Demonstrating competence and using the framework in practice...Competency Framework for all Prescribers as standards of competency for prescribing practice effective from 28 January

Demonstrating competence and

using the framework in practice

Claire Callaghan,

Programme Lead, Non-Medical Prescribing

University of Cumbria

Session brief

1. using the framework to demonstrate competence in non

medical prescribing practice

2. implementing the framework within different professional groups

3. training and educating prescribers to use the framework in

practice

4. supporting non medical prescribers: infrastructure needed to

support the safe and effective development and

implementation of non medical prescribing

5. developing advanced roles and services around prescribing

6. ensuring you have the history-taking, clinical assessment and

diagnosis skills to prescribe appropriately and effectively

7. keeping your prescribing knowledge up-to-date: accessing

education, training and resources

Purpose of the framework(RPS, 2016)

A tool to:

facilitate good prescribing practice by all health

care professionals who can prescribe

to help ensure that patients receive the same

high quality of care irrespective of the

professional background of the prescriber

Patient-centred prescribing (RPS, 2016)

1. The patient

2. The consultation

3. Prescribing

governance

Ten competency dimensions

The Consultation Prescribing Governance

1. Assess the patient 7. Prescribe safely

2. Consider the options 8. Prescribe professionally

3. Reach a shared decision 9. Improve prescribing

4. Prescribe 10. Prescribe as part of a team and system

5. Provide information

6. Monitor and review

Scope of the framework(RPS, 2016)

a generic framework for any prescriber (independent or

supplementary) regardless of their professional

background

must be contextualised to reflect different areas of

practice and levels of expertise

applies equally to independent prescribers and tosupplementary prescribers but the latter should

contextualise the framework to reflect the structuresimposed by entering into a supplementary prescribing

relationship

Uses of the framework (RPS, 2016)

if acquired and maintained… will help healthcareprofessionals to be safe, effective prescribers … ableto support patients to get the best outcomes fromtheir medicines

provides the opportunity to bring professions togetherand harmonise education for prescribers

used by any prescriber at any point in their career tounderpin professional responsibility for prescribing

used by regulators, education providers, professionalorganisations and specialist groups to informstandards, the development of education, and toinform guidance and advice

Uses of the framework (RPS, 2016)

1. professional organisations / regulatory bodies

o standards for prescribing practice

2. education

o initial preparation to prescribe: curriculum

development, outcomes and assessment

o support continuing professional development (CPD)

3. individual prescribers

o self-assessment and appraisal

4. managers or professional bodies for

o clinical governance

o recruitment

o training needs assessment

Use of the framework -

statutory regulatory bodies

1. outcomes for programmes of

education

2. standards for practise

NMC: standards approved new Standards for prescribing programmes

approved adoption of the Royal Pharmaceutical Society’sCompetency Framework for all Prescribers as standards of

competency for prescribing practice

effective from 28 January 2019

at that point the prescribing practice standards and guidancecontained within, and any circulars underpinning them werewithdrawn

from that date, the RPS competency framework to be used as NMCcore guidance on prescribing practice

Intention to work alongside key stakeholder partner organisations todevelop inter-professional guidance on key areas of prescribingpractice relevant to all prescribing professionals (e.g. remoteprescribing and prescribing in the aesthetic/cosmetic context)

NMC: standards for prescribing programmes (1)

commitment to inter-professional learning

emphasis on adoptinginterdisciplinary approachesto prescribing proficiency

for all categories ofprescriber

NMC: standards for prescribing programmes (2)

prescribing programmes must deliver

outcomes which meet the

competency framework

prescribing programmes to be

designed to fully deliver the

competencies set out in the RPS A

Competency Framework for all

Prescribers, as necessary for safe and

effective prescribing practice

state the learning and teaching

strategies that will be used to support

achievement of those competencies

competencies maintained thereafter

throughout subsequent prescribing

practice

NMC (2018): The Code

prescribe… including repeat prescriptions… if you have enough

knowledge of that person's health and are satisfied that the

medicines or treatment serve that person’s health needs

make sure that the care or treatment you advise on, prescribe ….

