Comment

Competence-based practising rights — we need the right tools to deliver the goods

By Sharon Steel

One of the Government's key targets is to improve quality in the National Health Service. One method of achieving this is to focus on practitioner competence and lifelong learning. Accordingly, the Royal Pharmaceutical Society's education division has developed and undertaken a continuing professional development (CPD) pilot scheme, in which I participated, and it is now exploring ways to develop that scheme to satisfy the Government's requirements for competence-based practising rights.

During the past year, I have been involved in supporting a number of pharmacists in developing new professional roles and services. I have worked with them to facilitate their own CPD and during this process I have identified a number of issues that need consideration if pharmacists are to undertake CPD successfully and truly raise standards of patient care.

Society model

The Society's model of a CPD cycle¹ consists of four stages:

1. Assessment of individual and organisational needs
2. Planning requirements of a personal development plan
3. Implementation
4. Evaluation of effectiveness of CPD intervention and of benefit to patient care

In practice, I have used a similar four-stage model comprising reflection, needs assessment, action and evaluation.

The process of reflection requires pharmacists to consider their key work tasks, their objectives for the next year, their likely future objectives, the competencies that are required to deliver their objectives and their professional experiences. During the next stage of needs assessment, pharmacists considers the competencies that they have achieved to date in their professional practice and prioritise those that they have not achieved in order of importance to their work. Next pharmacists select and undertake continuing education activities that are chosen with the aim of helping them to attain the competencies that they are trying to achieve. The final evaluation stage in the cycle requires pharmacists to demonstrate that they have achieved their target competencies.

The first two stages are virtually the same as in the Society’s model, but the crucial point is that, in practice, success in needs assessment is dependent upon knowledge of the competencies required to undertake a job effectively.

Competencies include knowledge, skills, motives and personal traits that are related to effective performance. In reality, opportunities to develop new professional roles and services as a result of the Government's agenda to modernise the NHS will require realignment of existing skills and the development of new skills by the majority of the profession. Can we really expect individual pharmacists accurately to assess their needs with respect to CPD in an emerging environment in which few practitioners have a clear understanding of new roles, let alone effective performance?

The National Prescribing Centre (NPC) together with the NHS Executive have recognised this problem and led the way by developing the document “Competencies for pharmacists working in primary care”.² This document is an excellent resource and has the potential to facilitate CPD and to achieve consistency in service delivery across the profession among pharmacists working in this environment. However, this initiative needs to be extended across all areas of pharmacy practice if the aim of competence-based practising rights is really going to improve the quality of care in the NHS.

The crucial final stage of the CPD cycle requires evidence that a competency has been achieved and that there is or is likely to be real benefit to patient care. In order for pharmacists to measure this for themselves, they need to have in mind a clear definition of the behaviour that they should be able to demonstrate if the competency is applied effectively. Examples of some behavioural indicators are contained in the NPC document, but even these need to be tailored to local circumstances. My question is the same as before: is it realistic to expect individual pharmacists to identify such indicators for themselves in an emerging environment? Do we really hope to achieve uniform and consistent improvements in patient care across the profession in such an ad hoc manner?

It seems to me that pharmacists will need considerable support in undertaking CPD, at least initially. Like me, some pharmacists are already engaged in facilitating CPD. From my experience this facilitator role requires the following portfolio as a minimum:

• Specialist knowledge — of CPD process and toolkit, competencies required in different areas of pharmacy practice, continuing education resources and behavioural indicators that demonstrate achievement of competency
• Skills — facilitation, change management, listening, time management, motivational and negotiation
• Personal traits — successful undertaking of CPD oneself and extensive experience of pharmacy practice in the area facilitating CPD

At the least, all of these requirements should be incorporated into a framework of core competencies for CPD facilitators that is recognised and accepted throughout the profession.

Better patient care

Quality improvement and professional accountability are key themes in the Government's agenda for the NHS. The introduction of competence-based practising rights is one initiative aimed at delivering higher standards of practice and better patient care. If we are serious about embracing this initiative rather than simply paying lip service to the process of CPD and if we as a profession are intent on rising to the challenge and delivering the goods we need to provide pharmacists with the right tools to do the job properly.

References
1. Royal Pharmaceutical Society of Great Britain Health Act Working Party. Reform of disciplinary machinery and the introduction of competence based practising rights. Proposals for a first order under the Health Act 1999. London: The Society; 2001.
2. National Prescribing Centre. Competencies for pharmacists working in primary care. Leeds: NHSE; 2000. Available here.