Exploring factors influencing the choice of clinical area for scope of practice among trainee pharmacist independent prescribers: a qualitative study

Introduction: Trainee Pharmacist Independent Prescribers (tPIPs) must demonstrate clinical and diagnostic skills appropriate to their Scope of Practice (SoP) to certify as Pharmacist Independent Prescribers (PIP). However, the definition of SoP is often ambiguous and differs between professional groups and evolves throughout the professional’s career. This ambiguity may lead to confusion and opposition to pharmacist SoP extension. Conversely, a rigid SoP may be restrictive and reduce holistic care. There is limited literature on the implementation of SoP, especially with current changes to initiate newly registered pharmacists as independent prescribers from 2026 and onwards.

Aim: This study aims to investigate the factors influencing the choice of SoP among t-PIPs and its impact on their professional practice.

Methodology: Six t-PIPs from a university in Southeast England participated in a focus group to provide insights into factors influencing their SoP choices. Thematic analysis was employed to identify and analyse patterns in the data, to understand current beliefs around SoP. This study has been ethically reviewed at Tier 1 by the University of Brighton.

Results: For t-PIPs, SoP was perceived as a boundary, comprising of their responsibilities, confidence and competence - for safe and effective practice. Factors influencing SoP included work expectations, personal interest, patient connections, fear of missing out, perceived competence, and mentorship. Notably, work expectations emerged as the most significant factor, driven by the need to align with evolving pharmacy practices. T-PIPs also perceived SoP to be ambiguous and restrictive in the context of pharmacy independent prescribing. Lastly, T-PIPs expressed that most patients and colleagues are supportive to pharmacist SoP expansion, with minor opposition.

Discussion: Work expectations are the biggest factor influencing t-PIPs’ SoP as this heavily influences their roles and responsibilities. However, this is different compared to early-career family physicians and medical students where personal interests is the major theme [1, 2]. This may be due to the desire to align with current changes to pharmacy practice which if not met, may concern t-PIPs of reduced employability. Additionally, SoP can be seen as restrictive if an exclusive approach is taken while an inclusive and collaborative approach may enhance the role of PIPs in healthcare [3]. The place of PIPs in healthcare is yet to be clearly defined and only time will tell if their patients and colleagues will accept pharmacist SoP expansion.

Limitations of this study include reduced generalisability as only one focus group was carried out, with a small sample size, with mainly hospital pharmacist and with t-PIPs at the researcher’s university only. Moreover, this study may be subjected to bias as this is a focus group study, utilising purposive sampling and due to coding being a subjective process. To minimise bias, a reflexive and iterative approach was taken throughout.