Members of the pharmacy profession are carrying out increasingly varied roles in the community, care homes and urgent care. The General Pharmaceutical Council (GPhC) says that now is the time to change pharmacy education to reflect the changing position of pharmacists in the health service.
In January 2019, the GPhC published proposals which, it claims, will integrate academic study and workplace experience for pharmacy students. The regulator proposes one set of standards and learning outcomes that will cover a five-year period of education and training, strengthening experiential learning and interprofessional learning. These standards will have a bigger focus on clinical and communication skills, while retaining critical scientific content.
There are also new requirements relating to selection and admission, including a requirement to assess the values of prospective students, as well as their academic qualifications, through activities such as multiple mini interviews or group work.
Here, a former GPhC council member and a pharmacy school head share their thoughts on the far-reaching proposals.
Yes: We need graduates with real-world experience
Source: Courtesy of Berwyn Owen
Berwyn Owen, former council member, General Pharmaceutical Council; chief pharmacist, Betsi Cadwaladr University Health Board
Pharmacy has had a tough time in recent years and, if pharmacy teams are to meet the demands of the future, we will need to balance expectations with realism. Our focus should remain in helping the public to realise the true value of medicines, in a safe and effective way. But it is increasingly evident that to secure the future skills and sustainability of our workforce, we need knowledge-rich graduates who have gained a great deal of experience of patient care during their undergraduate learning.
The General Pharmaceutical Council’s (GPhC’s) consultation on pharmacists’ initial education and training, which closed on 3 April 2019, marks an opportunity for pharmacy to transform pharmacists into truly patient-centered clinicians. It proposed replacing the current model of four years’ education and a preregistration year with 52 weeks of ‘learning in practice’ placements distributed throughout training, exposing students to patients in a range of settings at different stages of their education. This could be embedded within a five-year undergraduate programme, although the GPhC has not been prescriptive about how this could be achieved.
This confidence gap means pharmacists need a further two to three years of training to bring them to an equivalent level to other clinicians
The legacy of four-year undergraduate pharmacy education (which takes place mainly outside of the clinical environment) is most evident when our preregistration pharmacist graduates start working alongside trainee doctors, dentists, nurses and therapists, all of whom have been able to build clinical confidence and communication skills during early exposure to patient care in their undergraduate training. This confidence and exposure gap means pharmacists need a further two to three years of clinical training in the hospital and primary care to bring them to an equivalent level to other clinicians.
In 2016/2017, the health service in North Wales sought to close this skills gap and commissioned a multisector preregistration ‘pathfinder’ across acute hospitals, community pharmacy and general practice. Trainees were exposed to three four-month periods within each sector, rather than the traditional full year in one. The pathfinder was a transformative success: the trainees gained a better understanding of patient needs across different settings, and confidence in working as part of a multidisciplinary team. The Welsh government later announced the roll-out of multisector preregistration training across the whole of Wales, with an extra £3.6m in funding in 2020/2021, rising to £4.9m by 2023/2024.
The injection of funds will provide the foundation for accredited training academies across all sectors, and opportunities for undergraduate clinical placements throughout a five-year pharmacy programme. Pharmacy students will be able to gain interprofessional and patient-facing learning from year one, and the new model could also lift the current high-pressure focus on success at the preregistration examination.
Alongside this, the Scottish government plans to introduce a five-year integrated pharmacy degree from 2020/2021, and some universities in England have established five-year degrees for international students, who can undertake preregistration training as part of their degree on a student visa.
These initiatives demonstrate that, when government departments, funding bodies, health education and training bodies, schools of pharmacy and employers work collaboratively, we can realise the ambition of a clinically based five-year degree that develops a modern clinician-based pharmacy workforce that supports all sectors of the healthcare community.
No: There is little evidence to justify such a radical change
Source: Courtesy of Nigel Ratcliffe
Nigel Ratcliffe, chair, Pharmacy Schools Council; emeritus professor of pharmacy and head, School of Pharmacy, University of Keele
The GPhC seems to have arrived at a proposal that leaves one asking: what are the issues with the current standards for pharmacist training? Where is the structured evidence that suggests a need for such radical change? We need to see a risk–benefit evaluation of this suggestion, and of other means to the same end, before we rush to make major changes.
Importantly, the degree must remain appealing to students. If they’re going to have a fifth year, they will lose the salary that they would have received as a preregistration pharmacist, and they’re going to have another year of fees and maintenance considerations; a decision to take this course would not be taken lightly.
The move towards a five-year pharmacy degree has significant financial implications for universities and stakeholders
And the move towards a five-year pharmacy degree has significant financial implications for universities and stakeholders, who will need to find resources to organise and provide placements. Have those proposing this course of action got a full understanding of all the associated costs of a five-year course? We need a comprehensive breakdown of the costs and proposed solutions — it will not be straightforward. We need to make sure that pharmacy is still an attractive degree for universities to provide. A university is, after all, running a business, and if they must bear the costs; some vice chancellors may question whether they really want to run this course.
While any professional degree requires elements of communication and leadership training, we need to explore where and how this can be incorporated — but this should not come at the expense of the crucial science content; you cannot be a good communicator if you do not know what you’re communicating. It would be good to see a full evaluation of the skills and knowledge required in the multidisciplinary team, and to identify and build on those that differentiate the pharmacist from other members. If pharmacists do not have unique knowledge and skills, what do they have to offer?
Communication skills can be developed through experiential learning, which universities are already doing a great deal of, certainly compared with just a few years ago. Many universities are organising patient-facing interaction within the students’ first two months of the first year. You could argue that there has already been enough change in experiential learning.
We need to investigate whether there are more constructive, and more financially sustainable, changes that can be made more easily. There may be options that reach the same objectives without such upheaval. One option would involve putting a little more experiential learning into the first four years of the degree, and doing a little more work experience during the holidays; students would still complete a fifth year of one continual period of supervised clinical practice. Breaking up that year throughout a five-year undergraduate course risks the student becoming an observer, rather than a doer — an important part of training is living with accountability and responsibility.
Change is exciting and it must be embraced, but any change is worthy of detailed evaluation and careful consideration of other options. A move to a new model must be based on concrete evidence of feasibility and benefit.