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.

Association of Ambulance Chief Executives outlines strategic priorities for 2015/16

Paramedic prescribing and reform of paramedic education and training with Health Education England are among the key strategic priorities of the Association of Ambulance Chief Executives (AACE) for 2015/16.

The AACE National Programme, which is comprised of nine national groups and their respective 2015/16 work plans, as well as a number of other projects that are being progressed by the AACE with input from the national groups as required, is informed by its four strategic objectives: Ambulance Service: 2020 and beyond; Workforce, education and development; Operating model and efficiency; Clinical and patient safety.

The AACE aims to report on its ‘Ambulance service: 2020 and beyond’ project in May/June with an informed vision of what the ambulance service should look like beyond 2020 and suggestions to the ambulance sector on the steps and actions required to realise this vision.

Implementation of the Urgent and Emergency Care Review (U&ECR) will be an ongoing focus for the AACE in 2015/16, and will include the enhancement of NHS 111 services and reform of paramedic education and training with Health Education England.

Continued support and input will continue to the reform of paramedic education and training, with paramedic prescribing remaining a priority for the AACE to equip the profession for the ongoing expansion and diversification of the role.

The identification and development of future ambulance leaders is also a priority of the AACE, with focus being made on leadership development and consideration of a virtual academy and its potential for multidisciplinary training.

Ambulance service response will remain a focus for the AACE in 2015/16, and will include the development of future performance and clinical measures in light of the U&ECR, and the facilitation of any required changes to response protocol nationally following the completion of pilots in early 2015/16.

Finally, the AACE plans to deliver the National Ambulance Service Medical Directors’ Group’s Future National Clinical Priorities for Ambulance Services in England. Key clinical areas of focus include: emergency care; urgent care; mental health; the frail, elderly falls and dementia; long-term conditions; end of life patients; and public health and prevention.

To view the full list of strategic priorities, visit: http://aace.org.uk/national-programme/

Taken from Journal of Paramedic Practice, published 30 April 2015.

Tackling the shortage of paramedics

February marked the first time that paramedics were recommended for addition to the shortage occupation list (SOL), with vacancy rates running at approximately 10% of the total 12 500 paramedic workforce in England (Migratory Advisory Committee, 2015).

Using evidence received from the Centre for Workforce Intelligence, the Migratory Advisory Committee have identified a number of factors driving the shortage. These include: significant increases in demand for ambulances as a result of the shift in focus to treat people at home rather than in A&E; high staff attrition due to work pressures and stress brought on by longer working hours; and growing opportunities for paramedics to take on roles in alternative areas such as the 111 service, GP practices and walk-in centres.

In an attempt to combat the shortage, ambulance services have been forced to introduce a number of initiatives. Many have looked overseas to fill the gap in the workforce, as retraining a healthcare professional to meet Health and Care Professions Council (HCPC) standards usually only requires a short conversion course. This is particularly true for countries such as Australia and New Zealand, where the skills and training are similar to the UK. While only one paramedic was recruited from overseas from 2013–2014, 183 have already been recruited from 2014–2015, with further recruitment planned (Renaud-Komiya and Calkin, 2015). However, it is worth noting that the migration of healthcare workers brings with it ethical issues, as services abroad may suffer as a result of their own falling numbers (Peate, 2014).

Increasing the number of student paramedics will help to secure future generations of the workforce; however, it does not tackle the problem now, and does not help deter those paramedics who are already considering leaving the profession. Not only this, but higher education institutions (HEIs) are limited by the number of places they can offer. The shift of training in 2009 from in-house ambulance service training to a mix of degree, diploma, and foundation degree courses, has had a considerable impact on the profession. What is really needed, therefore, is a national funding scheme for the training of paramedics (Barnes, 2015). If national investment was made in paramedics then HEIs would be able to take in bigger cohorts as more places would be funded. Health Education England (HEE) has pledged to increase the number of paramedic training places by 87% over the next two years, but these additional commissions will not produce qualified paramedics until 2016/17 (HEE, 2015). Growth to the paramedic workforce is essential; however, the rapid level of increased demand from ambulance services means that shorter term supply solutions must be found if growing vacancy rates are not to deteriorate further until this newly trained supply becomes available.

References

Barnes S (2015) National fund needed to address paramedic shortage, says ambulance chief. HSJ. http://tinyurl.com/q2z8wez (accessed 27 March 2015)

Health Eucation England (2015) Workforce Plan for England: Proposed Education and Training Commissions for 2015/16. HEE, Leeds

Migration Advisory Committee (2015) Partial review of the Shortage Occupation Lists for the UK and for Scotland. MAC, London. http://tinyurl.com/qdaqbbl (accessed 26 March 2015)

Peate I (2014) Ethical recruitment and employment of internationally educated paramedics. Journal of Paramedic Practice 6(10): 500–501. doi: 10.12968/jpar.2014.6.10.500

Renaud-Komiya N, Calkin S (2015) Trusts forced to look overseas to plug paramedic gaps. HSJ. http://tinyurl.com/pqeo4k5 (accessed 27 March 2015)

Taken from Journal of Paramedic Practice, published 3 April 2015.

