The Pharmaceutical Journal
Vol 270 No 7242 p438-439
29 March 2003

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Letters to the Editor

Pharmacist prescribing

Doctors need more training on prescribing

From Mrs Y. Haarhoff, MRPharmS, and Mr J. P. Anthistle, MRPharmS

The Pharmaceutical Journal (4 January) reported major changes in pharmacy practice: the right to prescribe. Although we read the articles with great interest, there are aspects that need urgent attention.

Medical practitioners have had the legal right to prescribe since the 1858 Medical Act. This right has never been questioned; instead, it has always been assumed that doctors are trained in the act of prescribing and as a result are expected to be competent. The decision to appoint doctors to supervise and train nurses in prescribing was probably based on this assumption, which clearly has also been accepted by the Royal Pharmaceutical Society and applied in this new scenario of pharmacist training for prescribing.

The reality is unfortunately quite the opposite. Medical students in the United Kingdom are taught clinical therapeutics, which includes the selection of drugs for specific indications. Unfortunately, little or no formal practical prescribing training or application of their prescribing ability takes place during their years at university. These skills are normally acquired during their year as a preregistration house officer.

The National Prescribing Centre has identified clear competencies for nurse prescribers. The same competencies acted as a basis for determining the competencies required by potential pharmacist prescribers. Training programmes have been designed around these competencies and have already commenced for future nurse prescribers. The supplementary prescriber must demonstrate these competencies before they will be allowed to prescribe. In stark contrast, no competencies exist to use as a basis for training or assessing the prescribing ability of medical students, or medical practitioners. Yet, according to the Royal Pharmaceutical Society, it is the latter group that will be required to act as trainers and supervisors of supplementary prescribers.

One would think that a pro-active view on practical prescribing as part of medical education should be of utmost importance. The General Medical Council has identified this possibility by stating clearly in its document "Tomorrow's doctor" (June 2003) that medical students must be able to perform accurate drug calculations and to write prescription for analgesics and antibiotics. The GMC further requires these two competencies to be signed off before doctors' full registration, but no standardised assessment exists to ascertain and evaluate achievement against these competencies.

In some trusts the prescribing ability of preregistration house officers is assessed. In the majority of these cases, the pharmacy department carries out these competence assessments — that in itself is ironic.

With the current focus on medication errors, the cost to the NHS in additional hospital days due to medication errors, the establishment of the National Patient Safety Agency and the goal of the Department of Health to reduce medication errors by 40 per cent by 2005, the importance of training and actively teaching practical prescribing in the undergraduate medical course becomes an issue of national importance. Competencies need to be agreed and assessment of the prescribing ability of preregistration house officers should be a prerequisite to their full registration.

Yolinda Haarhoff
Pharmacist Teacher Practitioner
Cambridge Graduate Course for Medicine

John Anthistle
Chief Pharmacist
West Suffolk Hospital

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