Short Course Guidance Notes

The entry requirements for the pharmacist independent prescribing course are that:

a) Applicants are registered as a pharmacist with the General Pharmaceutical Council (GPhC) or, in Northern Ireland, with the Pharmaceutical Society of Northern Ireland (PSNI) (GPhC, 2022a, 10).

b) Applicants are in good standing with the GPhC and/or PSNI and any other healthcare regulator with which they are registered (GPhC, 2022a, 10).

c) Applicants must have relevant experience in a UK pharmacy setting and be able to recognise, understand and articulate the skills and attributes required by a prescriber. This experience and awareness will act as the basis of their prescribing practice whilst training (GPhC, 2022a, 12).

As stated above, applicants must be able to provide examples of relevant experience in a UK pharmacy setting. An applicant’s experience must be meaningful and highlight outcomes that evidence both significant and positive impacts on patient care.

Experience could have been obtained, for example:

• whilst studying pharmacy, and could include experiential learning, simulation, summer placements and other relevant activities
• during their foundation training year (referred to as ‘pre-registration training’ prior to the 2021/22 academic year)
• whilst employed in a pharmacy setting

Examples of relevant experience may include, but are not limited to:

• counselling patients whilst working in collaboration with multidisciplinary hospital pharmacy teams on a ward where shared decision making and consideration of patient dignity, capacity, and consent are essential
  
  
• drug history taking and medication reviews whilst assessing patients’ medicines as part of an annual review in a GP practice and where consideration of diversity and cultural differences influences their recommendations
  
  
• resolution of prescribing queries potentially in a community pharmacy where service provision to a care home is part of their role
  
  
• dealing with ethical dilemmas whilst working in a community pharmacy on a weekend and having to decide whether to supply medicines to a patient who has run out and they cannot discuss this with the patient’s GP
  
  
• observation/involvement in specialist clinics in their local GP surgery where maintaining patient confidentiality will be essential, particularly as they know many of the patients who attend their community pharmacy
  
  
• reflection on practice and recognising their limitations in competence potentially when faced with a request to treat a patient or issue a prescription for a condition that they are unfamiliar with whilst working in a GP practice.

The examples given above are intended to demonstrate the wide ranging and unique nature of relevant pharmacy experience that can contribute to a pharmacist’s overall readiness to enrol on an accredited independent prescribing course. There is not a specific length of time that will determine this. It is the overall breadth and range of relevant experience that is important (GPhC, 2022b, 3).

You will be requested to provide your CV as part of our application process at the University of Lincoln School of Pharmacy and to provide a written narrative (of no more than 800 words) summarising how your experience within the roles or placements detailed within your CV have prepared you to undertake your training as a pharmacist independent prescriber. Your narrative must include the following:

• Patient-orientated/person-centred experience
• Clinical/therapeutic experience
• Evidence of continuing professional development (GPhC, 2022b, 2).

As stated within entry requirement c) above, you must be able to recognise, understand, and articulate the skills and attributes required by a prescriber.

The application process at the School of Pharmacy requires you to provide a short reflection to demonstrate how your personal experience has strengthened your understanding of the role of the prescriber and has supported how you recognise, understand, and articulate the skills and attributes of a prescriber.

It is important to note that many of the skills required by a prescriber are the same as those of a non-prescriber. Your Standards for Pharmacy Professionals (GPhC, 2017) should, therefore, underpin and inform your application. There are nine standards that every pharmacy professional is accountable for meeting. They describe how safe and effective care is delivered through ‘person-centred’ professionalism.

The standards are a statement of what people expect from pharmacy professionals and reflect what pharmacy professionals have told the GPhC that they expect of themselves and their colleagues. The meaning of each of the standards is explained, and there are examples of the types of attitudes and behaviours that pharmacy professionals should demonstrate, and therefore, are consistent also for prescribing.

The Standards for the initial education and training of pharmacists (GPhC, 2021b) have determined key learning outcomes that a trainee pharmacist would be expected to demonstrate upon registration in relation to being a prescriber, and the GPhC expects applicants to understand these and their importance when prescribing medicines. These also align to the Prescribing Competency Framework (RPS, 2021) (see below).