is compatible with any other care or treatment… including (where

possible) over-the-counter medicines

keep to appropriate guidelines when… using controlled drugs and

recording the prescribing … of controlled drugs

wherever possible, avoid prescribing for yourself or for anyone with

whom you have a close personal relationship

nurses and midwives who have successfully completed a further

qualification in prescribing and recorded it on our register are the

only people on our register that can prescribe

HCPC Standards - practice

the HCPC has adopted ‘A Competency Framework for allPrescribers’ (the Framework) as its standards for allprescribers

where the Framework uses the term ‘patient’, the HCPC willuse the term ‘service user’ to carry out our processes andfunctions

the competencies detailed in the Framework set out theknowledge, understanding and skills that a registrant musthave when they complete their prescribing training andwhich they must continue to meet once in practice

HCPC Standards - education

learning outcomes must ensure that learners meet the standards set

out in the Competency Framework for all Prescribers, as appropriate

to the prescribing mechanism(s) delivered by the programme

structure, duration and range of practice-based learning must

support the achievement of the learning outcomes and the standards

set out in the Single Competency Framework for all Prescribers, as

appropriate to the prescribing mechanism delivered

assessment strategy and design must ensure that those who

successfully complete the programme meet the standards set out in

the Competency Framework for all Prescribers, as appropriate to the

prescribing mechanism delivered

Uses of the framework -

education of prescribers

1. inform the design and delivery of education

programmes, for example through validation of

educational sessions (including rationale for need), and

as a framework to structure learning and assessment

8. inform the development of education curricula and

relevant accreditation of prescribing programmes for all

prescribing professions

Example: in education as individual programme leads and as a collaborative

group, we have used the framework to inform NMPstudents in their professional development planning during

the course and beyond

we adopt a consistent approach across programmes and

the framework has formed the basis of our practice

assessment documentation

nurses, pharmacists and AHPs undertaking NMP

programmes are familiar with the framework prior to

qualification

the framework is also used to inform a range of sessions

within programmes and to underpin programme

development

(North West Non Medical Prescribing Education Group)

Uses of the framework -

individual prescribers

2. help healthcare professionals prepare to prescribe and

provide the basis for on-going continuing education and

development programmes, and revalidation processes

3. help prescribers identify strengths and areas for

development through self-assessment, appraisal and as

a way of structuring feedback from colleagues

Examples: individual prescribers

personally, I intend to use the framework to evidencehow I have stayed up to date as a prescriber as partof the Nursing and Midwifery Council revalidationprocess

(NMP Lead)

undertaken a reflection assignment on using theframework during the training to become a HealthVisitor. For this we had to use the framework tostructure the assignment and reflect on a recentprescribing experience

(Health Visitor)

Uses of the framework -

organisational level

4. provide professional organisations or specialist groups

with a basis for the development of levels of prescribing

competency, for example, from recently qualified

prescriber through to advanced prescriber

5. stimulate discussions around prescribing competencies

and multidisciplinary skill mix at an organisational level

6. inform organisational recruitment processes to help

frame questions and benchmark candidates prescribing

experience

7. inform the development of organisational systems and

processes that support safe effective prescribing, for

example, local clinical governance frameworks

Examples: organisations

used to underpin the outline curriculum frameworks for supplementary andindependent prescribing to be used by radiographers

(The Society and College of Radiographers)

included within the organisation's three yearly revalidation programme for

nurse prescribers. Other allied health professional prescribers and

pharmacist prescribers will also be asked to complete revalidation.

Throughout the three years the framework will be used as part of individual

prescriber’s appraisals and supervision(Northumberland Tyne and Wear NHS Foundation Trust)

to support NMPs when they have been put under pressure to prescribe

medicines or for conditions they aren't familiar with - both as a tool to

explore the issues with managers and to guide NMPs in the further

education they might need to fulfil the expected role. I expect every NMPin this organisation to be familiar with the framework - I direct new NMPs

and those new to the organisation to it(NMP Prescribing Lead)

Using the framework to identify strengths

and development areas… (1)

Reflect on a recent prescribing consultation

Consider each of the framework competencies one at a time

What are the key areas to develop and enhance to improve your prescribing?