Looking forward: the Five Year View

On 23 October, Simon Stevens outlined his Five Year Forward View for the NHS. Developed by the partner organisations that deliver and oversee health and care services, including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority, it offers a look at why change in the NHS is needed, what that change might look like and how we can achieve it (NHS England et al, 2014). This ‘upgrade’ to the public health system will take into account growing problems associated with obesity, smoking and the consumption of alcohol; greater control of patients’ own care through fully interoperable electronic health records that are accessible to the patient; and decisive steps to break down the barriers in how care is provided.

In line with the Urgent and Emergency Care Review (NHS England, 2013), the Five Year Forward View proposes an expanded role for ambulance services, highlighting the increasing need for out-of-hospital care to become a more notable part of the work the NHS undertakes. The plan highlights the need to dissolve traditional boundaries and integrate urgent and emergency care services between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Through empowering ambulance service staff—including paramedics—with the ability to make make more decisions, treat more patients and make referrals in a more flexible way, it is hoped that pressure on other services can be alleviated and patients can receive the care they deserve. Highlighting the success of the introduction of major trauma centres, it emphasises the need for developing networks of linked hospitals that ensure patients with the most serious needs get to specialist emergency centres.

The Five Year Forward View also promotes the need to engage with communities in new ways by involving them directly in decisions about the future of health and care services (NHS England et al, 2014). Through the encouragement of community volunteering, it is hoped that a critical contribution to the provision of health and social care in England can be made. It is suggested that this could be done through further recruitment of community first responders, particulary in more rural areas, who are trained in basic life support. In addition, proposals for new roles include family and carer liaison, educating people in the management of long-term conditions and helping with vaccination programmes.

The Five Year Forward View is a welcome proposal of how the NHS can tackle changing demands in health care. By recognising how and why the health system needs to evolve, it is hoped the NHS will be able to provide better, higher quality, and more integrated care to its patients.

References

NHS England (2013) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England – Urgent and Emergency Care Review End of Phase 1 Report. NHS England, London

NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 1 December 2014)

Taken from Journal of Paramedic Practice, published 5 December 2014.

Health Education England chair praises WMAS staff developments

Sir Keith Pearson, chair of Health Education England and Jenni Ord, chair for Health Education West Midlands have praised the staff developments that are being undertaken by West Midlands Ambulance Service NHS Foundation Trust (WMAS).

During a visit to the WMAS headquarters on 12 March, the pair received an overview of the educational systems embedded into the Trust, such as paramedic progression and apprenticeships.

Key to the presentations were the way the Trust has invested heavily in helping staff to train to higher levels of education which ultimately allows individuals to deliver better patient care. For example, they heard about the additional skills paramedics have which means many more patients are now cared for within their own homes rather than needing to be taken to hospital as might have happened only five years ago.

The role of WMAS critical care paramedics and their role within the Medical Emergency Response Intervention Team (MERIT) was next on the agenda. MERIT has been noted as a world leading trauma initiative, which sees highly skilled paramedics and trauma doctors being dispatched to some of the most serious incidents within the region.

WMAS Chief Executive, Anthony Marsh said: ‘The visit provided the opportunity to demonstrate how we are strengthening our workforce, particularly with paramedic progression through recruitment as well as providing existing staff development opportunities. This progression will help to ensure we continue to provide patients with high quality services. We are getting ever closer to our aim of having a paramedic on every vehicle which will undoubtedly improve patient care.’

Taken from Journal of Paramedic Practice, published 26 March 2014.

Report calls for national education and training framework for paramedics

A recent report issued by the Allied Health Professional Health Education Advisory Group (formally the Department of Health’s AHP Professional Advisory Body) has called for the introduction of a national education and training framework for paramedics.

The Paramedic Evidence Based Project (PEEP), which was funded by the College of Paramedics, emphasises the need for a more robust education and training system. As current education and training for paramedics in England is locally determined, very different levels of learning outcomes are being achieved at the point of registration. It has therefore been highlighted that education and training needs to be standardised, and a clear framework enabling this to happen be developed.

The report proposes a model that would lead to an all-graduate paramedic profession by 2019.

Some of the notable recommendations outlined in the report include: a standardised approach to education and training; the need for an agreement of a pre-registration education development model leading to an all-graduate profession; knowledge and skills enhancement; the development of a partnership model; the appointment of a national lead for education and training of paramedics in England; and a standardised approach to identification.

Professor Chris Welsh, Director for Education and Quality for Health Education England, said: ‘We note the recommendations in this report, however we also understand it is not a full account of issues paramedics are facing in relation to education and training. We’ll be working closely with the College of Paramedics and other stakeholders to look at these recommendations and implement those that have the greatest impact on patient care.’

Professor Andy Newton, Chair of the College of Paramedics, said: ‘As sponsors of the report we were delighted to receive this wide-ranging review highlighting many of the issues facing the profession. The College fully endorse the proposed move to graduate entry and believe that this should be achieved in a timely fashion. We believe that having a well-prepared paramedic at the heart of unscheduled urgent and emergency care will be of major benefit to the wider community. The College looks forward to working with Health Education England, educational leaders in Scotland, Wales, and Northern Ireland and other stakeholders on the report’s recommendations.’

Taken from Journal of Paramedic Practice, published 25 September 2013.