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Pharmacist prescribers: is finding a mentor a barrier to accreditation?

In order to enrol on a supplementary prescribing course, pharmacists need two things: a medical supervisor and a specified service for which prescribing will be required. Many pharmacists have successfully found a mentor and qualified as prescribers but for others finding a supervisor has proved harder than they imagined. What it seems to come down to is location and the sector in which the pharmacist works.

Amanda Evans, deputy head of medicines management at Burntwood, Lichfield and Tamworth Primary Care Trust, is the PCT’s lead for non-medical prescribing. All requests for prescribing training are made to her. “None of the pharmacists who have applied so far has had a problem finding a mentor but, having said that, all are practice pharmacists who are already working closely with GPs. We have not had any applications yet from community pharmacists,” she said.

A similar picture has emerged in London. Anne Lovejoy, pharmacy practice lecturer at King’s College, told The Journal: “I do not have any evidence, but the impression I get from talking to pharmacists enrolling on the course is that community pharmacists find the process harder than hospital pharmacists. Hospitals seem to be set up for training so pharmacists just slot into an existing system. Similarly, practice pharmacists and prescribing advisers find the process relatively easy because already they have the support of the PCT.”

Other universities paint a slightly different picture. At Keele University, Pat Black, director of postgraduate studies, commented: “Our experience has been positive and we have not come across any particular issues. Yes, there has been the odd student who has changed supervisor but that is usually for logistical reasons within a GP practice. I would say that there may be individual cases of pharmacists having difficulties with supervising doctors but it is not a general pattern.”

Brian Addison, pharmacy practice lecturer, Robert Gordon University, Aberdeen, also believes most pharmacists can find a mentor. “We have heard of certain locations where local politics seem to create problems but it is certainly not widespread,” he said. However, he noted the following caution: “Having a medical supervisor is a requirement of the course, so we would not necessarily know the whole degree of the problem because we only see those pharmacists who make it onto the course.”

Perhaps this is demonstrated by the experience of one pharmacist, who asked not to be named. She explained: “It is difficult to find a GP mentor. They want something in return for helping you and they are still uncertain about the pharmacist’s role in prescribing. I have had to persuade my mentor that I can be of benefit to him by seeing the patients the practice is struggling to see. This ticks boxes in the GP contract but what I would really like is someone who is interested in training me to work effectively in their team, rather than feeling I have to prove myself first.”

An issue mentioned by a number of pharmacists is money. Some doctors think they should be paid to be a mentor, particularly if the pharmacist works in a different location to them. Ms Evans pointed out that nurses in primary care have had fewer problems than pharmacists finding doctors to supervise their training because they are direct employees of GP practices.

Sharon Maxted, medication review pharmacist, Rugby PCT, reports mixed experiences. “My GP approached me about supplementary prescribing so that I could make better use of my time supporting him with clinics. He could see the potential benefits and was not concerned that he would not be paid for the supervision time,” she said. “But when another surgery, which was considering supporting a medication review pharmacist through the course, found out that there was no payment, it backtracked. This was despite the fact that we are a ‘free’ resource paid for by the PCT and that the course itself would be funded through the local workforce development confederation,” she added.

Something that must be recognised is that supplementary prescribing is still in its infancy. As Bob Saunders, prescribing adviser, Wolverhampton City PCT, commented: “In the early days of the first cohort, it was difficult because there was no real understanding of what was required of medical supervisors in terms of both support and workload.”

Perhaps many of these problems will be solved as more and more pharmacists undertake the training. Encouragingly, pharmacists are helping their colleagues. Amy Chan, a locum community pharmacist in Glasgow, said: “I had help from an established pharmacist supplementary prescriber to find a GP mentor. As a locum moving from place to place, it is difficult to build rapport with any one GP practice. If I had to approach a random GP it would not have been an easy task to persuade them to mentor me.”

Art of persuasion

How should a pharmacist persuade a doctor to supervise his or her prescribing training? “Demonstrating a clinical need for the service is key. It is much easier to persuade a doctor to become a supervisor if they can see the potential outcome of the time invested in training,” explained Mr Addison. In today’s target-driven world, ensuring a pharmacist-run service will meet a target is bound to be a winner. For example, setting up a clinic in a community pharmacy can reach patients who do not attend GP practices.

“Initially we approached innovative GPs with significant training experience and a role in the PCT, for example, prescribing leads,” said Mr Saunders. “They were predisposed to try something new and possibly challenging. They were used to training health professionals and they understood the future need for more prescribers.”

One of the biggest concerns for potential medical supervisors is finding the time to support a trainee. Mr Addison commented: “GPs ask how they can spare 12 days for the training. But it is not a requirement for the GP to support each of the 12 days on a one-to-one basis. Some can be delegated, perhaps to a nurse or an existing supplementary prescriber.” But he added that at the end of the training it is the GP’s responsibility to ensure that the pharmacist is competent.

Another suggestion is to split the training into small chunks so it seems more manageable, for example, two days learning specific skills then two days observing consultations and so on. Presenting the training to a GP in this way makes it appear less daunting.

Maybe the most important thing is to keep trying: the practice mentioned earlier which pulled out of training a pharmacist was, eventually, convinced of the idea. The trouble with all new ways of working is that they rarely come easily.