Support for pharmacist designated prescribing practitioners (DPPs)

Position Statement

Prescribers must be appropriately supported to undertake the DPP role; with dedicated time to train, to supervise and support the trainee and protected learning time for self-development within the workplace.

Job planning with clear descriptors of the role of the DPP is essential to ensure realistic time estimates to undertake this role.

Clinical supervision* for prescribers is essential throughout the prescribing practice continuum.

Employers and NHS education organisations** must collaborate to remove barriers to prescribing training.

Consistency of expectation for DPPs in qualifications and workplace support is important across all sectors and across Great Britain.

* The RPS is currently working on finalising guidance surrounding Clinical Supervision and this will be made widely available when finalised.
** NHS Education organisations are NHS England Workforce, Training and Education (NHS WTE), NHS Education Scotland (NES) and Health Education and Improvement Wales (HEIW).

Implementing the recommendations above will ensure the right conditions so that prescribers want to become a DPP, directly addressing the DPP shortage that we are currently faced with.

Since the introduction of independent prescribing, trainees have undertaken a period of learning in practice (PLP) to consolidate and contextualise the academic learning delivered by the programme provider. The PLP enables the trainee to put theory into practice; to develop and demonstrate competence as a prescriber under the supervision of an experienced prescribing practitioner, the DPP. Experienced prescribers of any professional background can become responsible for a trainee prescriber's period of learning in practice.

To help train safe and effective prescribers, we've worked with multidisciplinary experts to develop and publish a competency framework for Designated Prescribing Practitioners.1

The competency framework underpins quality in training in practice, supporting DPPs to optimise learning and assessment in practice and ensure the safety and quality of future prescribers.

The DPP role is a central component of the PLP and the aim of this role is to oversee, support and assess the competence of prescribing trainees, in collaboration with academic and workplace partners, during the period of learning in practice. Prescribers undertaking the DPP role make a highly valued contribution to supporting our profession to achieve our ambitions and place pharmacy at the forefront of healthcare.

This position statement expands on the strategic and operational conditions which further support DPPs to undertake their role.

Education and training parameters

The General Pharmaceutical Council (GPhC) stipulate that a pharmacist prescriber in training must spend a minimum of 90 hours in their period of supervised learning in practice.2. From the academic year 2025/26, this period of learning in practice will be incorporated into the foundation training year.

Higher education institutes, NHS education organisations, employers and the RPS have developed materials and offered examples of both planned and opportunistic learning episodes to support prescribers in training in planning.

Employers and NHS education organisations, together with the wider profession, must work together to remove any barriers to training, including those between sectors.

This may include working together to identify prescribing pharmacists who meet the criteria to be DPPs, and facilitate prescribing pharmacists in training to access opportunities appropriate to the PLP. Ongoing training for those undertaking the DPP role must be encouraged and facilitated to ensure they can keep their skills and practice up to date. This will enable them to continue to undertake the DPP role.

The educational reforms within pharmacy are essential developments for the pharmacy profession to achieve its potential, support the wider priorities of the NHS and continue to deliver excellent patient care. Individual pharmacists accessing training, learning new skills and achieving further qualifications is a vital component, equalled by the necessity and responsibility to support future pharmacists.

This message that contribution to the support and training of future pharmacist prescribers is essential to develop the workforce and is everyone’s responsibility, must be included within the initial education of undergraduates and the independent prescriber training of registrants. Instilling this culture change throughout the profession can only be achieved with appropriate resources, time and support.

Example

NHS England has recognised that support and development for current educators, as well as succession planning, must be a priority if the challenge to educate future healthcare professionals is to be met. They have developed an Educator Workforce Strategy to help support the development of the workforce.

This can be used as a foundation by Integrated Care Board (ICB) Pharmacy workforce leads to help implement DPP locally.

NHS England have commissioned the ProPharmace programme for DPPs which has helped over a thousand DPPs get the training and support they need to undertake this role

Support for DPPs

Prescribers must be supported in their workplace to train as a DPP and to undertake the DPP role. Realistic estimates of the time taken to be an effective DPP must be sufficient, defined, and consideration given to this when job roles are created, amended or updated to ensure prescribing pharmacists have the time to train others.

Prescribers who undertake the DPP role require protected learning time to support their own development, both as a practicing prescriber (self) but also within the role of DPP for prescribers in training (others). Time to undertake the duties of the DPP role and the necessary protected learning time should be detailed within the DPP’s workplan or job plan and must be described in the job description.

Clinical supervision for prescribers in training is essential, but this requirement does not end at the point of qualification or registration and continues throughout the prescribing practice continuum.

As a pharmacy professional, there is a duty to educate and support those pharmacists who are newly qualified or new to the prescribing role.

