Within the last few weeks, at least six pharmacists have been subjected to interim order applications - either suspended or had significant restrictions
placed upon their registration pending a full 'Fitness to Practise' hearing into serious allegations being made about their prescribing practices, the Pharmacists'
Defence Association (PDA) has found.
It said that there has been a "dramatic increase in action being taken by the pharmacy regulator (GPhC) against pharmacist prescribers associated with certain types
of online prescribing services".
It has warned pharmacist prescribers who work for online pharmacies about the specific risks associated with remote prescribing using a questionnaire-based model,
typically with no direct prescriber/patient interaction.
Common features that underpin the allegations include the following: Overreliance on a patient questionnaire to inform clinical decision making; No patient/prescriber
interaction; Prescribing high risk medicines without adequate safeguards; Inadequate systems and processes leading to inappropriate prescribing; Very high volumes
of prescriptions being authorised in short periods of time; and Prescribers/patient relationship established via an unregulated online portal.
Boots is planning to invest more than £3.5 million to accelerate its capacity to offer prescribing services in its stores across England.
The company is inviting 500 of its pharmacists to apply for a bursary which will cover the cost of pharmacist independent prescriber (PIP) courses starting this
September.
The value of the bursary is up to £7,000 per pharmacist, and it will enable time off work for those who need it to complete the training.
The move by Boots will support its current pharmacists to gain this qualification via courses accredited by the General Pharmaceutical Council (GPhC). From 2026,
all qualified pharmacists will be able to prescribe as part of new curricula for pharmacy degrees.
Under current GPhC guidelines and with an independent prescribing qualification, pharmacists can prescribe autonomously for any condition within their clinical
competence.
Marc Donovan, the chief pharmacist at Boots, said the ambition of the company was "to have a pharmacist prescriber available at every store".
Health Education England (HEE) has announced launch of a new funded Independent Prescriber courses for pharmacists to be made available before March 2022.
Places are available for both Independent Prescribing (IP) and Clinically Enhanced Independent Prescribing (CEPIP), and eligible pharmacists are encouraged to apply to the course providers directly.
These courses will be allocated on a first come, first served basis, and a further round of funded Independent Prescriber training will be made available from Autumn 2022.
The independent prescriber guide offers practical guidance and support on the prescriber role, such as how to become an independent prescriber, applying for an IP course, or expanding the scope of practice.
Healthcare reform emerged as a cornerstone of the Labour Party's manifesto leading up to the recent general election. A standout pledge was the establishment
of a Community Pharmacist Prescribing Service, aimed at granting pharmacists independent prescribing rights where clinically suitable. This initiative is seen as a
positive step in addressing critical challenges within the National Health Service (NHS).
Numark Chairman Harry McQuillan praised Labour's recognition of pharmacists' role in patient care through expanded prescribing rights.
"Let's be honest, pharmacists are an underutilised resource within the healthcare system. We possess extensive training and expertise, yet our full potential
hasn't always been acknowledged.
"By harnessing pharmacists expanded prescribing rights, Labour is acknowledging our significant role in patient care. This initiative aims to recognise our skills
and enhance patient care, ensuring quicker access to necessary treatments," he said.
However, he pointed out that the concept requires further exploration, as the rights to prescribe are already granted through the recent change to undergraduate
training that incorporates prescribing.
The fusion of the unique in-depth understanding of medicines by pharmacists together with the competence to prescribe offers will improve access to care and
increase capacity in the health system, said the Royal Pharmaceutical Society (RPS) Director for England Ravi Sharma to Parliament at the Health and Social Care
Select Committee's inquiry on workforce on Monday (May 23).
However, he also stated that a new workforce strategy must support and harness the skills of pharmacist independent prescribers in clinical care with investment
in training, both for new and existing workforce; access to supervisors; protected learning and development time; and commissioning of services to make best use of
independent prescribers across care settings, supported by appropriate prescribing budgets in community pharmacy.
"We're about to see new generation of pharmacists independent prescribers that will make a huge difference to the clinical role of pharmacists to support patient care, but this must be underpinned by protected learning time and a more ambitious approach to commissioning new services to use their skills," Ravi said.
He spoke to MPs in Parliament at the Health and Social Care Select Committee's inquiry on workforce, highlighting the vital contribution of pharmacy teams during
the pandemic and called for action to support the current and future workforce.
