Pharmacists appeared to value their SP training overall, identifying both positive and negative aspects and suggesting improvements, and revealing aspirations about IP training and practice. The only significant association in relation to when pharmacists undertook courses was that early cohorts were more likely to be currently using SP in practice. Although inferences about the influence of actual courses are not possible, a practical explanation may be that earlier cohorts will have had more time and opportunities to begin prescribing compared to later cohorts. There was no significant association between training cohorts and attitudes towards courses although all cohorts reported some concerns about SP training that have emerged in earlier studies , such as dissatisfaction with being taught basic pharmacology and mixed responses to inter-professional training. That these concerns are emerging even amongst later cohorts is interesting since SP courses and content have changed and continued dissatisfaction with pharmacology, for example, was identified despite changes to indicative course content guidance offered by the RPSGB, which no longer involves an:'update on relevant aspects of basic and applied therapeutics [and] clinical pharmacology' . The use of approved prior learning (APL) – where some course components may be omitted if evidence of previous training and competency can be shown – may be relevant. However, APL cannot currently exempt pharmacists from whole sections of courses and although individual HEIs may allow pharmacists to negotiate exemption from some taught elements (such as numeracy which nurses must undertake), pharmacists must still sit and pass every course exam.
It was apparent that pharmacists' perceived themselves to be competent in their pharmacological knowledge. This has also been identified in previous research [6, 21] and may be contrasted with empirical research  and lecturers' perceptions [17, 18] about nurses' pharmacological competency and training needs. Pharmacists' undergraduate pharmacology training and the number of post-graduate qualifications identified may inform this perceived competence but concerns remain. Firstly, if pharmacists consider SP course pharmacology content to be too easy or basic then does this mean that nurses and AHPs might be receiving pharmacology training that is also too basic? Secondly, pharmacists' pharmacological knowledge may still need to be assessed formally in a course exam, to ensure a minimum competency, and empirical research is needed to confirm pharmacists' pharmacological competency.
Pharmacists' desire to learn more about diagnosis, consultation and clinical examination skills is revealing since although some clinical examination and consultation skills are required on SP courses, pharmacists wanted both more of these skills and also training in diagnosis, which is not directly relevant to SP. This may be related to most pharmacists' intentions of becoming independent prescribers and belief that independent and supplementary training be taught together. Pharmacists' references to SP being a 'stepping stone' to IP were telling and SP training appeared not only to prepare pharmacists for initial prescribing but also represented the first part of a larger professional project towards independent prescribing.
The findings of this study suggest that inter-professional learning may be problematic despite the benefits offered. Challenging the traditional approaches to health care training that were distinct and proceeded along very 'discrete occupational lines' is recognised as an important project . Benefits of increased understanding of different professions and improved communication and collaboration are all laudable aims that could have benefits not only in training but also in subsequent practice, reflecting a more fundamental socialization process that can occur in healthcare training [8, 22]. However, the need to provide different professions with potentially different sets of skills may be difficult to accommodate in practice. Pharmacology training and numeracy exams for nurses illustrate these quite different training needs.
This study offers suggestions as to possible changes to prescribing course content. Obvious points are that pharmacology content should be reduced or made specific to pharmacists' clinical areas, that inter-professional courses be offered only if they can avoid teaching of existing knowledge and that more diagnostic, consultation and clinical examination skills should be offered, preferably on an integrated SP/IP course. Other possibilities are to include more practical aspects of training, as this was especially valued by pharmacists, possibly by involving practicing non-medical prescribers in courses and most importantly increasing the period spent with a doctor in practice, which pharmacists' particularly valued. In the UK, doctors are presently not remunerated for their roles as DMPs and this may need to be addressed, to both encourage more doctors to participate and also to ensure that their time and skills are recognised. If the role of the DMP is to be increased, however, more attention may also need to be given to doctors' understanding and awareness of SP, since research suggests that this may be lacking at present . Finally in relation to course changes, giving more consideration to pharmacists' existing workload or making courses longer or more flexible may also be needed.
Finally, this study may inform proposed changes to pharmacist SP training. One is that all pharmacist courses will eventually offer a combined SP and IP course, bringing pharmacist training more in line with that of nurses, where a single extended, independent and supplementary prescribing qualification is now offered. The findings of this study indicate that this process would be welcomed by pharmacists, in allowing them to obtain diagnostic and clinical skills and attain their ultimate goal of IP status. A further issue concerns the integration of prescribing training into the undergraduate curriculum, as has been proposed  and this study raises questions about such a proposal. In particular, how will undergraduate students' lack of clinical experience affect the success of such courses and will it be possible to incorporate the period of learning in practice and time with a DMP that pharmacists so valued into an undergraduate course? Such concerns have emerged in other research  but further research will be needed to assess these developments.
In terms of study limitations, the response rate means that it may not be possible to generalise from this sample to all RPSGB registered pharmacists, or those in other parts of the UK. Due to study time limitations, it was not possible to analyse non-respondents. The limitations of a questionnaire format must also be recognized and, for example, the data obtained from the open response questions was often succinct and pharmacists did not describe or articulate their experiences and perceptions in the same detail that, for example, qualitative interviews might have permitted. Finally, the survey included pharmacists from early cohorts and so the results do not necessarily reflect pharmacists' views about only the most recent SP courses.