These are:

• recognise the psychological, physiological, and physical impact of prescribing decisions on people
• consider the quality, safety, and risks associated with medicines and products and take appropriate action when producing, supplying, and prescribing them
  
  
• take responsibility for the legal, safe and efficient supply, prescribing, and administration of medicines and devices
  
  
• apply the principles of clinical therapeutics, pharmacology, and genomics to make effective use of medicines for people, including in their prescribing practice
  
  
• critically evaluate and use national guidelines and clinical evidence to support safe, rational, and cost-effective procurement for the use, and prescribing of, medicines, devices, and services
  
  
• apply relevant legislation and ethical decision-making related to prescribing, including remote prescribing
  
  
• prescribe effectively within the relevant systems and frameworks for medicines use
  
  
• understand clinical governance in relation to prescribing, while also considering that the prescriber may be in a position to supply the prescribed medicines to people
  
  
• use tools and techniques to avoid medication errors associated with prescribing, supply, and administration

The Competency Framework for all Prescribers (RPS, 2021) describes the demonstrable knowledge, skills, characteristics, qualities and behaviours for a safe and effective prescribing role and sets out what good prescribing looks like. It is a generic framework that can be used by any prescriber at any point in their career, regardless of their professional background. It should, however, be contextualised to reflect different areas of practice, levels of expertise, and settings.

There are ten competencies within the framework which are presented in two domains and describe the knowledge, skill, behaviour, activity or outcome that prescribers should demonstrate.

Domain One - the Consultation:

This domain looks at the competencies that the prescriber should demonstrate during the consultation. Domain one contains the following competencies:

1. Assess the patient

2. Identify evidence-based treatment options available for clinical decision making

3. Present options and reach a shared decision

4. Prescribe

5. Provide information

6. Monitor and review

Domain Two - Prescribing Governance:

This domain focuses on the competencies that the prescriber should demonstrate with respect to prescribing governance. Domain two contains the following competencies:

7. Prescribe safely

8. Prescribe professionally

9. Improve prescribing practice

10. Prescribe as part of a team

Each of these competencies contains several supporting statements related to the prescriber role, which describe the activity or outcome that the prescriber should actively and routinely demonstrate.

The GPhC would expect applicants to have a broad understanding of this framework and use this as the basis for recognising, understanding, and articulating the skills of a prescriber specifically. This, alongside their understanding of the standards for pharmacy professionals and consideration given to scope of practice, is fundamental to confirm that an applicant has the appropriate knowledge to commence as a pharmacist independent prescriber in training.

Based on the above, the GPhC suggests some notable examples of the skills and attributes required by a prescriber that may include, but are not limited to:

• demonstrating person-centred care
• applying professional judgement and professionalism
• using effective communication skills
• utilising diagnostic and consultation skills
• using wide ranging information gathering skills
• using critical appraisal, clinical reasoning, and decision-making skills
• considering prescribing governance
• cognisant of reflective practice
• collaboration, team working, and multi-disciplinary engagement (GPhC, 2022b, 5).

Applicants should be able to demonstrate a thorough understanding of how their personal experience has strengthened their understanding of the role of prescriber and has supported how they recognise, understand, and articulate the skills of a prescriber.

This will be unique to each applicant, however, this in combination with their relevant experience in a UK pharmacy setting should be considered by the educational institution on an individual basis, to gain assurance that they are suitable candidates to commence on an independent prescribing course (GPhC, 2022b, 5).

For the purposes of developing their independent prescribing practice applicants must identify an area of clinical or therapeutic practice on which to base their learning (GPhC, 2022a, 10).

Pharmacist independent prescribers in training will need to identify an area of clinical or therapeutic practice on which to base their learning and develop their independent prescribing practice. This does not necessarily have to align to previous experience or a specific area of competence (GPhC, 2022b, 5).

The application process at the University of Lincoln therefore requires you to describe the clinical or therapeutic area in which you intend to base your learning and to give the rationale for your choice.

An understanding of scope of practice, the activities a healthcare professional carries out within their professional role, is fundamental. The healthcare professional should understand that they must have the required training, knowledge, skills, and experience to deliver prescribing activities lawfully, safely, and effectively.

Scope of practice should be informed by the individual’s professional judgement as well as, for example, regulatory standards, the professional leadership body’s position, employer guidance, and evidence-based documents and guidance from other relevant organisations, such as NHS guidelines or journals. The identified area of clinical or therapeutic practice can be either specialist or generalist (GPhC, 2022b, 5).

Once a pharmacist has successfully completed the training, they can apply for an annotation to their entry on the GPhC’s register. The annotation is a public record that they can practise as an independent prescriber. Pharmacists should, however, only prescribe within their area of competence upon annotation.

It is accepted that, provided the pharmacist independent prescriber expands their scope of practice subsequently, they can prescribe accordingly.

d) Applicants have a designated prescribing practitioner who has agreed to supervise their learning in practice (GPhC, 2022a, 10). The applicant’s designated prescribing practitioner must be a registered healthcare professional in Great Britain or Northern Ireland with legal independent prescribing rights, who is suitably experienced and qualified to carry out this supervisory role, and who has demonstrated CPD or revalidation relevant to this role.

Although an applicant may be supervised by more than one person, only one prescriber must be the designated prescribing practitioner. The designated prescribing practitioner is the person who will certify that successful pharmacists are competent to practise as independent prescribers (GPhC, 2022a, 11).

