In March 2020, the World Health Organisation (WHO) declared that the outbreak of COVID-19 infections across the world had reached pandemic levels. At this point the newest generation of pharmacists were working hard towards their pre-registration exam. However, on 26 March 2020, they were told that the exam would be delayed. This was followed by further announcements about provisional registration, and timing and format of rescheduled exams.
Whilst there was much social media speculation about the impact this would have on newly trained pharmacists, the UKCPA Education & Development Committee wanted to gain a more evidence-based insight.
We developed a questionnaire, mainly using open ended questions, which was reviewed by experienced academic pharmacists. We invited Provisionally Registered Pharmacists (PRP) and Pre-registration tutors from the cohort of 2019-2020 to voice their opinions anonymously about the impact that the delayed exam and provisional registered status was having.
Questionnaires were distributed via social media and the UKCPA Education & Development Committee networks.
A total of 44 PRPs and 11 pre-registration tutors completed the questionnaire. Just under 60 percent of PRPs were working in the hospital sector, and just under one-third in the community sector. The remainder were working in sectors such as, GP practices and COVID hubs. All tutors who responded were working in the hospital sector.
Impact of uncertainty
The General Pharmaceutical Council (GPhC) announced the cancellation of the pre-registration exam at the end of March, but there was no definitive detail on the postponed dates until six months later. The final exam dates were announced at the end of November, eight months after the initial announcement.
Whilst nearly all the PRPs we surveyed accepted and were grateful for the delay in the exam, they thought the delay was too long, and that communications they did receive were unclear and routinely involved an update about further delays.
All respondents understood that the exam delay was necessary and right, and some reported a sense of relief:
“I was feeling the pressure of my training being affected by the COVID pandemic and trying to balance that and the stresses of working on the frontline full-time with preparation for my exam.” (PRP)
The majority of tutors reported that they initially envisaged a delay lasting until around September; however, this was much longer and was uncertain. Tutors reported feeling empathy with how difficult this was for students:
“[I felt] deflated and empathetic toward the students. Also frustrated that it took so long to organise an online assessment” (PRP tutor)
Both PRPs and tutors believed that a final sign off or placement-based assessment could have been substituted for the exam. Many tutors and PRPs also felt that they had been treated differently to nurses and doctors and that this was unfair.
Impact on training
Training for a lot of staff was put on hold due to the pandemic. Tutors attempted to counteract this by continuing to learn remotely. Ward-based work decreased due to COVID-19 and restrictions on the wards. This had an impact on the PRPs, as many felt isolated in their learning or felt the day-to-day struggle of working through a pandemic affected their study:
“…rotations almost stopped and very little mentoring took place. Tutors and mentors were re-deployed to other areas within pharmacy which meant less support for learning.” (PRP)
Impact on career development
PRPs working within hospital sectors reported that many of their duties remained similar to that of a usual Band 6 pharmacist, including covering wards and on call. However, a number of pharmacists reported that there was an impact to their career development, with some outlining that they were not able to obtain a substantive job. Some also felt that their ability to apply for jobs was limited as they wanted to ensure that they gave themselves time for revision and focus on the pre-registration exam.
In addition, some community PRPs found themselves working as locum dispensers, which may have impacted their personal and professional development, as well as their confidence.
“[I was] unable to find jobs but thankfully was saved by my tutor who offered me 2 days a week just to help my career. Full-time jobs would mean I have no energy to study. No one wants to hire a part-time provisional pharmacist.” (PRP)
“I’m a locum dispenser at the moment. Not regular income, on top of this having to revise for an exam so have reduced my hours down a lot.” (PRP)
One PRP reported that they were unable to apply for higher banded positions as they were not fully registered:
“If i was already registered now I would have been able to interview for a Band 7 post…” (PRP)
Under normal circumstances, many pharmacists will look to commence their clinical diploma within the first year of registration and this has become a strain for some individuals as well, with one PRP reporting that they felt forced into starting this:
“My trust also have forced me to sign up for the post grad diploma.” (PRP)
This additional study may have added a lot of stress to the already difficult situation PRPs were experiencing. However, in other Trusts some opted to wait and this was accepted by line managers as completely reasonable in view of the circumstances.
Of great concern was the finding that some PRPs considered giving up on pharmacy altogether, and there were some reports of staff leaving the profession:
“…my friend who was also working part-time as a provisional pharmacist moved careers and said it was the best decision he has ever made… I am feeling unmotivated about continuing my career in pharmacy.” (PRP)
This is troubling, particularly as pharmacists have just been added to the governments ‘shortage occupation list’ and the difference that pharmacists have made to patients’ lives during the pandemic.
Financial impact
Like many people, PRPs were financially impacted by the COVID pandemic. It wasn’t easy to gain employment as a PRP and this brought with it financial hardships for some. One respondent stated that they were on universal credit and others outlined their employment status as unemployed. This not only affected the PRP but their families as well:
“I wasn’t able to get employment. Other than Boots no one was hiring provisional pharmacist. Other places wanted to pay me less than their own dispensers. Ended up on universal credit.” (PRP)
“Had to work as a dispenser for few months until I found the current job. Huge impact as I have a family to look after” (PRP)
“I was without work for a number of months, I had no income and struggled financially” (PRP)
“I’ve had to take out bank loans just to pay off my mortgage.” (PRP)
One pharmacist reported that they had to relocate in order to get a job as they were unable to find work within a reasonable radius for their personal circumstances:
“After finding a job that was one hour away from home, I felt that it would be too hard to commute every day and study at the same time so I decided to move closer to balance the two.” (PRP)
Some reductions in income were a deliberate choice. Several PRPs reported that they had reduced their hours (inevitably taking a pay cut) so that they could have more flexibility when they were informed of the new exam date. However, the delay in communication continued to impact until an exam date was announced.