Using the framework to identify

strengths and development

areas…(2)

Select a competency dimension or statements

Reflect on recent prescribing consultations

What are the key areas to develop and enhance to improve your prescribing?

History-taking, clinical assessment

and diagnosis skills to prescribe

appropriately and effectively

Assessment of the patient: Competencies 1.1 - 1.8

Reflect on recent prescribing consultations…. or consider the patient presentations for which new skills needed…

What are the key areas to develop and enhance to improve your prescribing?

Individual prescribers - NMC

registrants Nature of CPD activity?

consultation, reflection, self-assessment, peer review/discussion

What did you learn? assessmentand clinical skills - achieved/fordevelopment

How did you change orimprove? action plan, courseattendance, supervisedpractice, repeat consultationetc

How is this relevant to the Code?patient benefit…

Conference message:

Me and my medicines

Me and my medicines

Reaching a shared decision

Competencies 3.1-3.6

Reflect on recent prescribing consultations…. or consider the patient presentations for which new skills needed…

What are the key areas to develop and enhance to improve your prescribing?

Criticisms of a competence-based

approach (Banning, 2012)

deconstruction of professional competencies into

component competencies ignores complexity of

professional practice

how do we recognise competence against thesemeasures?

competent/expert continuum or competent/not

competent?

assessment relies on assessor’s differentiation

the competency framework… there is still a need for

prescribers to consider how their own professional codes

of conduct, standards and guidance apply to prescribing

The Code (NMC, 2018)

You must fulfil all registration requirements.. .

o keep to our prescribed hours of practice and carry

out continuing professional development activities

o keep your knowledge and skills up to date, taking

part in appropriate and regular learning and

professional development activities that aim to

maintain and develop your competence and

improve your performance

(NMC, 2018)

Continuing professional

development (HCPC)

3.5 you must ask for feedback and use it to

improve your practice

(Standards of conduct, performance and ethics, HCPC, 2016)

seek to ensure that … CPD has contributed to

the quality of their practice and service delivery

seek to ensure that their CPD benefits the service

user

(Standards of CPD, HCPC, 2017)

Standards for pharmacy

professionals (GPhC, 2017)

Standard 4: pharmacy professionals must maintain, developand use their professional knowledge and skill

people receive safe and effective care when pharmacyprofessionals:

❖ use their skills and knowledge, including up-to-dateevidence, to deliver care and improve the quality of carethey provide

❖ carry out a range of continuing professionaldevelopment (CPD) activities relevant to their practice

❖ use a variety of methods to regularly monitor and reflecton their practice, skills and knowledge

How will you use the competency

framework

What is your role?

What do you want to achieve by using the competency framework?

How will you use it?

References and useful sources Banning, M. (2012) Educating for capability in NMP education and training. Nurse Prescribing, 10(3),

pp. 148-153.

General Pharmaceutical Society (2017) Standards for pharmacy professionals. London: General

Pharmaceutical Society. Available at:

https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_

2017_0.pdf

Health and Care Professions Council (2018) Standards of continuing professional development.

Available at: https://www.hcpc-uk.org/standards/standards-of-continuing-professional-development/

Health and Care Professions Council (2019) Standards for prescribing. Available at: https://www.hcpc-

uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing/

Nursing and Midwifery Council (2018) The Code: professional standards of practice and behaviour for

nurses and midwives. London: Nursing and Midwifery Council.

Nursing and Midwifery Council (2017) Standards for prescribing programmes. Available at:

https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/programme-standards-

prescribing.pdf

Royal Pharmaceutical Society (2016) A competency framework for all prescribers. Available at:

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20sta

ndards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-

02-13-163215-030

Recommended sources:

Me and my medicines. https://meandmymedicines.org.uk/

Royal Pharmaceutical Society (2016) Prescribing competency framework: Frequently asked questions.

Available at: https://www.rpharms.com/resources/frameworks/prescribers-competency-framework