in sectors which they may not have had experience of during their undergraduate experiential learning placements.

However, with a phased implementation now in place, it is time to rethink both the funding model and structure of the foundation pharmacist training year before the next step is taken.

Structural changes

Moving from being a full-time undergraduate to becoming part of the workforce is a significant change for many trainees — not only do they need to learn how to apply their pharmacy knowledge and skills, but they need to adapt to going to work every day. 

This change also includes creating working relationships within multidisciplinary teams, in addition to familiarising themselves with new software and applications. Having been a designated supervisor (DS) for six years in a GP practice, I have observed that this in itself can be challenging for some, delaying their development as pharmacists. Additionally, increasing multi-morbidity and subsequent polypharmacy are increasing the complexity of pharmaceutical care^​4​.

For these reasons, expecting trainees to be able to be an effective pharmacist and a safe prescriber within 12 months post-graduation, without significant ongoing professional support, will be a challenge for many. Recent research has confirmed that ongoing support for new prescribers will be critical^​5​.

Expanding the length of the foundation training year to two years would allow trainees to gain exposure to a wider range of roles in more sectors and would allow the requirement for 90 hours of supervised prescribing training to be staggered over the two years, reducing pressure on the number of designated prescribing practitioners (DPPs) and provide greater flexibility.

However, a change of this nature would extend the time it takes to train to become a pharmacist overall, potentially deterring applicants from the undergraduate programme.

Funding model

Increasing the length of foundation training would also require an overhaul of the funding model.

As it stands, providing lead employers with a funding pot of £26,500 for each trainee, that essentially only covers salary plus employment costs, has meant there is no funding to cover the time required for supervision from a DS, trainee feedback and assessment, either within the lead employer placement or any secondary placements^​6​. Effective supervision requires dedicated time, which cannot be facilitated if funding is not available to release trainers and DSs from their routine activities. It is also likely to have reduced the number of placement sites, based on my discussions with local and regional colleagues.

We could learn from our medical colleagues and move to a model where NHS England pays foundation pharmacists’ salaries directly to them with a training fee paid to placement hosts to fund and backfill time removed from direct patient care for supervision^​7​.

Funding placements this way would allow dedicated time for trainees to undertake joint clinics, with a DS, complete structured learning events with time to debrief their patient interaction and to develop further learning opportunities.

Without this funding, employers are reluctant to provide DSs with the time they need owing to the impact on efficiency and delivery of their day-to-day role^​8​. There are concerns from pharmacists that a lack of dedicated time potentially compromises the safety of their own clinical role and the quality of the supervision provided. In its framework around becoming a competent prescriber, the Royal Pharmaceutical Society says that part of demonstrating competency in prescribing governance includes supporting others with their prescribing practice and continuing professional development^​9​. It adds that this can be demonstrated “by considering mentoring, leadership and workforce development (for example, becoming a DPP)”.

This can be seen in conjunction with guidance on ‘National profiles for pharmacy’ from the NHS Staff Council, which says that pharmacists working at Agenda for Change bands 7 and 8a should have a role in “day-to-day supervision [and] clinical/professional supervision” of junior pharmacy staff^​10​. 

Although this guidance is not directly applicable for those not employed by the NHS, many primary care networks and general practice roles advertise salary reimbursement equivalent to NHS Agenda for Change band 7 or 8a. Furthermore, market pressures means that pharmacist roles in community pharmacy have salaries that are at least equivalent and often higher than Agenda for Change banding.

With this level of responsibility intrinsic to the job, employers should prioritise time for pharmacists to take on DPP or DS positions within the remit of their current jobs.

Paid-for designated prescribing practitioners

Entrepreneurial members of the profession have tried to mitigate the lack of DPPs by working with private organisations to offer ‘paid-for services’ for qualified pharmacists studying to develop as pharmacist prescribers post-registration. Such services often cost individuals several thousands of pounds. 

It is imperative that there is governance in place so that those taking on such a role maintain their professional accountability when countersigning that an individual is competent to prescribe and that there is not any expectation that this signature will be automatic if the supervision time has been funded by the pharmacist prescriber in training. 

I have not yet seen any discussion about the appropriateness of using such services for foundation trainee pharmacists, and I would encourage NHS England to consider this within its review. 

While this delay to mandatory multi-sector placements is unfortunate, this should be seized as an opportunity. 

NHS England has time to review the wider funding model and structure of foundation training as part of the phased rollout of multi-sector placements to support our pharmacists of the future. The pressures on all healthcare providers have changed since the General Pharmaceutical Council published its update to the ‘Initial education and training standards’ in 2021.

The magnitude of the changes in legislation, allowing foundation year pharmacists to be able to prescribe at the time of registration, means it is imperative that as a profession we get this right. We have a responsibility to our colleagues and our patients to do so.

Newly qualified prescribers will need support in their ongoing development. National guidelines to inform this would ideally be created in tandem to a foundation training review, with sufficient flexibility to implement local solutions.