Some of the key issues highlighted in the parliament included, the risk of burnout and the need to help boost staff retention; staff wellbeing, including a zero tolerance of abuse from the public; the importance of professional development and protected learning time to enhance patient care and support rewarding careers; the potential of new pharmacist independent prescribers and the need for investment in the current workforce and the need for better workforce data and a pharmacy workforce strategy.
Health Education England (HEE) has developed funded training offers for community pharmacists, including locums aiming to become independent prescribers.
Almost 3000 independent prescribing training places will be available to pharmacists from March 2023.
This training enables pharmacists to support patients from diagnosis to prescribing, and to provide advice and follow-up - while also helping them to feel confident
and prepared for the new challenges of their role.
Courses will be available between April 2023 and March 2024, with several universities offering multiple dates for cohort intakes. Start dates will depend on the
university provider.
Training will enable the provision of new models of care: supporting patients from diagnosis to prescribing, providing advice and follow-up, and preparing pharmacists
to provide clinical care, as pharmacy services become more widespread within emerging clinical pathways.
With the Labour Party now in power, there is keen interest in the healthcare initiatives they pledged during their election campaign and how these proposals
will shape the future of NHS.
One of the key pledges in their healthcare reform is the introduction of the Community Pharmacist Prescribing Service, which aims to empower pharmacists with
independent prescribing rights where clinically suitable.
While pharmacists appreciated Labour's acknowledgment of their role in patient care through expanded prescribing rights, they foresee some challenges in
implementing the service.
"Budgets will be a key issue," said Pharmacist Thorrun Govind, also a Healthcare Lawyer (Brabners LLP).
However, she noted that, given the success of pharmacist prescribing services in the devolved nations, there is "a road map in place."
To help transform care for patients, the Royal Pharmaceutical Society (RPS) is calling on the General Pharmaceutical Council (GPhC) to remove the two-year post qualification wait for pharmacists before they are allowed to start their independent prescriber training.
RPS proposes that entry to training should be based on whether pharmacists can evidence the necessary skills, knowledge, and experience to undertake the training, and not the length of time a pharmacist has been on the register.
RPS president Claire Anderson said: "We've campaigned strongly for better use of pharmacist independent prescribers, who are becoming essential to multi professional teams in all health care settings.
"We want to ensure pharmacy remains an attractive career and has parity with the other professions. Pharmacist prescribing is now moving from being a skill only associated with advanced specialist levels of practice to a more generalist scope, providing a workforce that's more flexible with a shared set of capabilities.
The Pharmacists' Defence Association (PDA) has raised concern over the Health Education England (HEE)'s decision on cutting funding to independent prescribing
training.
The HEE has reportedly decided that no funding will be available to back-fill trainees undertaking the pharmacist independent prescribing (PIP) qualification, or
for the supervision of trainees by DPPs and DMPs.
The PDA noted that, whilst all successful trainee pharmacists will be entering the GPhC register as independent prescribers from 2026, the existing pharmacist
workforce is reliant on opportunities to undertake prescriber training through release from their employment, and the ability to secure a Designated Medical
Practitioner (DMP) or Designated Prescribing Practitioner (DPP) to support the 90 days of supervised practice required.
The association said it has already heard examples of potential DMPs or DPPs requesting a significant fee from trainees before they will provide supervision,
adding that meeting that request is not an option for many.
"This latest decision threatens to undermine the availability of the large numbers of pharmacists seeing supervisors as more IP training becomes available," it
said in a statement.
The General Pharmaceutical Council (GPhC) has raised concerns over the rising risks related to online pharmacy services.
It revealed over 30 per cent of its open Fitness to Practise (FtP) cases were related to online pharmacy, which is disproportionate to the sector of the market that
online services occupy.
The regulator has advised pharmacists and pharmacy owners providing online services that they should "not work with online providers who try to circumvent the
regulatory oversight put in place within the UK to ensure patient safety".
In the past five months, the Council has imposed seven interim orders on the registration of pharmacists who have worked for or with online prescribing services -
after identifying serious concerns with their practice.
It said: "These pharmacists were working as pharmacist independent prescribers for online services or were dispensing medicines prescribed online. Some of these
pharmacists were the Responsible Pharmacist (RP) or the Superintendent Pharmacist (SP)."
