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Foundation track

Prescribing skills

The consultation, examination, reasoning and governance skills your designated prescribing practitioner will sign off during the foundation year.

Who it's forFoundation trainee pharmacists working towards independent prescribing, and newly qualified prescribers.
PriceIncluded in the Foundation track: £299 for the training year.
Clinical reviewReviewed by GPs and experienced pharmacist prescribers.
StatusOpening in stages from early 2027. Waitlist members get early access and founding prices.

9 modules

Open a module to see what you will be able to do by the end of it.

P1Consultation and history takingRun a structured prescribing consultation: history, medicines, ideas and concerns, safety-netting and clear records.

By the end of this module you can:

  1. Open a prescribing consultation safely: introduce yourself, confirm identity, gain consent to proceed and agree an agenda with the patient.
  2. Take a structured history of the presenting complaint using SOCRATES, ODIPARA or an equivalent tool, and gather past medical, drug, allergy, family and social history.
  3. Take a complete medication history from at least two sources, including over-the-counter, herbal, recreational and online-bought products, and document allergies by reaction type.
  4. Explore the patient's ideas, concerns and expectations (ICE) and use what you learn to shape the plan.
  5. Adapt the consultation for remote, interpreter-supported and accessible consultations, and recognise when a remote consultation is not safe.
  6. Close the consultation with a clear summary, a safety-netting plan and an accurate, contemporaneous record.
  7. Reflect on a consultation using a recognised model (Calgary-Cambridge or similar) and record it as evidence for the NHS England foundation trainee e-portfolio.
P2Clinical examination and observationsTake and interpret core observations and focused examinations, use early warning scores, and recognise when someone is unwell.

By the end of this module you can:

  1. Prepare for any examination correctly: consent, chaperone offer, hand hygiene, equipment check and documentation (NHS England Prescribing Indicative Curriculum, Appendix 1 core skills).
  2. Measure and interpret blood pressure (manual and automated), pulse rate and rhythm, respiratory rate, temperature, oxygen saturation and level of consciousness, and calculate a NEWS2 score.
  3. Measure height, weight and BMI, peak expiratory flow, capillary blood glucose and urinalysis, and know the limits of each test.
  4. Perform a focused examination of the ear, throat, skin and head and neck lymph nodes to the standard needed for common primary care and Pharmacy First presentations.
  5. Recognise abnormal findings that need same-day or emergency escalation, and act on them.
  6. Explain sources of error, including device bias with pulse oximetry in darker skin, and adjust your decisions to allow for them.
P3Diagnostic reasoning, red flags and referralBuild a differential diagnosis, spot red flags and refer at the right speed, including suspected cancer and sepsis.

By the end of this module you can:

  1. Build a differential diagnosis from history and examination using hypothetico-deductive reasoning, and say which diagnoses you must not miss.
  2. Name common cognitive biases (anchoring, premature closure, availability, confirmation bias) and use at least two debiasing strategies in practice.
  3. Recognise the main red flags for chest pain, headache, back pain, abdominal and GI symptoms, infection and sepsis, stroke and mental health, and decide on the right level of urgency.
  4. Apply NICE NG12 suspected cancer criteria for common presentations, including the May 2025 change for upper GI symptoms and the April 2026 change to ovarian CA125 thresholds.
  5. Make a clear, structured referral (SBAR) to the right service at the right speed, and document it.
  6. Manage uncertainty safely with explicit safety-netting and follow-up, and recognise the limits of your own competence.
P4Shared decisions, consent and capacityReach shared decisions, obtain valid consent and assess mental capacity across the UK legal frameworks.

By the end of this module you can:

  1. Apply the NICE NG197 approach to shared decision making before, during and after a prescribing consultation.
  2. Communicate benefits and harms using absolute risks, natural frequencies, a common denominator and number needed to treat, and calculate these from trial data.
  3. Explain the legal basis of valid consent in England (voluntary, informed, given by a person with capacity), including the material risk test from Montgomery (2015) and its limits after McCulloch (2023).
  4. Assess mental capacity for a specific prescribing decision using the Mental Capacity Act 2005, and make or contribute to a best interests decision when a person lacks capacity.
  5. Apply the rules on consent for young people (16–17-year-olds, Gillick competence and the Fraser guidelines) and recognise the different law in Scotland and Northern Ireland.
  6. Respect an informed refusal, document consent and capacity decisions clearly, and know when to involve others (lasting power of attorney, IMCA, Court of Protection, safeguarding).
P5Prescribing governance, law and remote prescribingPrescribe within your scope: governance, law, records, controlled drugs, remote prescribing and the 2026 community pharmacy prescribing route.