There was also wide variability in how much PRPs were paid. Some were as low as £15 per hour in comparison to average locum rates being around £20-25 per hour. A few PRPs felt that some employers sought to take advantage of the situation by paying lower rates:
“ … [they] are acutely aware we have no other option but to continue working.” (PRP)
Impact on organisations
The need for increased risk assessments and supervision when employing PRPs in the middle of a pandemic has also impacted organisations. Ensuring that PRPs were sufficiently supported to revise and pass the exam alongside a global pandemic, second wave, end of year annual leave, COVID-19 risk assessments, GPhC risk assessments, new pre-registrations pharmacists and shielding staff has been stressful for organisations and their staff. One respondent advised:
“This has subsequently increased my stress and anxiety. I now have feelings of anger and am very disappointed and ashamed of the way our professional body has dealt with this…” (PRP)
Impact on workforce planning
It has been difficult for employers to consider staff for recruitment. Employing a high number of PRPs has its own risk: in view of failing the exam the supervision would need to be extended. This led to some employers opting not to shortlist PRPs:
“Unable to short list prov reg pharmacists for interviews to roles we need filling as a matter of urgency due to the risk of exam failure and disruption in our services.” (PRP tutor)
Some Trusts considered adding the employment of PRPs to their risk register as if any were to fail, this could leave a significant workforce shortage for organisations.
One Trust advised that they had employed their PRP and this had led to an impact to their own workload:
“…we took on a number of provisional registrants, but this in turn has increased the workload for us as employers, especially in the amount of support that is needed in regard to wellbeing and dealing with stress and anxiety.” (PRP tutor)
The registration assessment was rescheduled for March 2021. This caused issues for some PRPs, as this was a time when employers wouldn’t generally be expecting an examination, and the fact that PRPs were now competing with other pharmacists for leave, when as a pre-reg they might have been considered supernumerary. There were some PRPs who reported that leave became a difficult topic to approach with employers; some were denied leave close to the exam and some were only permitted to take the day of the exam. However, some employers were able to be more flexible and one Trust even organised for the provisionally registered to have five days of paid leave whenever they wanted to support them to revise for the exam. This was clearly an act of incredibly good will, but inevitably would have had an impact on services.
Impact on mental health
The pandemic has had an impact on the mental health of many and PRPs and their tutors and supervisors are no exception.
Many PRPs used the words “stressed”, “anxiety” and “depressed” in their responses, and some PRPs reported feelings of isolation. Fear of failure was also a common theme and, up until recently, the result of failing the exam would have meant that they were potentially out of a job which led to further anxieties:
“There is a massive lack of support throughout this pandemic. I feel burnt out, overwhelmed and stressed.” (PRP)
“My mental health has been worse than ever worrying about whether I’ll still be able to practice and what if I have a bad day and mess up the exam and how I will let my colleagues and patients down if I fail.” (PRP)
“… after work I lacked the energy or desire to revise and kept myself isolated from people as I felt I had no one to understand what I was going through” (PRP)
Many PRPs reported that training had ground to a halt due to the pandemic as other priorities took over:
“My clinical rotations ceased and pharmacists were put under more pressures, meaning they had less time to teach us. In addition, teaching sessions in house and externally were stopped.” (PRP)
However, not all PRPs had a negative experience. One reported a positive experience, detailing that they felt they had learnt a lot and had been supported during the pandemic:
“I had the privilege of working in three different pharmacies and time with a GP pharmacist. I feel like I learnt the most during the pandemic as it needed us to step up and really get things done.” (PRP)
Lessons to learn
Overall, the profession understood that the delay of the pre-registration exam was the right thing to do under the circumstances. However, the length of the delay and lack of information understandably led pre-registration pharmacists to feel let down by their leading professional organisations. Consequences such as difficulties in gaining employment, low incomes and cancelled training have had a negative effect on these pharmacists and in some cases has affected their willingness to remain in the profession.
Whilst some actions were unavoidable and decisions were made with safety in mind, there are lessons to be learnt from this pandemic. Some organisations within the profession need to become more agile in their response to a crisis. Further support for trainees and their tutors is also needed from organisations across the profession.
Having said this, there were some PRPs that did have a positive experience during the pandemic and they felt the additional responsibility and unique experiences had a positive impact on their training.
This findings of this survey represents a snapshot of experiences during the pandemic, but a larger study would be required to fully appreciate the issues involved. The GPhC has announced that they are working with Keele University to evaluate the impact of COVID-19 on pre- and provisional-registration pharmacists regs and PRPs.
Acknowledgments
The authors would like to thank all the PRPs and tutors who shared their thoughts and experiences, and wish those expecting exam results on 29 April 2021 the best of luck.
The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.
Competing interest statement:
The authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