The Pharmacists' Defence Association (PDA) says the pharmacy regulator should maintain a two-year post qualification eligibility criteria, in addition to
the qualitative measures being introduced which would be in the best interest of patient safety, before a pharmacist is allowed to commence an IP course.
The association was responding to an announcement by the GPhC's move to scrap the two year requirement for Independent Prescribing (IP) course.
"The PDA accepts that the qualitative approach could mean greater individual consideration of potential IP course candidates and the two-year measure could have
sometimes been a blunt tool. However, the PDA is already seeing cases of patient harm and allegations around fitness to practice arising from IP," the association
said.
The association also said that it supports individual pharmacists with near misses, as well as actual incidents, giving the organisation possibly the most
comprehensive understanding of risk.
Frontline pharmacists also recognise these issues and in a survey of over 1,000 pharmacists undertaken by the PDA in late 2021, of those who had 2+ years'
experience of practice and who were already independent prescribers, 90 per cent said the qualifying period should be two years or more.
Centre for Pharmacy PostGraduate Education (CPPE) has announced the launch of a new learning programme, Preparing to train as an independent prescriber.
The programme aims to build the confidence and competence of pharmacists who are planning to apply and train as independent prescribers and is open to pharmacists
from all sectors of practice, including community pharmacists who are planning to commence their independent prescriber training with a Higher Education Institute
(HEI).
The course is made up of four main components, including a self-directed e-course and self-assessment framework, a mandatory online workshop to support you to review
your self-assessment of competencies, an optional online workshop to support your readiness for academic writing and reflective practice, and optional peer support
sessions, providing the opportunity for you to develop your professional network and establish communities of practice.
The Royal Pharmaceutical Society (RPS) has introduced a new comprehensive learning programme to support pharmacists in Wales to deliver the Pharmacy
Independent Prescribing Service (PIPS).
Developed in collaboration with Health Education and Improvement Wales (HEIW), the programme is designed to "equip pharmacists with the essential knowledge,
skills, and confidence needed to provide excellent patient care."
While the primary emphasis is on pharmacists operating within primary care settings, those from various practice settings are also encouraged to register and
participate in the programme.
Commenting on the collaboration with HEIW, Elen Jones, director for Wales at the Royal Pharmaceutical Society, said that it will empower pharmacists across the
country to deliver high-quality prescribing services to local communities.
Pharmacists with 'relevant experience in a pharmacy setting' can enroll for accredited independent prescribing course, as the General Pharmaceutical Council (GPhC) has decided to scrap the requirement of spending at least two years on the register and having previous experience in a specified clinical or therapeutic area before enrolling for the course.
The GPhC Council meeting held on Thursday instead proposed that applicants must have "relevant experience in a pharmacy setting and be able to recognise, understand
and articulate the skills and attributes required by a prescriber." This experience and awareness will act as the basis of their prescribing practice whilst training.
The regulator noted that the majority of stakeholder organisations, including the Chief Pharmaceutical Officers, the Royal Pharmaceutical Society and the statutory education bodies, were in favour of removing the requirement in a consultation on the topic.
They highlighted that a specific two-year period was not in itself a robust indication of whether an individual was ready to become a prescriber.
They also highlighted that the rapidly developing roles in the profession meant more pharmacists were likely to gain the necessary experience more quickly than in the past. A smaller number of organisations and a larger minority of individuals were opposed, citing that a specific two-year period gave pharmacists the time they needed to develop experience and confidence before being ready to enrol on a course.
The General Pharmaceutical Council (GPhC) has announced that the new requirement for independent prescribing courses will be applicable from 1st of October 2022.
Pharmacists currently taking independent prescribing courses and those who apply before 1 October won't be affected by the changes.
The new guidance was agreed at the council meeting on 8 September and went to the initial education and training Advisory Group on 22 September where it was well
received, the GPhC said.
"The guidance is now being finalised to reflect the discussions at the Council meeting and the initial education and training advisory group and will be published
in October."
The new guidance is relevant for both course providers and applicants and gives some specific suggestions and examples of what we may expect. It will support
consistency in the way education providers applied the new standards and will help individual pharmacists to understand the relevant experience they would need
before enrolling on a course.
