Royal Pharmaceutical Society updates prescribing competency framework

Adobe Spark (1)The Royal Pharmaceutical Society (RPS, 2016) has published an update to the Competency Framework for all Prescribers to ensure health professionals prescribe safely and effectively.

Originally published in 2012, the framework was developed to offer a common set of competencies for prescribing, regardless of professional background. As a result, it is relevant to all prescribers, including doctors, pharmacists, nurses, dentists, physiotherapists, optometrists, radiographers, podiatrists and dietitians. However, the framework should be contextualised to reflect different areas of practice and levels of expertise.

Ash Soni, President of the RPS, said:

‘Both the number of medicines prescribed and the complexity of medicine regimens are increasing. The challenges associated with prescribing the right medicines and supporting patients to use them effectively should not be underestimated.

‘There’s lots of evidence to show that much needs to be done to improve the way we prescribe and support patients in effective medicines use. This guide will be invaluable and I’m delighted the RPS has coordinated the update.’

The initial framework was published by the National Prescribing Centre and the National Institute for Health and Care Excellence (NICE). For the update, the RPS was approached by NICE and Health Education England to carry out the work on behalf of all prescribing professions. Additionally, the RPS was asked to ensure the framework had UK-wide applicability.

A project steering group of prescribers across all professions and patients updated the framework. This involved a 6-week consultation of the draft policy, where hundreds of organisations and individuals responded.

The framework has been endorsed by the UK’s Chief Pharmaceutical Officers—Keith Ridge, Rose Marie Parr, Andrew Evans and Mark Timoney—who said:

‘The single competency framework provides a means for all prescribers to become equipped to support patients to achieve the best outcomes from their medicines.

‘This update will ensure individuals can continue to benefit from access to resources which help them continually improve their practice and work more effectively.

‘We commend the updated framework and encourage prescribers, professional bodies, education providers and regulators to use it to support their role in delivering safe and effective care.’

How the competencies are separated

The framework comprises 10 competencies split into two areas: the consultation and prescribing governance. Within each of these competency areas, statements describe the activity or outcomes that prescribers should be able to demonstrate.

The consultation

The first competency concerns assessing the patient. It promotes taking an appropriate medical, social and medication history, before undertaking an appropriate clinical assessment.

The second competency involves the prescriber considering the options for the patient. This includes both non-pharmacological and pharmacological approaches to treatment, and weighing up the risks and benefits to the patient of taking medicine.

The third competency is about reaching a shared decision with the patient/carer, so the patient/carer can make informed choices and agree on a plan that respects the patient’s preferences.

The fourth competency is the prescribing itself. The framework states the medicine should be prescribed only with ‘adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and unwanted effects.’ Where appropriate, medicines should be prescribed within relevant frameworks, such as local formularies or care pathways.

The fifth competency concerns providing information to the patient/carer about their medicines. This includes what the medicine is for, how to use it, possible unwanted effects and how to report them, and expected duration of treatment.

The sixth and final competency in the area of consultation is monitoring and reviewing. Here the prescriber should establish and maintain a plan for reviewing the patient’s treatment. The effectiveness of treatment and potential unwanted effects should be monitored.

Prescribing governance

The seventh competency, and first under the area of prescribing governance, concerns prescribing safely. It highlights that the prescriber should prescribe within their own scope of practice and recognise the limits of their own knowledge and skill.

The eighth competency comprises prescribing professionally, and ensuring the prescriber maintains confidence and competence to prescribe. This includes accepting personal responsibility for prescribing and understanding the legal and ethical implications.

The ninth competency focuses on improving prescribing practice through reflection. It also stresses the importance of acting on feedback and discussion.

The tenth and final competency involves prescribing as part of a multidisciplinary team to ensure continuity of care across care settings. Part of this concerns establishing relationships with other professionals based on understanding, trust and respect.