Example

In the North Highlands, pharmacists tend to work and live remotely from each other. When I studied to become an IP I had some challenges getting a DMP, so when the DPP role was introduced I felt that I could support colleagues through this. Uptake for the IP courses was very low in the Highlands in general, and a key driver for this was the lack of DMP/DPP due to geography and logistics.

When approached to be a DPP, the pharmacist and I have to discuss the realities of distance, which can easily be over 100 miles from each other. Technology has been a great bonus for enabling conversations online, as well as being able to “attend” clinics using secure networks where permitted.

The biggest challenge is getting some face-to-face time and trying to plan that into our already busy work and personal lives.

Discussing expectations before we begin is important and planning some early online meetings. It is not simple and has often involved time in the evenings, but it is worthwhile. I have been able to use my network of colleagues to support the PLP time which can be very difficult in a rural area and their support is so important too. We are all able to support colleagues in training in some way.

I find being a DPP really rewarding professionally. I learn something from every colleague I support, which is great for my own professional development. The course is very different to the one I completed so I learn from discovering new resources the universities are suggesting as well as from reading the case studies and coursework. I feel privileged to be given the opportunity to support colleagues to be in the best possible place for the future of the profession.

-Independent Pharmacist Prescriber and DPP in the Scottish Highlands

Consistency

There must be consistency in the expectations laid upon prescribing pharmacists who undertake the role of DPP. This consistency applies across all sectors of practice and geographically across Great Britain. This applies to the time commitment to undertake the role and the time which the trainee prescriber must spend with their DPP.

There should be further guidance on what constitutes 90 hours of practice, the ability to have more than one student per DPP, what appropriate nominated prescribing areas are so that there is a more consistent approach by HEIs and those providing DPP services.

There must also be consistency in the expected equivalent qualifications and experience to be a DPP, agreed between employers and those delivering the post graduate IP course. The equivalent level of experience and academic assurance must be applied to a DPP supervising a foundation pharmacist to one supervising a registered pharmacist.

Example

Pharmacy: Delivering a Healthier Wales is the vision for pharmacy in Wales. Launched in 2019, the vision sets out long term ambitions and short-term goals for how patients will benefit from the expertise of pharmacy teams by 2030. The vision describes how at different milestones, "all patient facing pharmacists in the managed sector will be actively prescribing’’ and by 2030 "There will be an independent prescriber in every community pharmacy".

To support these ambitions as part of a wider approach, Welsh Government, via Health Education and Improvement Wales (HEIW) funds Independent Prescribing training places for pharmacists in Wales. Separate funding for the DPP is also available via HEIW and Local Health Boards, to support the training of the prescribing pharmacist and recognise the time out of practice to facilitate this.

This approach with investment to support training and upskilling of prescribing pharmacists and funding support for DPPs is aimed to realise the ambitions of the profession in Wales, benefitting patients and the wider priorities of the NHS in Wales.

Quality Assurance

The competency framework for DPPs is the primary resource for assuring the quality of DPP performance.

To adequately support DPPs, NHS education organisations and employers should:

  • Offer access to, or signposting to the RPS mentoring programme ensuring peer support is available for prescribers undertaking the DPP role
  • Encourage pharmacists who are DPPs to join the RPS mentoring programme to provide the mentor support
  • Encourage pharmacists to seek support through professional networks and from members of the multidisciplinary team
  • Ensure effective clinical supervision arrangements are in place for all prescribers – both established and those in training
  • Encourage pharmacists to progress through assessment and credentialing of professional practice
  • Undertake regular evaluation of the learning infrastructure within the learning placement
  • Offer support with forming, maintaining and updating a scope of practice for all prescribers.

Example 1

In Scotland there is a Teach and Treat programme for IPs based in community pharmacy providing the national Pharmacy First Plus service, which involves assessment and prescribing for common conditions. This programme is funded and supported by NHS Education for Scotland and enables newly qualified IPs to spend time with an experienced prescriber in their clinic setting, seeing patients together and discussing ways of working and practical aspects of the clinic set up.

Being involved with Teach and Treat works well alongside DPP duties, enabling pharmacist prescribers to formalise some of their time in practice to be spent specifically on teaching and supporting others whilst also seeing patients.

https://www.nes.scot.nhs.uk/our-work/prescribing-and-clinical-skills/

Example 2

Devon Teach and Treat is a pilot project to support community pharmacists with their independent prescribing qualification by providing access to a DPP and clinical environment to facilitate the required 90 hours of supervised practice.

In May 2023, a nurse ACP from University Hospitals Plymouth, was employed into a new role of Independent Prescribing Clinical Lead, with the primary remit of being the strategic lead for this project. A cross-sector, multi-professional model of supervision has evolved, with DPP and DPS supervision capacity fulfilled by nurses, doctors, pharmacists and paramedics across primary and secondary care settings.

Devon Teach and Treat is on track to have supported 21 community pharmacists with their prescribing in the first academic year."