The Council of the Pharmaceutical Society NI (PSNI) to remove the two-year requirement as a registered pharmacist to have an Independent Prescriber (IP)
annotation on the pharmacy register in Northern Ireland.
It has further endorsed that the two-year requirement for entry onto stand-alone pharmacist independent prescribing courses be removed and replaced with an
assessment before admission, by course providers, based upon guidance provided by the regulator.
In conjunction with the Department of Health, the PSNI will now work towards a further public consultation on the necessary legislative changes.
Dr Jim Livingstone, president of the PSNI, said: "The Department of Health has set a clear direction which will see pharmacist independent prescribers becoming
increasingly important in the delivery of pharmacy services in Northern Ireland. Our role is to protect the public, but we are clear that our regulatory objective
should not be an unnecessary barrier to the development of the profession and enhanced services being provided to the public."
A new NHS-funded training course on clinical examination skills has been announced by Health Education England (HEE) for 10,000 community pharmacists.
The training will be provided by CliniSkills and be coordinated by HEE with the Pharmacy Integration Programme at NHS England.
With pre-registration now open to all community pharmacists, the programme will be available from 17th April 2023 and will until March 2024.
It will be delivered online, with optional face-to-face attendance for pharmacists who would find this beneficial.
Pharmacists will be required to complete a module on history taking and identification of serious conditions and can then choose from four optional modules,
which cover the following themes: dermatology; cardiology; paediatrics; and ear, nose and throat.
The training is designed to be complementary to the independent prescribing training and can be completed prior to or after an independent prescribing training
course. It is open to all community pharmacists including those that work part time and locums.
Two more independent community pharmacists have been appointed to the UK Commission on Pharmacy Professional Leadership.
NPA board member Reena Barai and Sheelin McKeagney from Lurgan in Northern Ireland will join 25 other commission members, including Ash Soni who was the only
practising community pharmacist on the initial list published in June.
Welcoming the announcement, the National Pharmacy Association chief executive, Mark Lyonette, said: "To their great credit, the co-chairs of the commission and the
UK's chief pharmaceutical officers have listened to our request for more community pharmacy presence on the commission. They have acted swiftly to achieve a better
balance in its membership and we thank them for responding to our representations.
"Around 70 per cent of pharmacists practice in the community. With more voices from community pharmacy within the leadership commission, there is a greater sense
that the profession as a whole will be able to own the final recommendations when they are ultimately made."
Community pharmacy bodies have said that the current crippling financial pressures and severe staff shortages will limit the sector from fully supporting the
new health secretary's ambition to improve patient care in England.
Thérèse Coffey announced her plans on Thursday (September 22) which would be looking to reduce the country's reliance on general practice by expanding the range of
services available from community pharmacies and allowing pharmacists more "prescribing powers".
"Pharmacists will be able to manage and supply more medicines, without a prescription from a GP. We will look to go further on enabling pharmacists with more
prescribing powers and making more simple diagnostic tests available in community pharmacy," she said in her foreword to Our Plan for Patients.
However, the National Pharmacy Association has lamented that the plan stops short of promising any fresh funding for community pharmacies to deliver patient care
and develop clinical services.
NPA vice-chair, Nick Kaye, said: "The life is being choked out of independent pharmacy businesses by the continuation of a fundamentally under-resourced contract
in England.
The government has unveiled its much awaited 'NHS Long-Term Workforce Plan' to tackle the staff shortage in the pharmacy sector. The plan set out an ambition
to increase the training places for pharmacists to around 5,000 places by 2031/32.
David Webb, Chief Pharmaceutical Officer for England, in his open letter to pharmacy professionals said: "The NHS LTWP sets out how we can build on changes,
addressing the changing needs of patients over the next 15 years, by closing the current workforce shortfall through funding for increased education and training
places and a comprehensive retention strategy."
The plan commits to expand training places for pharmacists by 29% to around 4,300 by 2028/29 and Grow the number of pharmacy technicians in future years.
"The development of independent prescribing as part of initial education and training is a gamechanger for pharmacists, patients and the NHS, with
approximately 2,800 newly registered pharmacist independent prescribers due to join the workforce every year from September 2026," said Webb.
"This will be transformational for all pharmacy teams, creating improved access and quality of care for patients and, importantly, a more flexible workforce with
skills that are equally applicable in all pharmacy settings, enabling multi-professional clinical teams to work in new ways."