Preceptorship: the key to unlocking advanced pharmacist practice

Expectations of advanced practice roles are expanding across healthcare, driven by NHS workforce strategy, professional strategy from professional bodies such as the Royal Pharmaceutical Society (RPS), and the strategic vision of the General Pharmaceutical Council (GPhC), reflecting the need for greater clinical contribution, patient-centred practice and workforce efficiency^​1–3​. 

Advanced pharmacist practice is an established ambition, yet progress in embedding these roles across sectors remains slow and patchy, leaving individuals and teams navigating a complex and often unclear landscape^​4–6​. 

While the ambitions of these organisations for advanced pharmacist practice are high, the reality of implementation is challenging^​1–3​. Advanced roles require not only individual competence, but also clear role definitions, organisational understanding, a supportive culture, an appropriate range of skills across the pharmacy team, and patient and multidisciplinary collaboration^​7​. Without these foundations, even the most capable practitioners may struggle to fulfil their potential and deliver consistent patient benefit.

In practical terms, an advanced pharmacist is one who can apply experience and professional judgement in situations where clear guidance may not exist, across multiple domains – clinical practice, leadership/management, education and research^​8​. In the clinical practice domain for example, this involves using professional judgement to make decisions that account for frailty, multimorbidity, diagnostic uncertainty, polypharmacy, shared decision-making and other patient-specific factors, adapting guideline or licence recommendations when appropriate to optimise outcomes. Similar expert judgement is required across other domains, as advanced practice also encompasses leadership within multidisciplinary teams, contribution to service improvement and the education of others. Advanced pharmacists act as both clinical experts and system collaborators, helping to shape services, support colleagues and embed a culture of quality improvement.

Several factors make the transition to advanced practice difficult. Pharmacists may lack confidence and structured support when moving into senior roles with greater responsibilities, while awareness among multiple healthcare stakeholders of what advanced practice entails remains limited^​9,10​. In effect, the challenges of advanced practice often stem from insufficiently supported transitions: even experienced and capable healthcare professionals may struggle to consolidate skills, exercise professional judgement and develop confidence across all domains without structured support. Current workforce structures do not always provide appropriate four-pillar roles, leaving some healthcare professionals without clear pathways for development^​4​. Recent data show that one in four NHS trusts and health boards do not provide protected learning time for pharmacists, which may limit progression into advanced roles^​11​. 

Beyond pharmacists, skill-mix issues compound the problem. Pharmacy technicians who have been overlooked in workforce development for years, alongside often underdeveloped or underutilised support staff, are vital to the effective functioning of the pharmacy team. It is hoped that the government will acknowledge this need in forthcoming updates to the NHS long-term workforce plan, expected in 2026, including consideration of protected learning time and wide range of skills. 

Ultimately, gaps in understanding, strategy and culture constrain both individual development and team performance, with potential consequences for patient care.

Preceptorship is a structured form of point-of-care supervision that helps healthcare professionals refine and consolidate their skills, while developing professional confidence as they move from one career stage to another. The relationship is intentionally time limited and highly focused, providing a bridge between career stages and a clear pathway towards initial functional capabilities in new roles^​12​.

Preceptorship in pharmacy

Although the term ‘preceptorship’ is not yet commonly used within pharmacy, it is a well-established form of supervision in other healthcare professions^{​12–15​}. Preceptorship is clearly distinct from mentorship, where a mentor offers a long-term relationship focused on career and professional socialisation, often extending across organisations and broader clinical supervision, where a clinical supervisor provides semi-structured support with an emphasis on clinical performance and reflection. This helps to ensure the specific purpose of preceptorship is understood. 

In contrast, a preceptor, who is typically a healthcare professional of an equivalent or senior level to the preceptee, and within the same discipline, forms a functional, short-term partnership centred on skill rehearsal, observation and feedback^​12,16​. 

While preceptorship programmes often focus on development of clinical skills, programmes may focus on different aspects of practice depending on the preceptees’ own learning needs^​12​. This could include development of skills in pillars beyond clinical practice. During clinical practice preceptorship, the pharmacist and preceptor work side-by-side, often observing each other’s clinics or patient reviews. Early focus centres around demonstrating and repeating crucial clinical skills, such as structured consultation, clinical assessment or therapeutic decision-making. As confidence grows, the balance shifts: the preceptee takes increasing responsibility, with a full caseload while the preceptor provides supportive observation and feedback. Regular review meetings ensure progress is discussed, learning needs are identified and met, and professional growth is documented. 

Preceptorship programmes are associated with strengthened professional identity, improved integration within teams, increased job satisfaction and help foster a sense of belonging — all factors linked to staff retention and organisational stability^​15​. They also provide an enabling structure for pharmacists transitioning into advanced roles^​17​. They support the development of reasoning in complex situations, enhance self-efficacy in autonomous decision-making and strengthen leadership and educational capability. By embedding skill rehearsal, reflective discussion and real-time feedback into everyday practice, preceptorship helps translate theoretical knowledge and skills into confident performance and competence.

Whole-team approach

From an organisational perspective, preceptorship can clarify expectations of advanced roles and promote a culture of shared learning. The preceptor–preceptee relationship models professional collaboration, encouraging open dialogue about clinical uncertainty and role boundaries. Extending preceptorship beyond pharmacists to include pharmacy technicians and support staff fosters a whole-team approach to development. When all members of the pharmacy workforce understand their responsibilities, feel supported and have opportunities for structured progression, the collective capacity for patient-centred care is strengthened.

Any attempt to develop advanced-level professionals, including through preceptorship, requires structural support and cannot rely on goodwill or luck. Important considerations include ensuring protected time for learning and reflection, which is currently not universally available^​11​; supporting preceptees who may vary in confidence and clinical decision-making readiness; clarifying preceptor and team roles; engaging stakeholders; and fostering a workplace culture that understands and values advanced practice. 

Developing advanced pharmacists requires more than preceptorship alone. After an initial consolidation period, practitioners may benefit from additional approaches to the delivery of clinical supervision, including peer review and regular case-based discussion, to support ongoing growth and safe, autonomous practice. At present, clinical supervision in pharmacy is not always consistently structured, with expectations of supervisors and supervisees varying between organisations. A more deliberate approach could include point-of-care supervision to refine clinical decision making, educational supervision to guide longer-term development and reflective supervision to provide space for uncertainty and the emotional demands of practice. Establishing a clearer, more consistent supervision framework would help sustain development beyond preceptorship and provide the continuing professional support advanced pharmacists require.

Given the multifaceted challenges in embedding advanced pharmacist practice, there is a clear need for structured support mechanisms. Preceptorship offers a promising approach to address the support gap, providing a structured framework for skill development, professional confidence and integration into complex clinical roles^​13​. While evidence in pharmacy is currently lacking, experience from other healthcare disciplines suggests that preceptorship is feasible and potentially impactful^{​12–15​}.

There is strong consensus on how pharmacy professionals can explore the impact of preceptorship programmes further^​17​. Senior leaders and educators seeking to embed and sustain advanced pharmacist practice should actively commission, pilot and evaluate preceptorship models in real-world practice settings, including hospital, primary care and community pharmacy, to determine feasibility and impact. By doing so, they can ensure that development pathways for advanced pharmacists are equitable, structured and resilient, and that workforce development is guided by evidence and strategy, rather than chance or goodwill. Structured exploration of preceptorship is therefore a necessary step toward achieving the ambitions of advanced pharmacist practice at scale.