The Pharmaceutical Journal
Vol 277 No 7410 p100
22 July 2006

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Could a review of pharmacy training benefit independent prescribers?

By Chijioke Agomo

The Government, as part of its developmental strategy for pharmacy, has once again displayed the importance of the profession of pharmacy in health care delivery by giving pharmacists the right to prescribe independently. Before this there were other landmark initiatives in pharmacy, such as the development of patient group directions, repeat dispensing, supplementary prescribing and medicines use reviews. Although each of these was developed with the main objective of reducing the pressure on NHS resources and, maybe, raise the profile of pharmacists as health care providers, none of them seems able to change the face of the profession as much as the independent prescribing right. However, many are wondering how prepared the profession is to take on the great opportunity offered by independent prescribing?

Community pharmacists are the group who are likely to benefit most from independent prescribing. They are already involved with counter prescriptions, the only difference being that their activities have been limited to pharmacy and general sale list medicines. Moreover, they do not have access to patients’ medical records and most of their recommendations are usually not documented. This is about to change through the NHSnet, which aims at linking the pharmacy computers with the NHS systems, including GP computers. The impact of independent prescribing for pharmacists is likely to be felt not only in the UK, but also around the world. At the same time, many critics, particularly in the medical profession, are wondering if pharmacists and nurses have the right training and attitudes to meet the challenges of independent prescribing. Although some of their fears may be genuine, many think that the loss of revenue and power to the medical profession contribute to these fears.

Framework

The Royal Pharmaceutical Society is already developing the framework under which independent prescribers will operate. Most pharmacists will be expecting a one-off course, which, when passed, will allow them to work as independent prescribers. I suspect that this training will probably take between six months and a year to complete. However, bearing in mind that community pharmacists are already engaging in over-the-counter recommendation, one could argue that further training, except in the area of documentation and guidelines, is not required to initiate community pharmacists as independent prescribers. To create flexibility in the role of independent prescribing, one might suggest that splitting the course into three parts, with all community pharmacists qualifying automatically for the first part, will go a long way to enhance participation. The first part of the course would allow only the prescribing of P and GSL medicines. The second part of the course, which will require qualification, could allow pharmacists to prescribe some prescription-only medicines, while further training and qualification in the third part of the course would be reserved only for those pharmacists with specialist interests. It is probably in the best interest of such pharmacists — and also for the safety of patients — that they limit themselves to three or four specialist areas. Patients who present with conditions outside their pharmacist’s area of competence would need to be referred to either fellow pharmacists with specialist training in those areas or to their GPs.

Lessons from abroad

Another important issue that will benefit pharmacists as independent prescribers is a review of pharmacy undergraduate and postgraduate training.

Not too long ago, I had the opportunity of witnessing pharmacy training in Nigeria. Pharmacy education there is more or less a prototype of the British system with a few adaptations from mainly the American and Canadian systems (countries in which there are much emphasis on studying clinical pharmacy at the undergraduate level). The desire to pay more attention to clinical pharmacy training in Nigeria was based purely on the need to put pharmacy graduates on a par with medical graduates in terms both of job satisfaction and of their ability to make useful contributions to the health needs of the nation. As a sequel to this, one of the leading schools of clinical pharmacy in Nigeria (University of Benin) has now introduced the PharmD degree (equivalent to five years of UK university training) in order to strengthen the clinical competence of its graduates.

The positioning of most pharmacy schools within the medical colleges in Nigeria enables students from pharmacy, medicine, dentistry and other biomedical sciences to interact effectively and even share lectures, thereby enhancing the use of resources, the sharing of ideas and the development of mutual respect among students and lecturers. For example, such arrangement allows pharmacy students to be taught biochemistry and physiology along with medical and dental students for almost a year. For the anatomy course, pharmacy students are taught separately by the medical school as their need for this subject is usually lower than that of medical and dental students. This becomes important because a weak foundation in these three subjects can weaken the understanding of certain core subjects such as clinical pharmacology and clinical pharmacy, and undoubtedly can affect the practice of pharmacists as health care providers.

Two-tier system

In the UK, where health care delivery and drug distribution systems are among the best in developed nations, pharmacy education does not have to follow the pattern described above. Although the health needs of a country like Nigeria are different from those of a developed nation like the UK, the skills and knowledge required of pharmacists to handle such varied health needs are about the same. In short, the UK would benefit immensely by training pharmacists up to the PharmD level (now popular in the US). This could be in the form of a two-tier system, in which those students not interested in clinical skills could opt for the MPharm degree and others would stay on at university to complete the PharmD degree. The focus of the PharmD degree could be geared towards producing pharmacists who can manage common diseases in the community setting, and at the same time are able to communicate effectively with medical doctors. The online version of the PharmD degree, as offered by the University of Florida to working pharmacists, could be a good source of revenue for UK pharmacy schools, thereby creating a win-win situation for the profession. Until recently, the need to train UK pharmacists to be clinically qualified was not necessary. However, this is also about to change, particularly with the expectation from primary care trusts for pharmacists to take up some of the commissioned services already provided by GPs.

Finally, encouraging all UK pharmacy schools to form alliances with medical and biomedical schools, and reviewing the pharmacy undergraduate and postgraduate training to produce clinically qualified pharmacists, would not only help to save resources for the NHS, provide greater choice for the public, and better the skills and motivation of independent prescribers, but would also further convince our critics that the pharmacy profession has a role to play in improving the health of the nation through independent prescribing.