An independent review has found some support for the idea of non-medical prescribers taking the Prescribing Safety Assessment (PSA), as more professionals including pharmacists gain prescribing qualifications.
The review also recommended a Prescribing Safety Assessment should become standardised and compulsory for all medics practising in the UK, with regulatory oversight from the General Medical Council (GMC).
The review was undertaken between November 2022 and February 2023, including an online survey with 700 responses, 89% of whom were individuals, mostly medical students, members of staff at schools of medicine or pharmacy, or foundation doctors.
It was commissioned jointly by the Medical Schools Council and the British Pharmacological Society, chaired by Professor Dame Jane Dacre and overseen by a group of experts including Chief Pharmaceutical Officer for England David Webb.
While the PSA that is currently in place was generally said to have had a positive impact on prescribing safety, respondents raised concerns about the risks of prescribing errors with an increase in polypharmacy, as well as a changing prescribing and workforce landscape.
They suggested that the current PSA does not prepare medics to use electronic prescribing systems, which are now commonplace across community prescribing in England but not implemented uniformly across the four UK nations.
And with a changing prescribing workforce – including a significant increase in pharmacist prescribers from 2026 and an 121% increase international medical graduates (IMGs) since 2017 – the review suggested changes to standardise prescribing safety assessments.
Currently, foundation year 1 doctors (FY1) must undertake a 60 question Prescribing Safety Assessment (PSA) in order to progress to their second foundation year.
However, many international medical graduates (IMGs) and other medics enter the UK workforce at a higher level and therefore do not undertake the PSA.
A new standardised Medical Licensing Assessment (MLA) is set to be introduced in 2024, and will be required for all UK and international medical graduates.
And the review suggested that a prescribing assessment be added to the MLA to form a Medical and Prescribing Licensing Assessment (MPLA).
It said that there was also ‘consistent feedback’ from respondents that non-medical prescribers should sit a standardised PSA.
‘Published studies have confirmed that the PSA is a viable assessment tool for pharmacists,’ the report said ‘Recommending specific assessments for allied professionals is beyond the scope of this report, but learnings from the PSA could be taken and considered.’
A community pharmacy survey undertaken in 2021/22 found that community pharmacists contacted prescribers to discuss 1.3% of antibiotics prescriptions issued.
When a reason was given for this, 26% wanted to discuss the appropriateness of the antibiotic dose, 14% were concerned about a possible patient allergy, 9% wanted to discuss recent antibiotic use, 9% related to course duration and 6% were getting in touch about the choice of antibiotic.
In 34% of cases where the outcome of a clinical discussion was reported, the prescription dose, formulation, directions, strength, or duration was changed, in 25% of cases, the prescriber confirmed the prescription was appropriate and did not need to change, and in 21% of cases, an alternative antibiotic was prescribed.
In 4% of cases the patient required a re-consult with the prescriber, and in 3% of cases the antibiotics prescription was cancelled.
This article was originally published by our sister publication The Pharmacist.
