The Pharmaceutical Journal Vol 266 No 7154 p887
June 30, 2001

Comment

We need to rise to the challenge of CPD

By Douglas Hancox

In the past decade considerable prominence has been given to the concepts of continuing professional development (CPD) and lifelong learning. The National Health Service has included CPD within its clinical governance framework and the Royal Pharmaceutical Society is considering CPD records as a basis for competence-based practising rights.

CPD is a personal process, owned and managed by each one of us, whereby we maintain and, where appropriate, enhance our knowledge, skills and attributes in order to continue to meet our evolving professional roles and responsibilities.

In line with the advice to many other professional groups, we are being encouraged to use a structured approach (of reflection, planning, action and evaluation) for our CPD and to maintain a record of our activities and their outcome. The process is simple and straightforward, unless we choose to make it difficult and burdensome.

Reflection on practice

Initially all we are asked to do is to reflect on our own professional practice. To take a few minutes, a few hours, over a few days to sit down and ask ourselves a few questions. What do we do? How well do we do it? What do we do well? What do we not do well? Do we want to provide other services? Do we want to change the direction of our career? What are the expectations of our employer, customers, the NHS? From these and similar questions we can draw up a list of learning and development needs, of knowledge, skills and competences that we wish to gain and then set about prioritising them.

Evidence points to a general inaccuracy in self-assessment and help will be needed. However this can be obtained by frank and open discussion with friends and colleagues, line managers and education, training and development specialists, among others. Evidence in respect of our learning and development needs can also come from our audit of our services, from appraisals and from completion of various self-assessment tools. Learning and development needs that are supported from two or more of these various approaches are most probably those that should receive the higher priority. All this may sound daunting, and trained facilitators may be useful, but it can be kept simple and be successful.

Having prioritised our learning and development needs the task of planning how to meet them is relatively straightforward. Among many opportunities will be our attendance at workshops and courses, our study of articles and books, shadowing others, and completing postgraduate qualifications. Evaluation will once more benefit from discussion, reaudit of services or reappraisal. The CPD cycle can then resume. In reality more than one stage will be operating at any one time and significant reflection and learning will continually arise from our everyday activities. At essence the process is simple and enjoyable for all of us who enjoy our work and wish to do it well. The only real challenge we face is that of maintaining the discipline of continually recording our CPD activity and thereby ensuring that all relevant learning and development needs are addressed within an acceptable time frame.

It is encouraging that the NHS has recognised the importance of lifelong learning and CPD and included them within its model of clinical governance. Since these are personal activities, the challenge for NHS trusts and other employers is to provide appropriate support and to create a learning culture within the organisation — to provide “top down” support for what is necessarily a “bottom up” approach to quality enhancement.

The NHS provides significant “top down” support through the four centres for pharmacy postgraduate education and the various NHS Education and Training Consortia. However, support must go beyond providing and funding continuing education events and funding staff to complete postgraduate qualifications. It must also ensure that, in the managed service, there are appropriate staffing levels and, for pharmacy contractors, an appropriate level of remuneration, to enable staff to participate and benefit from the various learning and development opportunities. The whole culture of the organisation, whether a large NHS trust or a small community pharmacy business, must be focused on personal enhancement and on quality enhancement of services, and the organisation must give recognition to such achievements.

The Society, in company with various other professional bodies, is examining the possibility of CPD records being used to provide public reassurance that those on its register keep themselves up to date and are fit for current and evolving practice. An alternative approach to the assessment of CPD records would be the assessment of individual pharmacists’ competence. How-ever, while competence can be assessed through written and observational techniques, there is the fundamental difficulty of determining the required competencies of any individual pharmacist. There is a wide variation in each pharmacist’s practice, even within broad categories such as “hospital” or “community” pharmacist, and no single list of competencies would ever be satisfactory. Although they are not direct measures of competence the assessment of CPD records must be the most practical way to provide the necessary public reassurance of fitness to practise.

There has been discussion of “practising” and “non-practising” registers. Such discussion brings with it the question of defining practice and of determining how a pharmacist can transfer from a “non-practising” to a “practising” register. Let us keep it simple. Let a system for reregistration, based on CPD records, be introduced that applies to all pharmacists — to those providing NHS services and to those working in academia, journalism, industry or any other branch of pharmacy. The same ethical requirement of “fitness to practise” should apply to everyone on the Register independent of the area in which they practise. Let continued registration be dependent on our ability to be able, at any time, to provide a record of our CPD which is consistent with our continued competence within our own area, and any intended future area, of practice.

If we are now retired, or currently not practising in any sense, our CPD record will be brief and could attest to our continued awareness of current trends and developments within pharmacy. If we have a wide range of responsibilities, are at the cutting edge of practice or seeking to change our area of practice, our CPD record will be far more extensive and weightier. Our ability to deliver specialist services can be covered by inclusion of specific assessment of competence or membership of specialist bodies, such as the Faculty of Prescribing and Medicines Management of the College of Pharmacy Practice, in our CPD record.

A five-year interval for submission of CPD records and reregistration should be chosen. This will ensure that there is time for most if not all aspects of a pharmacist’s practice to be addressed within their personal CPD programme. Longer intervals may not be compatible with reassurance of continued “fitness to practise” whereas shorter intervals would impose too great an administrative cost to the Society.

Acceptable assessment procedure

The challenge for the Society is to design an acceptable assessment procedure for the CPD record. The underlying principle is one of relating the pharmacist’s professional role and responsibility with the content and achievement within their CPD record. The persons chosen to assess the CPD records must be credible in the eyes of members and there must be appropriate feedback to every pharmacist following submission of their CPD record. Of importance the assessment process must allow pharmacists to admit areas of personal concern and weakness and provide support for those who at any time fail to meet the requirements set for the CPD record. This challenge is not insurmountable. There are many pharmacists who have the necessary wisdom and ability to guide, assess and support their colleagues and thereby ensure that the profession is, and is seen to be, taking appropriate steps to ensure the competence of its members.

Mr Hancox was principal education and training pharmacist in the South Thames region until 1999. He has now retired and lives in Auckland, New Zealand