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Will a shortage of designated prescribing practitioners jeopardise foundation year pharmacist training places? By Saša Janković

Independent prescribing has been hailed as a revolutionary change in pharmacists’ professional development, with independent prescriber annotation set to be a requirement for all newly qualified pharmacists from 2026.

However, while extending the clinical capabilities of community pharmacists in this way has benefits for them, their patients and their wider primary care colleagues, it comes with extra responsibilities for employers offering foundation year placements.

Trainees must be able to access a designated prescribing practitioner (DPP) – a healthcare professional with legal independent prescribing rights – to supervise them for 90 hours over the course of their placement and provide ‘sign-off’ on their competency to prescribe.

England’s Chief Pharmaceutical Officer David Webb announced an additional 3,000 funded independent prescribing (IP) training places for community pharmacy in 2024/25 in May. Latest data from Oriel – now the sole platform through which all pharmacist foundation training places must be offered – shows there are currently 4,102 foundation pharmacy programmes available across England, Wales and Scotland.

Nonetheless, there is concern amongst some contractors and pharmacy bodies that a shortage of DPPs could jeopardise many pharmacies’ ability to offer foundation year pharmacists a training place.

In May, the Company Chemists’ Association (CCA) said it had repeatedly raised concerns with NHS England that DPPs are in short supply and had urged it to provide a list of organisations that have DPPs before students were given placement information. The CCA said it was “hearing from pharmacies that they cannot find the DPPs that NHS England says are available”, with chief executive Malcolm Harrison warning: “We want to avoid a situation where our members are unable to offer placements to pharmacy students graduating in 2025”.

Jumping the gun

In light of these concerns, have the Government and NHS England jumped the gun in rolling out the requirement for all newly qualified pharmacists to have IP annotation from the 2025-26 cohort onwards?

“The number of available DPPs presents a significant challenge and the profession will have to look to its own IPs to share some of this load,” says Numark chairman Harry McQuillan. “Without sufficient numbers of qualified DPPs to mentor and support trainees, there is a risk that some pharmacies will struggle to meet the new requirements, potentially limiting the availability of training places and, by extension, newly qualified pharmacists ready to meet the IP mandate. That’s why the planning has to start now and there are schemes already in place that can be learned from.”

Independent community pharmacist Reena Barai says she “cottoned on a while ago” that being able to find a DPP for any potential foundation trainees might not be straightforward.

“I’m not prescribing enough to feel confident to be a DPP,” she says. “Because from 2026, the trainee year will be in a multi-sector environment, I reached out to all my IP pharmacist friends in general practice, PCNs and hospital to ask if any of them wanted to share a trainee and be a DPP as well. But most said no as while there is some funding to host a trainee, it is not much, so as a trainer you end up doing it for free and as part of your day job, whereas if I was a GP trainer, I’d be funded. I have, however, managed to find two pharmacists who work in GP practices who will do it as long as I hold their hand through the whole process.”

NHSE solutions

According to data from the GPhC, there are 18,720 pharmacists with a prescribing annotation on the register (29.1 per cent of all pharmacists), with the regulator saying “good progress” has been made by the statutory education bodies with employers to increase the number of DPPs.

“Given the scale of the reforms and the importance of the prescribing element, our Initial Education and Training for Pharmacists Advisory Group will continue to monitor closely the work being done to ensure there are sufficient, trained DPPs in time for the full implementation of the standards,” said a spokesperson.

In June, GPhC meeting papers revealed plans to allow “virtual supervision” of trainee prescribers “where appropriate”, alongside other steps such as allowing trainees to complete their 90 hours of training in different blocks of time.

The regulator’s commitment to maintaining a watchful eye may reassure some, but McQuillan says that while the NHS has “acknowledged the importance of DPPs” in the successful rollout of independent prescribing, more detailed analysis of demand and availability is needed. “Solutions could include offering targeted resources to encourage experienced IP pharmacists to become DPPs,” he says. It could also mean providing “more robust training and support for this role and exploring partnerships with academic institutions to expand and highlight the pool of potential DPPs”, he adds.

NPA warning

The NPA advised contractors to withdraw from the 2025-26 Oriel trainee pharmacist placement programme before the end of May if they were concerned about being able to access a DPP. “Under scrutiny by the NPA, it has become increasingly apparent that access to a DPP in community pharmacy is becoming very difficult,” it said. “Unless you already have someone in place, the likelihood of having access to a DPP in time for the start of the foundation year 2025-26 is slim.

“This could lead to unintended adverse consequences for the prospective pharmacist student, who would need to find another placement at very short notice, plus a risk to your reputation as a prospective training site for students.”

At the time, Primary Care Pharmacy Association president Dr Graham Stretch urged contractors to “reach out to your local NHSE Workforce, Training and Education and ICS workforce team” before pulling out. He remains sanguine.

“My argument is that yes, there is a risk but not yet,” he says. “Oriel is the only way to access trainees and to receive funding for the provision of foundation training, so if you opt out, you won’t receive funding, which is why withdrawing now is premature.

“I say that because students don’t get ranked by Oriel and then allocated their preference for where they go to train until September, so if a pharmacy withdraws their place before Oriel runs the algorithm, the student won’t know why they didn’t get the place at that pharmacy, and that won’t damage your business reputation – although to ensure you avoid reputational damage, you must withdraw before the Oriel algorithm is run.”

Nonetheless, Dr Stretch says: “The fact remains that there is the critical issue of capacity, time and funding for provision of supervision, and if all those were in place, I’m sure there are lots of people who would love to help train.”

Further considerations

For pharmacy businesses still willing to offer foundation year pharmacists a training place, McQuillan offers the following advice:

Capacity and resources: Assess whether you have the capacity and resources to support the training and supervision requirements associated with the IP mandate.

Incentives and support: Evaluate potential incentives for existing staff to become DPPs and provide the necessary support and training to fulfil this role effectively.

Strategic partnerships: Explore partnerships with other pharmacies or healthcare organisations to share resources and expertise in training and mentoring new pharmacists.

Long-term benefits: Weigh up the long-term benefits of having pharmacists who are qualified to independently prescribe, which can enhance your service offerings. This should attract more patients, improve health outcomes and your pharmacy’s commercial success.

In addition, although the 2017 RPS DPP competency framework specified that an IP had to have been actively prescribing for three years before being able to become a DPP, this was superseded by the HEE [as was] framework for training provision. This does not specify a time period but a level of competence, as long as the prescriber is working in an active prescribing setting.

Bukky Alli, community pharmacy manager and education and training pharmacist at Green Light Pharmacy Group, where she is also an IP and a DPP – acknowledges that “it can be daunting” for pharmacists who are already IPs and trainee supervisors and are thinking of becoming a DPP. But she stresses: “If you have the right skills and experience yourself, it’s only a slight step up from what you’ve done before. And just because you are a mentor doesn’t mean you can’t still have a mentor yourself. If confidence is an issue for you but you’ve got the knowledge and experience then don’t let lack of confidence hold you back – get a community around you and reach out for help and guidance.”

Dr Stretch says this particular dearth of DPPs should not last forever. “Remember, in three years’ time, the newly qualified IPs will have had three years under their belt and can step up as trainers themselves,” he says. “So this is just a bump in the road – although some funding would undoubtedly make this story very different.

“The message is engage, integrate, work with local GP pharmacists and if you need to spend some money, then do.”