The foundation training year: an introduction

The current cohort of trainee pharmacists are now well into the first ever pharmacy foundation training year, which has replaced the former pre-registration year as part of major reforms to the initial education and training of pharmacists. 

Although headline changes such as integrated independent prescriber training are expected to be introduced gradually, pharmacies, supervisors and trainee pharmacists have been getting to grips with the new requirements since the GPhC published a revised set of standards for the initial education and training of pharmacists in January 2021.

Perhaps reassuringly for trainee pharmacists and their employers, there has been little immediate change. The initial 2021/2022 foundation year uses the same progress reports and assessment summaries that were in place for previous pre-registration trainees. Neither will any previously approved training plans need to be replaced. Instead, there are new interim learning outcomes from the GPhC and, in England, Health Education England will support the assessment of trainees against these outcomes.

"The hardest part is learning the new terminology!" says Babir Malik, foundation and pharmacy student training lead at Weldricks Pharmacy, who is responsible for interviewing and placing trainee pharmacists across the group’s 60 branches. "But in essence it is still one year of training before registration – it has just had a name change. The tutors are now called supervisors and the pre-regs are trainee pharmacists, while performance standards have become learning outcomes."

New standards

The new standards for education and training leading to registration came into force in October. Interim learning outcomes will bridge the gap between the old performance standards and the introduction of new learning outcomes that will run across years one to five of pharmacist undergraduate and pre-registration training in England, Scotland and Wales.

It is important to note that this is just the first step in a five-year phased plan that will introduce new learning outcomes for pharmacist education and training, and for those who supervise and educate them – whether they are supervisors in a pharmacy or those responsible for the MPharm degree at the various schools of pharmacy. 

A key distinction between the old and new education and training standards is the inclusion of pharmacist independent prescribing training. However, the GPhC recognises that this cannot be introduced immediately so the interim learning outcomes do not require 2021/22 trainees to have independent prescribing training. 

Nevertheless, prescribing is becoming an essential clinical skill for pharmacists and, after extensive discussions with the statutory education bodies (SEBs), employers and other stakeholders, the GPhC expects to include the requirement for independent prescribing in later iterations of the transitional learning outcomes.

Why the changes?

It has been ten years since the last set of standards for pharmacist education and training were introduced and a lot has happened in pharmacy and indeed the health service since then. The new standards document from the GPhC explains that the NHS and the society pharmacy serves have changed considerably in recent times and that the educational standards for pharmacists need to reflect this. 

Citing factors like increasing life expectancy, polypharmacy and the integration of health and social care in the UK, the regulator says this calls for a more person-centred approach when training the pharmacists of the future. 

The new standards document specifically cites "ambitious healthcare strategies in Great Britain and Northern Ireland" and points out that "all of these refer to the role pharmacists and pharmacies can play in bringing about change, and the skills they will need to do this – including prescribing."

The Covid-19 pandemic has only served to emphasise the need for these changes, says the GPhC, adding: "The global pandemic highlighted why these changes are so important and need to be brought in quickly. We need to make sure future pharmacists have the necessary skills and knowledge to play a bigger part in delivering care."

Foundation year key elements

First, let’s consider what is staying the same. Pharmacy students will still study for four years at university on the MPharm course and spend a year gaining experience in practice before they register as a pharmacist.

However, the new learning outcomes will cover the full five years of a pharmacist’s training, from their first day at university, through to the GPhC registration assessment. Many of the changes are actually more applicable to those responsible for delivering the education and training, rather than the trainees receiving it. 

To reflect this, the learning outcomes are split into two. There are learning outcomes for trainee pharmacists, and also for the tutors teaching and supervising them. 

Pharmacy foundation year trainees will now have more than one person signing them off at the end of their pre-registration experience. The final declaration must include confirmation that the views of a named second registrant or other healthcare professional have been obtained before sign-off at the end of the training year.

Noma Al-Ahmad, a visiting lecturer at King’s College London and director of ProPharmace, which delivers training for foundation year pharmacists, thinks this is a positive move. "This shared decision making will provide a better outcome and is more realistic of current training sites, where trainees can have healthcare professionals other than their designated supervisor involved in their training," she says.

The changes aim to make the four-year degree course and one-year foundation training more flexible in approach, but with clear learning outcomes for the full five years of training. It is expected that the schools of pharmacy and statutory education bodies will play more of a role in setting standards and supporting foundation trainee placements alongside employers. 

Standard 9.5 states, for example, that all supervisors must be trained and appropriately overseen to act in this capacity and that they are competent to assess trainees. However, there appears to be a degree of variability in the quality of supervision that foundation trainees receive.

Al-Ahmad says: "Unfortunately, there are designated supervisors currently undertaking this role without the necessary skills to carry it out effectively, which is one of the reasons why we see a huge disparity in training between various sites. Although the GPhC does not accredit supervisor training programmes, the message needs to be consistent with the new standards – namely, that proper supervisor training is essential to enable them to develop those skills."