Applicants must provide evidence that they meet the GPhC’s criteria for eligibility to access this educational programme. It is the responsibility of the University of Lincoln, as the course provider, to evaluate all applications and to assess the suitability of pharmacists already on the register to enter training (GPhC, 2021, 15). You will therefore be required to evidence the quality of your patient-facing experience as part of your application for this short course.

In addition, the School of Pharmacy will act in full collaboration with our practice partners by ensuring that the relevant parties contributing towards your application for training as a pharmacist independent prescriber are appropriately consulted, in relation to your suitability for this training.

You will need to have written confirmation (via completion of the relevant application forms) from:

a) your employer/line manager (where applicable) of their support for you to undertake the Independent Prescribing for Pharmacists short course. Your employer will be required to confirm that you have identified an area of clinical or therapeutic practice on which to base your learning.

b) a Designated Prescribing Practitioner (DPP) who meets the eligibility criteria for supervision of trainee independent prescribers, and who has agreed to provide supervision of your learning in practice for a minimum of 90 hours (GPhC, 2022a, 6). Your nominated DPP will be required to confirm that you have identified an area of clinical or therapeutic practice on which to base your learning.

Please note that any places offered on this short course will be subject to all of the GPhC and University of Lincoln entry requirements detailed above being fully met. Further, you will not be able to commence your Short Course if any of these requirements remain outstanding.

Trainee prescribers have historically undertaken a period of learning in practice to consolidate and contextualise their academic learning. Until recent regulatory changes, medically qualified doctors have carried out the vital role of supervising, educating, and assessing trainee prescribers in practice. The title for this role was formerly ‘Designated Medical Practitioner’ (DMP).

However, since 2018/19, some experienced non-medical prescribers (NMPs) have now become eligible to fulfil this essential role. The Royal Pharmaceutical Society (RPS) published guidance following these changes to reflect the expansion of this role to include NMPs, adopting the term ‘Designated Prescribing Practitioner’ (DPP) for all roles that "…oversee, support and assess the competence of non-medical prescribing trainees in collaboration with academic and workplace partners during the period of learning in practice." (RPS, 2019, 3). Medically qualified doctors continue to be included within the new title of DPP.

The role of DPP is a significant and important one as, at the end of their short course and providing all aspects of the assessment strategy are completed successfully, the DPP is responsible for signing off a trainee as being fit to practice as an independent prescriber (GPhC, 2022a, 11).

Eligibility for the DPP Role

A prospective DPP must be registered, and in good standing with their professional regulator(s). All non- medical prescribers (NMPs) undertaking the role should have the necessary annotation for a prescriber as required by their regulator (RPS, 2019, 4; GPhC, 2022a, 10).

This means that the DPP must be a qualified Independent Prescriber (V300) or medical prescriber with legal independent prescribing rights, not a supplementary prescriber or specialist community nurse prescriber. The DPP must be suitably experienced to carry out this supervisory role and have demonstrated Continuing Professional Development (CPD) or revalidation relevant to the independent prescribing role (GPhC, 2022a, 10).

General Pharmaceutical Council (GPhC) requirements:

Prospective designated prescribing practitioners (DPPs) must have:

• active prescribing competence applicable to the areas in which they will be supervising
• appropriate patient-facing clinical and diagnostic skills
• supported or supervised other healthcare professionals
• the ability to assess patient-facing clinical and diagnostic skills (GPhC, 2022a, 18).

Course providers are required to have appropriate mechanisms for ensuring that designated prescribing practitioners are fit to be the supervisors of pharmacist independent prescribers in training (GPhC, 2022a, 17). The School of Pharmacy is therefore required to evaluate the suitability of each nominated DPP, and for this reason, we ask that you provide additional information about your independent prescribing experience during the application process.

It is recommended that Non-Medical Prescribers (NMPs) and Independent Prescribers (IPs) complete the training for the role of Practice Assessor, or equivalent training, where this is provided by your organisation.

If you are a nominated DPP, and have any questions about this, or would appreciate some assistance with the completion of the application form, please email our administrative team in the first instance, who will ensure that an appropriate member of the team responds to your enquiry: pharmacy@lincoln.ac.uk.

Royal Pharmaceutical Council (RPS): Prescribing Competency Framework Requirements

The expectation of any health professional practitioner acting in the DPP role is the ability to demonstrate they meet all competencies within the Competency Framework for all Prescribers (RPS, 2021, 4).