Putting the framework into practice

The framework can be used for a variety of reasons by prescribers to help them improve their performance and work more effectively. The following examples are highlighted in the framework:

  • To 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
  • To help health professionals prepare to prescribe and provide the basis for ongoing education and development programmes, continuous professional development and revalidation processes. For example, use as a framework for a portfolio to demonstrate competency in prescribing
  • To help prescribers identify strengths and areas for development through self-assessment, appraisal and as a way of structuring feedback from colleagues
  • To inform the development of education curricula and relevant accreditation of prescribing programmes for all prescribing professions
  • To 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
  • To stimulate discussions around prescribing competencies and multidisciplinary skill mix at an organisational level
  • To inform organisational recruitment processes to help frame questions and benchmark candidates’prescribing experience
  • To inform the development of organisational systems and processes that support safe effective prescribing; for example, local clinical governance frameworks.

The RPS is liaising with the professional bodies and organisations of the other prescribing professions to encourage uptake of the framework, which will be reviewed again in July 2020.

References

Royal Pharmaceutical Society (2016) A Competency Framework for all Prescribers. http://www.rpharms.com/support-pdfs/prescribing-competencyframework.pdf (accessed 1 August 2016)

Taken from Nurse Prescribing, published 12 August 2016.

Pay survey reveals two thirds of paramedics considering leaving ambulance service

Adobe Spark (5)Two thirds of staff say they will consider leaving the ambulance service if a change to the pay banding of paramedics is not made, according to a survey carried out by the Journal of Paramedic Practice.

An online poll completed by 1084 paramedics has revealed that 67% will consider leaving the ambulance service if the Government continues to fall back on its 2015 promise of reviewing the banding system to recognise the skill set of paramedics. Additionally, 87% felt the Government has misled ambulance service staff over promises for pay.

One respondent said: ‘Increased pressure to use alternative pathways, treat at home, discharge on scene. Increased level of assessment and treatment options, together with increased expectation of qualifications and study, but for no extra pay? Ridiculous.’

Another said: ‘Several of my colleagues and friends are struggling to pay their home bills and have left the job for better paying roles in the Arab states.’

Commenting on the findings, Gerry Egan, chief executive officer for the College of Paramedics, said:

‘Since its establishment, the College of Paramedics has worked hard to develop the paramedic profession in the interests of providing the best possible care to patients and to ensure that paramedics receive due recognition for the service they give to society.

‘This combined with the increased reliance on paramedics by the health system, which has come about for a number of reasons, means that there has been a continuous increase in the expectations of the range and quality of services that paramedics provide. So it comes as no surprise that the results of the Journal of Paramedic Practice’s survey are similar to a survey conducted by the College of Paramedics last year.

In 2014, paramedics were among the thousands of health professionals who took to the picket line in the first NHS strike over pay in 32 years.

The dispute came as ministers in England awarded NHS staff a 1% increase in pay, but only for those without automatic progression-in-the-job rises.

Despite the independent NHS Pay Review Body recommending a 1% rise across all pay scales, ministers claimed this was an ‘unaffordable’ cost.

In a desperate effort to resolve the pay dispute of 2014/15, the Secretary of State for Health, Jeremy Hunt, agreed to a number of commitments to ambulance staff, including a review of the banding system.

Current vacancy rates for the paramedic profession are at 10%. This represents 1 250 vacancies out of a total workforce of 12 500. It is believed that these high vacancy rates are due to changes made to the healthcare system in recent years. This includes a shift in focus to treat patients at home rather than conveying them to A&E, as well as a change in the nature and volume of job opportunities for paramedics.

Almost all respondents (93%) of the survey believed that the current scope of practice of paramedics is changing as a result of increased skills and competencies. Additionally, 94% felt band 6 of the Agenda for Change pay scale was a more appropriate pay band due to the level of responsibility and autonomy practised within the paramedic role, including triage, referrals, and decisions around non conveyance. Overall, 96% believed their pay did not reflect their responsibilities.

However, not all believed that current pay for paramedics has contributed to increasing vacancy rates and the number of people leaving the profession.

‘I disagree that this would be a reason for paramedics leaving,’ said one respondent. ‘With the role having changed so much, I believe that our advanced practice colleagues (paramedic practitioner/emergency care practitioner) are leaving to work in hospitals. There is potential to earn more money, better chance of a break, and better working conditions. I disagree that pay alone is a reason staff are leaving.’