In addition, supervisors need to be supported and appropriately resourced to carry out their roles effectively, she adds.

Independent prescribing

As already mentioned, the biggest change in the standards is the introduction of pharmacist independent prescribing. While details regarding timings and funding for prescriber training placements have not yet been finalised, the aim is to have all pharmacy graduates trained as independent prescribers in five years' time (2026/27). Prescriber training will take place across 90 hours of the foundation training year, but related skills will be taught throughout the entire five-year training period. 

One of the biggest challenges is that relatively few current supervisors or even existing pharmacists are qualified and practising independent prescribers, so are unable to deliver this training. So most of the prescriber training will need to be delivered by local GPs, which poses logistical and financial challenges.

Babir Malik says he is concerned that some pharmacies may initially struggle to sort out GP placements for their foundation trainees. "It is going to be hard for pharmacies across the country to arrange 90 hours of supervised practice for their trainees in general practice," he believes. 

Health Education England will need to be involved as well, says Malik, as some GP practices will not take part unless they are remunerated. "A lot of community pharmacists may need help to arrange these placements. I think some independents may struggle."

It is still unclear if independent prescribing training will be mandatory from August 2022. 

Gail Fleming, Royal Pharmaceutical Society director of education and professional development, explains that England, Scotland and Wales are at different points in their pharmacist independent prescriber journey, including having the necessary training requirements in place. However, everyone is working towards a common prescribing goal. 

"Scotland is probably further advanced, as they have already been thinking about a five-year programme and how to get better integration and connections between the foundation year and the MPharm degree. In Wales more elements are already in place, which is easier to do when working with different stakeholders in a smaller geographical area." In Wales and Scotland there is a focus on the clinical placements, she adds.

Details are beginning to emerge about funding for independent prescriber training in England. This month saw an additional £15.9m from NHS England & Improvement pledged towards training initiatives (including prescribing training) for pharmacists and pharmacy technicians through the Pharmacy Integration Programme. 

Fleming hopes the funding arrangements will eventually include a tariff that would part-fund some of that educational supervision. "In England there is a tariff that is associated with non-medical placements and pharmacy is not included in that at the moment, although I would hope as part of these reforms that it will be. [We also need] some additional funding that would help us to get in place the right infrastructure and support."

A spokesperson from the GPhC said: "[We] will engage with the statutory education bodies through an accreditation process, so it can be assured that there is sufficient capacity of independent prescribers in the system who can act as designated prescribing practitioners for trainees to ensure that independent prescribing can be delivered as part of [pharmacists'] foundation training."

Covid-19 disruption

Pharmacist trainees taking up placements this year will have had their third academic year in a row disrupted due to the pandemic. The only good news is that at least most students are now more used to handling that disruption. 

Gail Fleming says: "We all learnt so much over the past 18 months about how to deliver teaching remotely in a way that we hadn’t in the past. [We are] able to switch from face-to-face to remote learning very quickly when needed and have the necessary contingency plans in place."

She advises trainees to spend some time thinking about how Covid-19 and lockdown disruption have affected their learning and to identify any gaps in their knowledge. 

"It is important to make sure you have that open discussion with your designated supervisor about whether you have any [learning] gaps you want to address during your training year. If you talk about it at the start, it is easier to plan things in than if you identify any gaps later on," she said.

Get off to a good start

Foundation year pharmacists need to get off to a good start by making sure everybody in their organisation knows who they are because of the name changes. "For 30-odd years it has been 'pre-reg pharmacist' so when you say 'trainee pharmacist' you might need to remind people what that means," warns Babir Malik. 

He also suggests quickly getting to grips with the practical requirements of the foundation year. "Speak to your supervisor about how they want your evidence submissions," he advises. 

"A lot of trainees are using the online e-portfolio from the Royal Pharmaceutical Society. Prior to this, trainees often used to record their evidence in hard copy form unless their employer had a specific recording platform. It is not compulsory yet to use the RPS platform but it might be from next year, which would mean all trainees recording their evidence using the same platform."

Malik is also keen to reassure this year’s cohort of trainee pharmacists that they shouldn’t worry about being ‘guinea pigs’ for the new arrangements. "Many aspects of the year’s experience are very similar to before. Mainly it is just the names that have changed," he emphasises.

Foundation year trainee pharmacists should also take heart in the fact that there is widespread recognition that they are the first cohort to be following the new standards and there is plenty of support available. They only have to ask for it.

•  This education series is financially supported by Accord UK, who have been given the opportunity to review the articles to ensure they meet requirements set out by the Association of the British Pharmaceutical Industry (ABPI Code of Practice) before submission. Any resulting changes were made at the expert reviewers' and editor's discretion.