By Gillian Cameron Lead Pharmacist Non-Medical Prescribing (secondment), NHS Lothian

"How can I be sure that pharmacists are prescribing safely and appropriately?" This was the question at the forefront of my mind when I stepped into post in February 2024.

With the growing number of pharmacist prescribers across the UK, ensuring safety, consistency, and appropriateness in prescribing is more important than ever. Pharmacists work across diverse clinical settings, with varying levels of experience and support. As advanced practice continues to expand, we must find ways to assure safe and effective prescribing while also supporting professional development.

Introducing work-based assessment for pharmacist prescribers

In my new role, I sought a solution that would not only provide assurance but also offer an educational opportunity for pharmacists to reflect on and improve their prescribing practice. Looking across professions, I discovered the Work-Based Assessment of Prescribing (WBAP) used for GP trainees —a reflective, peer-reviewed tool designed to enhance prescribing habits through structured feedback.

Inspired by this, I explored whether a similar approach could benefit pharmacist prescribers. The WBAP tool evaluates key aspects of prescribing: drug choice, dose, clarity of instructions, follow-up plans, monitoring, documentation, and patient communication. It also highlights examples of good prescribing practice.

I adapted the tool using the Royal Pharmaceutical Society’s Competency Framework for All Prescribers, incorporating pharmacist-specific metrics such as adherence to guidelines, person-centred care, multidisciplinary collaboration, and deprescribing.

Pilot study of prescribing assessment in NHS Lothian

To test its effectiveness, I conducted a two-phase pilot study within NHS Lothian. Definitions from the WBAP guided the review:

• Prescribing error: Unintentional, significant reduction in the probability of treatment being timely, effective or increased risk of harm when compared to generally accepted practice.
• Suboptimal prescribing: A prescribing issue that is not an error but falls short of best practice.
• Legal error: Breaches in legal prescription requirements.

Phase 1 involved eight senior pharmacists (Band 8a) from both primary care and hospital sectors. They reviewed their own prescribing and provided feedback. Two completed peer reviews, while others self-reviewed up to 20 episodes. No errors were found, but five suboptimal cases were identified. Feedback was positive, though the process was time intensive.

Phase 2 included ten specialist pharmacists (Band 7) across sectors. They reviewed an average of 18 episodes each, taking around three hours. Of 181 episodes reviewed, 50 examples of good prescribing were identified—showcasing guideline-based, patient-centred care within multidisciplinary teams and scope of practice. Nineteen suboptimal episodes and four prescribing errors were noted, none resulting in harm.

Seven of the ten undertook peer review which promoted self-assurance and clinical decision making when prescribing.

Key learning outcomes for pharmacist prescribers

• Use appropriate resources to support prescribing decisions.
• Improve documentation of clinical management and monitoring.
• Manage risk confidently, including extending prescriptions for stable patients.
• Ensure adequate appointment time for complex patients.
• Ensure effective counselling and communication with patients, and document this clearly.

Feedback was overwhelmingly positive. Participants felt the tool promoted reflective practice, assured safe and effective prescribing, and supported development. It was seen as suitable for all levels of prescribers, though challenges included time constraints and peer availability. Suggestions included additional training materials and refinement for hospital settings.

Future plans for prescribing assessment in pharmacy

The adapted WBAP shows promise as a tool to enhance pharmacist prescribing through structured reflection and peer review. It could be integrated into annual appraisal to assure prescribing competence and there are plans to launch this resource within NHS Lothian. In the meantime, findings from this pilot will be shared with NHS boards and non-medical prescribing leads to inform national practice.

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