According to Egan, the significance behind the figures for those considering leaving the profession may be unclear:

‘The responses regarding those intending to leave their positions as paramedics may be blurred somewhat between those intending to leave ambulance service employers and those who might leave the profession,’ he said. ‘It is a well-known fact that many paramedics are leaving ambulance services to take up opportunities in walk-in centres, minor injuries units and the like.’

A large number of respondents felt that it was work pressures and stress that have contributed most to the number of paramedics leaving the ambulance service:

One respondent said: ‘I don’t think pay is a factor in staff leaving. Lack of retention [is] more likely due to increased workloads, poor culture and public expectation.’

Another respondent said: ‘There have been some paramedics with MSc or BSc that have left to find better paid jobs. But the majority of paramedics leaving the profession is due to the increasing workload and the undertaking of urgent care alongside emergency work. Demand, stress and pressure are why paramedics are leaving, not money.’

Stress and burnout remain an undeniable issue facing ambulance staff, with paramedics in England taking 41 243 days off in 2014 as a result of stress-related illnesses. This has had an inevitable impact on those choosing to leave the ambulance service. Only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics .

Another significant finding was that 66% of respondents believed there are no adequate opportunities for career progression.

A common consensus was that progression only came in the form of management positions, with few opportunities for promotion in a clinical capacity.

One respondent said: ‘There are a number of areas within the paramedic profession to progress to, such as critical care roles or minor health roles, or management; however, these areas still do not have the same pay scale as other health sectors, meaning progression, while increasing skills, does not increase pay, therefore [it] is seen as a way to gain skills in order to leave to a sector with increased pay.’

However, this was not felt by all, with one respondent highlighting the work that the College of Paramedics has done to outline career pathways:

‘The College of Paramedics (and South East Coast Ambulance NHS Foundation Trust) has done a lot to develop career pathways. Integration of the out-of-hours providers and the ambulance service would provide even more opportunity for paramedics to progress as well as improving the response times for patients.’

Commenting on the suggestion there are insufficient career progression opportunities within the paramedic profession, Egan said: ‘The College would argue that its career framework sets out the roadmap for career progression and the shortage of opportunities may be a problem to be addressed by the main employers of paramedics.’

As a result of the Government not reviewing the banding system for paramedics, the unions UNISON, GMB and Unite conducted consultative ballots of ambulance staff. The responses indicated that ambulance staff in England will take part in industrial action, including strike action, if the Government continues to not deliver in its promises over pay.

Each union is reporting their ballot results to members, before consulting over the next steps.

Results published by Unite show that 66% of members voted yes to taking strike action and action short of strike action, with a turnout of 31%.

Results from the other two unions have not yet been made public.

A joint statement issued by the unions said:

‘We are clear that ambulance staff have waited for 12 months and are not going to wait longer. If possible, we would also like to avoid a dispute, and the disruption that strike action will bring, however we know that ambulance staff are not prepared to wait indefinitely.

‘We will be calling on Government to make real commitments to ambulance staff, within clear timescales. If there is a genuine will to avert a dispute then we will pause the move to a full industrial action ballot while we hold constructive discussions.’

While the National Ambulance Strategic Partnership Forum have made a formal request to the National Job Evaluation Group to look at the National Job Evaluation paramedic profile, only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics. This includes East of England Ambulance Service NHS Trust, West Midlands Ambulance Service NHS Foundation Trust, Yorkshire Ambulance Service NHS Trust. There is currently no indication that other services will follow suit.

Taken from Journal of Paramedic Practice, published 1 July 2016.

Ambulance service contributed to loss of lives at Hillsborough disaster

Adobe Spark (2)Following the longest inquest in British legal history, the jury of the Hillsborough disaster that occurred at the 1989 FA Cup semi-final between Liverpool and Nottingham Forest, ruled that lives were lost as a result of mistakes made by the ambulance service.

The disaster, which saw 96 Liverpool fans die and 766 injured, occurred after police opened an exit gate to alleviate the throng of people outside. This lead to a huge influx of supporters into two of the pens, causing severe crushing to those fans already in the terrace.

After hearing evidence for over 2 years, the jury of six women and three men reached a verdict of unlawful killing by a 7-2 majority.

They were asked 14 questions related to areas such as basic facts of the disaster, policing, behaviour of the supporters and defects in the Hillsborough stadium.