Personal Characteristics

The practitioner taking on the DPP role:

1.1 Recognises the value and responsibility of the DPP role
1.2 Demonstrates clinical leadership through their practice
1.3 Demonstrates a commitment to support trainees
1.4 Displays professional integrity: is objective in supervision and/or assessment
1.5 Is open, approachable and empathetic
1.6 Creates a positive learning culture through their practice

Professional Skills and Knowledge

The practitioner taking on the DPP role:

2.1 Works in line with legal, regulatory, professional and organisational standards

2.2 is an experienced prescriber in a patient-facing role (an experienced prescriber is defined as an active prescriber who would normally have at least 3 years recent prescribing experience)

2.3 Is an active prescriber in a patient-facing role with appropriate knowledge and experience relevant to the trainee’s area of clinical practice (an active prescriber consults with patients and makes prescribing decisions based on clinical assessment with sufficient frequency to maintain competence. Reflects and audits prescribing practice to identify developmental needs)

2.4 Has up-to-date patient-facing clinical and diagnostic skills and evidence of demonstrating competence in an area of practice relevant to the trainee

Teaching and Training

The practitioner taking on the DPP role:

3.1 Has experience or had training in teaching and/or supervising in practice

3.2 Has knowledge, either experiential or through formal training of different training methods to facilitate learning in practice and adapt to individual student needs

3.3 Articulates decision making processes and justifies the rationale for decisions when teaching or training others

3.4 Has knowledge of a range of methods of assessment and experience of conducting assessment of trainees in clinical practice

3.5 Delivers timely and regular constructive feedback

3.6 Facilitates learning by encouraging critical thinking and reflection (RPS, 2021, 9)

Preparation for the Role of Designated Prescribing Practitioner (DPP)

The GPhC requires course providers to facilitate training for Designated Prescribing Practitioners (DPPs). This must comprise:

• the pharmacist independent prescribing role
• the course for pharmacist independent prescribers in training on which they will be working, including its learning outcomes
• the role of designated prescribing practitioners in the course
• assessing the performance of pharmacist independent prescribers in training
• giving feedback to pharmacist independent prescribers in training
• supporting pharmacist independent prescribers in training
• raising concerns (GPhC, 2022a, 18-19)

The academic programme team will provide all DPPs with the opportunity to attend this IP specific training in person or alternatively, will provide a link to an online teaching package that you will be able to access remotely. The training will take around 45 minutes whether accessed online or in person.

The academic teaching team will ensure that you have the opportunity to ask questions, whether you choose to attend the training in person or complete the video teaching package which will be accessed via the University Panopto platform (no passwords are needed).

The programme team pledge to support DPPs in their role, and to provide feedback about their performance as prescribing supervisors and assessors. The team is committed to the provision of ongoing support and advice for DPPs and will arrange extra training, support, and development as necessary (GPhC, 2022a, 19).

The academic teaching team appreciate your feedback, and we will ask you to kindly provide some qualitative comments on aspects of our short course, such as your suggestions for specific improvements we might make, and how well you feel you have been supported as a DPP, at the end of your trainee prescriber’s period of supervision.

GPhC (undated) Education and training of pharmacist independent prescribers: evidence framework. London: General Pharmaceutical Council. Available from https://www.pharmacyregulation.org/sites/default/files/document/education-and-training-of-pharmacist-independent-prescribers-evidence-framework-may-2019.pdf [accessed 9 August 2022].

GPhC (2017) Standards for Pharmacy Professionals. London: General Pharmaceutical Council. Available from https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_2017_0.pdf [accessed 7 October 2022].

GPhC (2021a) Revising the education and training requirements for pharmacist independent prescribers. London: General Pharmaceutical Council. Available from https://www.pharmacyregulation.org/sites/default/files/document/gphc-revising-education-training-requirements-pharmacist-independent-prescribers-sept-2021.pdf [accessed 19 July 2022].

GPhC (2021b) Standards for the initial education and training of pharmacists. London: General Pharmaceutical Council. Available from https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-initial-education-and-training-of-pharmacists-january-2021_1.pdf [accessed 7 October 2022].

GPhC (2022a) Standards for the education and training of pharmacist independent prescribers. London: General Pharmaceutical Council. Available from: https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-education-and-training-of-pharmacist-independent-prescribers-october-2022.pdf [accessed 18 November 2022].

GPhC (2022b) Education and training of pharmacist independent prescribers - Guidance to support the implementation of the standards. Draft October 2022. London: General Pharmaceutical Council.

RPS (2019) A Competency Framework for Designated Prescribing Practitioners. London: Royal Pharmaceutical Society. Available from: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/DPP%20Framework/DPP%20competency%20framework%20Dec%202019.pdf [accessed 13 July 2022].

RPS (2021) A Competency Framework for all Prescribers. London: Royal Pharmaceutical Society Available from: https://www.rpharms.com/resources/frameworks/prescribers-competency-framework [accessed 18 August 2022].