Independent review into the Prescribing Safety Assessment (April 2023)

Summary

The Prescribing Safety Assessment (PSA) is a 60-question exam required as part of UK medical training to progress from FY1 to FY2. This independent review into the PSA was commissioned by the Medical Schools Council (MSC) together with the British Pharmacological Society (BPS) in the summer of 2022. It suggests a strategic future direction for the PSA and addresses how the PSA has impacted prescribing assessment and practice for medical students and Foundation Year 1 (FY1) doctors. It is intended to support national decision making about the future of UK prescribing assessment in the context of the imminent introduction of the Medical Licensing Assessment (MLA).

Content

Recommendations

• Appropriate and mandatory assessment of prescribing should remain as a condition of practice for doctors in the UK: evidence of prescribing competence is highly desirable for new UK doctors, and those entering the UK from overseas.
• The addition of the PSA to the MLA should be considered as a pragmatic suggestion to form a Medical and Prescribing Licensing Assessment (MPLA): this could comprise an additional and separate paper under the umbrella of the MLA. 
• The examination regulations need standardising and publishing: both the PSA and the MLA, when launched (or the MPLA) should publish examination regulations. This will standardise examination delivery between administering institutions and clarify the management of irregularities or appeals. The governance of the PSA should be reviewed to ensure that any examination irregularities are identified and addressed prior to confirming results to candidates.
• The PSA or combined MPLA should be considered as a requirement for medical practice in the UK: this could be a summative assessment as an exit from medical school or an entry requirement for FY1, and should be required for international medical graduates licensing (IMGs) via the PLAB route for entry at FY1 and FY2.
• The GMC should have regulatory oversight: the PSA (or MPLA) should be a national requirement for medical practice. As such, it should be subject to regulatory oversight from the GMC.
• If implemented, the proposed MPLA should be funded in the same way as the MLA: the MPLA should be funded in the same way as the MLA will be funded (by universities). In the case of IMGs, funding would follow the model of the PLAB test (self-funded).