When questioned on the emergency response and the role of the South Yorkshire Metropolitan Ambulance Service (SYMAS) after the crush in the west terrace had begun to develop, it was agreed that error or omission on behalf of SYMAS contributed to the loss of lives in the disaster.

In particular, it was felt that SYMAS officers at the scene failed to ascertain the nature of the problem at Leppings Lane, and the failure to recognise and call a Major Incident led to delays in responses to the emergency.

Speaking after the ruling, Rod Barnes, Chief Executive of Yorkshire Ambulance Service NHS Trust, extended his sympathies to the bereaved families of those who lost their lives as a result of the tragedy.

‘We fully accept the jury’s conclusions that after the crush began to develop there were mistakes made by the ambulance service,’ said Barnes. ‘Lives could have been saved on the 15th April 1989 had the emergency response been different.’

He went on to apologise on behalf of Yorkshire Ambulance Service: ‘I am truly sorry. Our thoughts remain with the families as they continue to grieve and come to terms with the evidence they have heard over the last 2 years.’

‘As one of the successor organisations of South Yorkshire Metropolitan Ambulance Service, we have had a responsibility to ensure a full and fair examination of their response. We have done our best to make sure all relevant evidence about the ambulance service response has been put before the Court, placed in context and properly explored in an open way,’ he added.

He highlighted how the ambulance service has changed in the last 27 years and stressed how a lot has been learned from Hillsborough and other incidents.

‘We, as an organisation, are not complacent. I would like to reassure the public that the ambulance service’s ability to respond to a major disaster such as this has changed beyond all recognition.

‘We understand the importance of today for the families and friends of those who died. Our thoughts remain with them.’

In addition to the ambulance service, it was concluded that the South Yorkshire police were responsible for the development of the dangerous situation and subsequently contributed to the loss of lives due to a lack of coordination, communication, command and control, which in turn delayed or prevented appropriate responses.

The Prime Minister, David Cameron, said that the jury’s ruling of the Hillsborough inquests has provided ‘official confirmation’ that Liverpool fans were ‘utterly blameless in the disaster’.

Chief executive of The Ambulance Services Charity leaves to pursue other interests

Lorna Birse-Stewart, chief executive of The Ambulance Services Charity (TASC), has left the organisation to pursue other interests, it has been revealed.

According to a statement issued by TASC, Birse-Stewart was instrumental in launching the charity in March 2015, which aims to support current and former members of the ambulance services community, as well as their families and dependents. She also played a key role in setting up the charity’s new UK head office in Westwood Way, Coventry.

While at the organisation she led in its regional engagement programme, touring the UK and visiting ambulance services both within the NHS and the independent sector, as well as engaging with leading figures from the ambulance industry.

A replacement chief executive for TASC has not yet been announced.

Taken from Journal of Paramedic Practice, published 22 April 2016.

Anthony Marsh to become improvement advisor at struggling East Midlands Ambulance Service

Anthony Marsh, CEO of West Midlands Ambulance Service NHS Foundation Trust (WMAS), is to become improvement advisor at East Midlands Ambulance Service NHS Trust (EMAS) as part of plans to help turn around the struggling service.

Marsh will be supporting EMAS on an interim basis, providing advice and support to the executive team. He will work the equivalent of one day a week, starting from Monday 25 April 2016, for a period of 6 months.

It has been confirmed that he will continue his role as CEO of WMAS.

When asked how he intends to ensure his role at WMAS will not be affected by his new position, a spokesperson said: “West Midlands Ambulance Service will operate in the normal way with the executive team continuing to run the organisation in the same way as it normally does, for example when Mr Marsh goes on holiday.”

EMAS chairman, Pauline Tagg, has been in discussions with NHS Improvement over how the service could strengthen its leadership following the departure of its former chief executive, Sue Noyes, due to “personal reasons” in March.

Mr Marsh’s appointment comes at a time when EMAS is facing considerable financial and performance difficulties.

Latest figures released by the Trust reveal a £12.46 million deficit—20 times the planned amount of £0.12 million.

The service’s financial position has triggered escalation with its regulator, the NHS Trust Development Authority, resulting in the application of a loan for £9 million.

