The views of pharmacists in England on their supplementary prescribing training

Introduction
Prior to practising as prescribers, UK pharmacists undertake an accredited prescribing course, unlike some international non-medical prescribing models.1 Initially supplementary prescribing(SP), and more recently independent prescribing (IP) courses were available, although these are increasingly taught together, as are pharmacists and other professionals such as nurses. Training also involves a period of learning in practice with a designated medical practitioner (DMP). Research to date is limited but has revealed possible course improvements and beneficial practical aspects.2 The aims of this study were to explore the perceptions and experiences of SP training by pharmacists in England.

Method
A postal questionnaire survey was sent to all pharmacists registered as supplementary prescribers in England in April 2007,following piloting. Non-responders were sent one reminder. Five-point attitudinal scale responses to questions about training were used, and three open response questions were included. Descriptive (univariate) analyses and analytical(bivariate) tests were undertaken using SPSS (v12). Relevant multicentre research ethics committee approval was obtained.

Results
The response rate was 51% (411/808), and 75% of respondents were female. Forty-seven per cent were currently prescribing, and of these 41% were working in hospital and 53% in general practitioner practices – 67% prescribed for 5 hours or less per week. Of practising supplementary prescribers, 11% were also independent prescribers, 33% were undergoing training, and53% intended to train. Regarding SP training, 82% agreed/strongly agreed that it was useful, and when asked about specific outcomes, 58% agreed/strongly agreed that they had acquired the appropriate prescribing knowledge and 62% felt they had gained the skills they needed to prescribe. DMPs were considered by 86% of pharmacists to have fulfilled their roles, and 63%of pharmacists believed independent and supplementary pre-scribing should be taught together. The most useful aspects of SP training were considered to be: clinical examination and consultation skill, law, and time spent with DMPs (although some pharmacists considered these unhelpful). The least useful aspects were: being taught existing skills and especially pharmacology, excessive paperwork, reflective practice, and demonstrating competencies. Interprofessional courses were praised in facilitating networking/support, but were reported to be too generic and to teach basic pharmacology. Pharmacists suggested course improvements in terms of more training on patient examination, clinical, consultation and diagnostic skills, learning from practising non-medical prescribers, and guidance on implementing SP.

Conclusions
Pharmacists appeared to be positive overall about SP training but some improvements were suggested, which could inform course development and better prepare pharmacists for prescribing practice. Pharmacology training was criticised, which although potentially exacerbated by increasing interprofessional prescribing courses, may be resolved by approved prior learning – exempting pharmacists from parts of courses.3 The trend towards more combined SP/IP courses being offered will be welcomed by many pharmacists, and may also complement their desire to learn more about diagnosis and clinical examination. Future courses could be informed by pharmacists’ desire for less paperwork and need to demonstrate competencies, and they could oncentrate more on consultation skill and greater involvement of practising doctors and non-medical prescribers. Study limitations arise in that some pharmacists may have been from early SP training cohorts and their responses do not reflect course changes since 2003.