The Pharmaceutical Journal
Vol 270 No 7230 p21-22
4 January 2003

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Pharmacist prescribing summary

The development of a curriculum for supplementary prescribing

Peter Wilson, MRPharmS, the Royal Pharmaceutical Society’s consultant on continuing professional development, describes the training that will be required for pharmacists to become prescribers and discusses the role of the Society

An education and training curriculum for supplementary prescribing by pharmacists1 was agreed by the Medicines Commission and the Committee on Safety of Medicines in September 2002 and by the Council of the Royal Pharmaceutical Society in October 2002. This raises two important questions: what training will be necessary to become a supplementary prescriber and what will be the role of the Society as the regulatory body?

Access to training

The Government has announced that training for pharmacists will begin in spring 2003 and up to 1,000 pharmacists and 10,000 nurses could be trained by the end of 2004.2 So although there are currently no training programmes available for pharmacists who wish to become supplementary prescribers, this position is likely to change rapidly. We can expect that some pharmacy education and training organisations will offer programmes and that the organisations providing training for nurse prescribers will also be thinking about extending their provision to include supplementary prescribing for both pharmacists and nurses.

For a pharmacist to gain admission to a training programme, they will need to have an identified prescribing role and be "sponsored" by a primary care organisation or NHS trust which has identified that supplementary prescribing will meet an identified service need and improve patient care. In addition, the pharmacist and sponsor will need to have identified a medical practi-tioner who will supervise and assess a period of learning in practice.

What is in the curriculum?

The curriculum describes what pharmacists should be able to do as a supplementary prescriber (Panel 1) and lists the underpinning knowledge and skills (Panel 2). It also outlines the initial education and training of pharmacists and describes how the level of relevant knowledge and expertise of pharmacists entering a training programme vary depending on the nature of their practice, the length of their experience and the conditions for which they will be prescribing. For example, some hospital pharmacists already monitor patients and adjust dosages; other pharmacists have wide experience of patients and their medicines but have not focused on specific conditions. The situation is further complicated by the fact that, although pharmacists will be monitoring patients and prescribing within an agreed clinical management plan, there will be no restriction on the range of medicines that pharmacists will be able to prescribe (except Controlled Drugs) or the conditions that can be included in the plan. So although the curriculum sets out what pharmacists need to be able to do, training programmes should allow pharmacists to achieve competence in prescribing by building on their existing knowledge and acquiring new knowledge and skills in areas relevant to prescribing, eg, pathophysiology, disease progression, the physical examination of patients and monitoring their responses to treatment.

Programme length

Experience with nurse prescribing programmes suggests that 25 to 27 days of study is required over a period of six months and the experience of colleagues involved in training nurse prescribers has been that students working together on prescribing-related tasks learn a great deal from each other.

Although pharmacists' learning needs and curriculum are different, programmes will need to include a significant element of class time and pharmacists will normally need to complete the whole programme. The diversity of pharmacists' background and learning needs, however, does mean that programme providers can make appropriate allowances for the range of pharmacists' experience and prescribing responsibilities by incorporating directed private study into their programmes. Programme providers will judge an appropriate balance between private study and class time.

In addition to theory, the pharmacist will be required to spend a minimum of half a day per week working in clinical practice supervised and guided by a medical practitioner. The practical experience involves gaining experience of working as part of the team, examining patients to monitor their responses to treatment and learning to prescribe for the conditions for which the pharmacist will take responsibility as a supplementary prescriber. This experience is essential to the development of practical competence and ensuring that the pharmacist can assess a clinical condition and spot problems. As the clinical experience is basic to patient safety, this element of the learning will be a key part of the assessment.

The role of the Society

Developing the curriculum is just a beginning. Pharmacists who are qualified as supplementary prescribers will have to be readily identifiable. The Royal Pharmaceutical Society's task force on prescribing by pharmacists3 recommended that the register should be the principal source of this information. Implementing this recommendation will require the development of a new framework by the Society to accredit prescribing courses and help quality assure the competence of pharmacist supplementary prescribers. A system will also be needed to monitor the CPD of prescribing pharmacists, including development into new clinical areas and, in the longer term, probably incorporating revalidation for prescribing.

The recognition of pharmacists as supplementary prescribers will be the first time that pharmacists have been formally accredited for a specific role by the Society. So the development of a curriculum is a first step towards potentially significant change. Training as a prescriber (either supplementary or independent) is likely to become an integral part of the undergraduate degree, with learning in practice taking place after appropriate experience in pharmacy practice. So, in time, with a combination of undergraduate training and postgraduate programmes, all pharmacists could be eligible to take on prescribing responsibility.