Responses to Red 1 calls at EMAS have been well below the national target of 75%, with the service failing to achieve a response within 8 minutes in 7 out of 8 months this year.

In addition to Mr Marsh’s appointment, Richard Henderson is to continue in the role of acting chief executive until further notice. Henderson has held a number of clinical and operational senior managerial roles including divisional director for EMAS’ Lincolnshire division, and chair of the National Ambulance Service Director of Operations Group.

David Whiting is to become chief operating officer for the next 6 months. Whiting has over 30 years’ experience in the ambulance service and previously worked for EMAS as director of operations until 2009.

“I’m excited about my return to EMAS and look forward to working with colleagues and staff to help further improve services for the communities we serve,” said Whiting.

Mike Naylor becomes acting finance director from today, as current director of finance Richard Wheeler leaves EMAS. Naylor has been leading EMAS’ future planning and budgets work for 2016/17 since 1 April.

“These leadership appointments bring expertise, knowledge and experience to allow us to continue to transform and improve services for our patients,” said Tagg.

Taken from Journal of Paramedic Practice, published 22 April 2016.

Welsh Government announces £10.3 million investment in vehicles for ambulance service

The Welsh Ambulance Service NHS Trust is to receive 94 new vehicles as a result of a £10.3 million investment from the Welsh Government, it was announced today.

Health and Social Services Minister, Mark Drakeford, who made the announcement, said:

“The demand on the Welsh Ambulance Service is growing each year, which is why it’s vital we invest in the latest vehicles so the service can deliver the best care for people in Wales.”

According to Drakeford, the investment will enable the Welsh Ambulance Service NHS Trust to upgrade its fleet. Among the vehicles to be purchased are 35 new emergency ambulances and 13 rapid response vehicles. Additionally, 10 patient care services vehicles capable of carrying stretchers, 32 patient care services vehicles capable of carrying wheelchairs, and four specialist vehicles are to be bought.

It is hoped the additional vehicles will ensure the most appropriate clinician is deployed in the most appropriate vehicle, allowing for the best possible treatment for patients.

The money was allocated to the ambulance service by Jane Hutt, the Minister for Finance and Government Business, as part of the Welsh Government’s Final budget for 2016–17.

The Welsh Government has invested nearly £45 million in new vehicles for the ambulance service since 2011.

Richard Lee, interim director of operations for the Welsh Ambulance Service NHS Trust, said:

“Our ambulances and response cars in Wales are some of the most modern and well equipped in the UK and this funding will allow us to continue to replace our vehicles as they reach the end of their working life. We are very grateful to the Welsh Government for their continued support.”

Currently the Welsh Ambulance Service NHS Trust has 706 vehicles in its fleet, covering an area of 8,000 square miles within Wales.

College of Paramedics sees 42% increase in membership

Membership of the College of Paramedics has increased by 42% from 2nd January 2015 to 1st January 2016, according to figures published in the Trustees’ Annual Report.

The College of Paramedics now has a total of 8,948 members, up from 6,296 announced last year, it has been revealed.

“The College of Paramedics has had a year of exceptional growth and success in 2015,” said Andy Newton, chair of the Trustee Board. “The College now has a membership of almost 9,000 and has grown both its staff and pool of expertise to enable it to continue forward.”

As of January 2016 there were 6,458 full members of the College of Paramedics. This represents 29.7% of all paramedic registrants of the Health and Care Professions Council, the regulatory body for the paramedic profession.

Additionally, student members saw a 42% increase from 1,274 in 2015 to 1,810 in 2016. Associate members saw a 25% increase from 545 in 2015 to 680 members in 2016.

It is believed the enhanced medical malpractice and public liability insurance cover offered as a benefit to full members attributed to the increase in full members over the course of the year.

Improvements in the communications to members, including the College newsletter, a revised website and the creation of a regular members’ news digest email, is also thought to have played a part.

The increase in members show the College is one step closer to its aim of becoming a Royal College, which requires that 50% of the profession are members of the professional body. This comes after the College achieved one of the other requirements by being awarded registered charity status in early 2016.

“With 30% of all registered paramedics now members of the College, we are rapidly approaching the position whereby such an application could become a reality within the next few years,” said Newton.