By the end of this module you can:

  1. Define your own scope of prescribing practice in writing, and explain how you would safely extend it.
  2. Apply the GPhC In practice: guidance for pharmacist prescribers (April 2025) to everyday decisions, including prescribing for yourself or people close to you and separating prescribing from supply.
  3. Apply the GPhC Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet (February 2025) to an online or telephone consultation, and name the medicine groups that need extra safeguards.
  4. Write a legally valid prescription for a Schedule 2 or 3 controlled drug, and state what pharmacist independent prescribers (PIPs) cannot prescribe.
  5. Decide when an unlicensed or off-label medicine is justified, and record and explain that decision.
  6. Keep a prescribing record and GP notification that would stand up to audit, complaint or a fitness to practise investigation.
  7. Describe how NHS community pharmacy prescribing in England works from 2026/27, including the governance it requires.
P6Interpreting blood testsRead common blood tests in context, act at the right speed on abnormal results, and monitor high-risk medicines.

By the end of this module you can:

  1. Use a five-step method to interpret any blood result and decide how urgently to act.
  2. Interpret urea and electrolytes, eGFR and creatinine clearance, and choose the right estimate of renal function for dosing, including the Cockcroft-Gault calculation.
  3. Apply NICE NG203 thresholds for potassium and creatinine after starting an ACE inhibitor or angiotensin receptor blocker (ARB).
  4. Interpret liver function tests, full blood count, thyroid function, HbA1c and lipids in the context of a prescribing decision.
  5. Request and interpret therapeutic drug levels (lithium, digoxin, phenytoin) with correct sample timing.
  6. Recognise results that need same-day action or referral, and record and communicate your plan.
P7Special populationsPrescribe safely in pregnancy, breastfeeding, older people and kidney or liver impairment, with drug-specific advice.

By the end of this module you can:

  1. Ask about pregnancy, contraception and breastfeeding in every relevant consultation and act on the answer.
  2. Choose safer first-line medicines in pregnancy and breastfeeding using UKTIS, bumps and the SPS breastfeeding resources.
  3. Apply the MHRA pregnancy prevention requirements for valproate, topiramate and isotretinoin, and the 2025 MHRA advice on GLP-1 medicines and contraception.
  4. Adjust prescribing for older and frail people using STOPP/START, anticholinergic burden and falls risk.
  5. Dose renally cleared drugs using creatinine clearance and identify drugs to avoid or stop in chronic kidney disease and acute kidney injury.
  6. Recognise when liver disease changes a prescribing decision, and when to seek specialist advice.
P8Polypharmacy and deprescribingRun a structured medication review, recognise harm from polypharmacy, and stop or taper medicines safely with the patient.

By the end of this module you can:

  1. Define appropriate and problematic polypharmacy and identify people who need a structured medication review (SMR).
  2. Carry out a medication review using the 7-Steps approach, starting from what matters to the person.
  3. Use STOPP/START, anticholinergic burden scores and number needed to treat (NNT) data to prioritise changes.
  4. Plan and explain a safe taper for dependence-forming medicines (benzodiazepines, Z-drugs, opioids, gabapentinoids, antidepressants) in line with NICE NG215.
  5. Deprescribe common low-value medicines safely: PPIs, aspirin for primary prevention, bisphosphonates after a course, antipsychotics in dementia, and over-treatment of blood pressure and diabetes in frailty.
  6. Record, communicate and follow up deprescribing decisions with the person, carers and the GP.
P9Antimicrobial stewardshipPrescribe antibiotics only when they help, choose the right drug and duration, and support national stewardship targets.

By the end of this module you can:

  1. Explain why antimicrobial resistance (AMR) matters, and state the main antibiotic targets in the UK national action plan Confronting antimicrobial resistance 2024 to 2029.
  2. Decide whether an antibiotic is needed at all, using validated scores (FeverPAIN, Centor) and NICE antimicrobial prescribing guidance, and choose between no, back-up or immediate prescribing.
  3. Choose the right drug, dose, route and shortest effective duration for common infections, using NICE NG-series antimicrobial guidance and the local formulary.
  4. Apply Start Smart then Focus in secondary care, including the 48 to 72 hour review and the national IV-to-oral switch criteria.
  5. Assess a penicillin allergy label, separate intolerance from true allergy, and choose a safe alternative.
  6. Recognise high-risk antibiotics and interactions, including fluoroquinolone restrictions (MHRA 2024), Clostridioides difficile risk and common drug–drug interactions.
  7. Counsel patients on self-care, safety-netting and the reasons for not prescribing, using the TARGET toolkit.

Each module includes teaching content, worked cases, a 10-question quiz with explanations, a one-page prescribing summary and a short video. Courses support your learning and CPD; they do not confer prescribing rights.

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