Prescribing Safety Assessment (PSA): The Complete Guide to the 8 Sections and How to Pass

The Prescribing Safety Assessment (PSA) is the online assessment that checks whether new doctors can prescribe safely and effectively in the NHS. Most UK medical students sit it in their final year, and some foundation doctors and international graduates entering the Foundation Programme sit it too. It is unlike any other written exam you will take: you write real prescriptions, review drug charts, calculate doses and use the BNF throughout. This guide explains the format, the eight item styles, who needs to pass it and how to prepare.

What is the Prescribing Safety Assessment?

The PSA is a pass or fail assessment of the skills, judgement and supporting knowledge needed to prescribe medicines in the NHS. It was developed by MSC Assessment and the British Pharmacological Society, which deliver it as an equal partnership, and it is based on the prescribing competencies in the GMC's Outcomes for graduates. It is designed around the work of a Foundation Year 1 doctor and assesses, as far as possible in a virtual environment, the practical judgement required on the ward and in general practice.

PSA format and structure

The assessment comprises eight sections, each containing one item style, with six or eight items per section. It offers 200 marks in total and must be completed within two hours.

• Prescribing (8 items, 10 marks each): write a single prescription for a medicine or intravenous fluid on a realistic prescription form, with marks for drug choice and for dose, route and frequency.
• Prescription review (8 items, 4 marks each): review a list of current medicines and identify those that are inappropriate, unsafe or ineffective.
• Planning management (8 items, 2 marks each): choose the most appropriate treatment from five options.
• Providing information (6 items, 2 marks each): select the most important information to give a patient or colleague about a medicine.
• Calculation skills (8 items, 2 marks each): calculate a dose, volume or infusion rate and record it with the correct units.
• Adverse drug reactions (8 items, 2 marks each): identify likely adverse effects, causative drugs, dangerous interactions or the right response to an adverse event.
• Drug monitoring (8 items, 2 marks each): choose the best way to monitor the beneficial and harmful effects of a medicine.
• Data interpretation (6 items, 2 marks each): interpret results such as drug levels or blood tests and choose the right prescribing change.

Notice the weighting: the prescribing section alone carries 80 of the 200 marks, and prescription review a further 32. Items are set across clinical settings including medicine, surgery, elderly care, paediatrics, psychiatry, obstetrics and gynaecology, and general practice. The pass mark is set by a standard-setting process and is not published in advance.

Who needs to sit the PSA?

Final-year students at medical schools that use the PSA summatively must pass it to complete their degree, while other schools use it formatively. Foundation Year 1 doctors who have not passed it within the two years before starting F1 must pass it before the end of F1. Non-UK graduates appointed to the UK Foundation Programme who have not passed it sit it through their foundation school. A pass is valid for two years. Your medical school or foundation school registers you, so confirm your sitting arrangements with them.

PSA syllabus: where to focus

The PSA blueprint is mapped to the prescribing competencies expected of a new doctor, with an emphasis on common conditions and high-risk drugs. Prioritise:

• Prescribing for common acute presentations and long-term conditions, including analgesia and intravenous fluids.
• High-risk medicines such as anticoagulants, insulin, opioids, antimicrobials, digoxin, lithium, aminoglycosides and drugs with a narrow therapeutic range.
• Prescribing in special groups: renal and hepatic impairment, older adults, children, pregnancy and breastfeeding.
• Important interactions and how to spot them on a drug chart.
• Drug calculations, including weight-based doses, concentrations and infusion rates.
• Monitoring requirements and the interpretation of drug levels and blood results.

A realistic PSA study plan

• Phase 1, learn the BNF: get fast at finding indications, doses, renal adjustments, interactions and monitoring in the online BNF and BNFc. Speed of navigation is a real advantage on the day.
• Phase 2, practise by section: work through each item style in turn, with extra time on prescribing and prescription review, which carry the most marks. Write full prescriptions for practice items rather than just naming the drug.
• Phase 3, timed papers: complete the official practice papers and full timed mocks to rehearse the two-hour pace and the online interface, then target the sections where you drop the most marks.

Common mistakes candidates make

• Writing incomplete or ambiguous prescriptions: missing units, wrong formulation, or an unclear route or frequency.
• Spending too long on low-mark items and running short of time for the high-value prescribing questions.
• Relying on memory when a quick BNF check would confirm a dose or interaction.
• Making unit errors in calculations, such as confusing milligrams with micrograms or millilitres per hour with millilitres per minute.
• Not practising with the online interface beforehand.

Exam technique and what to expect on the day

The PSA is sat online on the PSA interface at a venue arranged by your school. During the assessment you can use the BNF and BNFc through the permitted online routes, but not other NICE guidance or paper copies, and a basic calculator is built into the interface. Plan your time around the marks: give the prescribing section the attention its 80 marks deserve, and avoid spending several minutes on a two-mark item. For prescribing items, use the approved drug name, an appropriate formulation, a clear dose with units, the route and the frequency, and check against the patient's allergies, renal function and current medicines. For calculations, write down your working and check the units twice.

The best way to revise for the PSA

Because the PSA tests applied prescribing judgement in eight distinct formats, the most efficient preparation combines practice in every item style with detailed explanations that show the reasoning and the BNF information behind each answer. Use the official practice papers to learn the interface, and use a question bank to build volume across the sections and clinical settings, tracking where you lose marks. Practise with the BNF open, exactly as you will on the day.

Passmed's PSA question bank is written by qualified doctors and mapped to the PSA blueprint, covering all eight item styles with detailed explanations and performance tracking by section. Explore the question bank →

Frequently asked questions

How long is the PSA?

Two hours, covering eight sections and 200 marks in total.

Can I use the BNF during the PSA?

Yes. The BNF and BNFc are available through the permitted online routes. Other NICE content and paper copies are not allowed, so practise with the online BNF beforehand.

Which PSA section carries the most marks?

Prescribing, with eight items worth 10 marks each, 80 marks in total. Prescription review is next, with 32 marks.

How long is a PSA pass valid?

A pass is valid for two years. Foundation doctors who have not passed within the two years before starting F1 must pass before the end of F1.

Is there a fixed PSA pass mark?

No. The pass mark is set by a standard-setting process for each assessment and is not published in advance.

Exam format details were checked against the official examining body (accessed October 2026). Specifications, dates and fees change, always confirm the current details on the official website before you sit.