The Pharmaceutical Journal Vol 267 No 7171 p613-615 27 October 2001

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Continuing professional development

A review of pharmacy continuing professional development

By Fawz Farhan

The debate over whether practising pharmacists should have to undertake continuing professional development throughout their careers is over. The only outstanding discussions concern the practicalities. This feature reviews the current position and sets out some of the available courses that lead to formal qualifications

The Royal Pharmaceutical Society has decided that mandatory continuing professional development is the way forward for the profession. Earlier this month it moved a step further towards this goal with the announcement that it plans the gradual introduction of a voluntary continuing professional development (CPD) scheme, starting in 2002, with the aim of a seamless transition to a mandatory system when the appropriate legislation comes through. The news is a wake-up call to pharmacists everywhere. "Undertake CPD or you're out," is the message. Pharmacists will have to demonstrate to the Society that they are undertaking CPD but whether in reality this could be linked to revalidation and remaining on the register is still unclear. Costs, practicalities of assessment and legislation are all issues that will need to be addressed first. Focus on mandatory CPD The news that mandatory CPD is on its way should come as no surprise. It has been driven by both internal and external forces. Internally, the profession has realised for a number of years that it must move with the times if it wants to take on extended roles (and be paid for them), develop patient care and be taken seriously by the multidisciplinary team and by government. That means undertaking continuing education and continuing professional development and demonstrating clinical governance. Externally, government has recognised that pharmacists can meet some of its NHS plans more cost-effectively than other health professionals. However, pharmacists need to prove to the Government and to society that they are capable of, and competent to take on, these new roles. In May this year, the Society submitted its proposals for mandatory CPD to the Department of Health with the hope of legislation, through a Parliamentary Order, being granted by the end of the year. This now seems unlikely, says Robert Dewdney, head of education at the Society, as the Department seems to be heavily engaged in other policies from the NHS plan. "It is a priority among other priorities," he explains. While dealing with these other priorities, the Department has also realised that there are common issues running in the other health care professions that could be better and more efficiently addressed by an overarching body. As a result, the Department of Health set up a regulatory health framework in August to oversee the regulation of health professions. The Department may therefore wait to hear what this body has to say before progressing with the Order for mandatory CPD. The phrase "standing still is no longer an option" applies aptly to the CPD situation in pharmacy. Following the developments at the Department of Health, the CPD advisory group, which was overseeing the Society's CPD pilot, advised the Council that it was time to progress to a voluntary CPD system until the legislation was passed. This means that the CPD framework can progress and be put in place on a voluntary basis, ready to be switched to a mandatory scheme when the time comes. Setting the CPD framework At its October meeting, the Council reaffirmed investment in, and implementation of, a voluntary scheme by the end of 2002. Its first job was to set up a CPD implementation committee to oversee the framework for the voluntary CPD scheme. This committee is expected to be formed around February next year once the Council has approved the committee members. The voluntary scheme will be based on the Society's CPD pilot and will involve pharmacists maintaining a CPD portfolio. They will need to complete the CPD cycle — needs assessment, planning, implementation and evaluation — according to the activities and responsibilities of their particular jobs. These records of CPD can then be requested by the Society for evaluation. The scheme is "voluntary" in the sense that it will not yet be linked to "revalidation" and remaining on the register. Dr Dewdney hopes to get as many as 5,000 people, with material in hand to get started, by the end of 2002. By the end of 2004, this will have extended at least to everybody engaged in patient care. The CPD implementation committee will decide on who the first 5,000 are. It could be random or it could consist of defined groups such as preregistration tutors, older pharmacists or pharmacists switching fields of practice. Groups may also be identified in terms of risk reduction and public interest. Dr Dewdney believes the voluntary scheme will be driven by a change of emphasis from "should do" to "must do" and by pressure from primary care groups and trusts and employers who will expect a high take-up. Anyone refusing to participate will be challenged by their employer. However, Dr Dewdney admits that, until legislation comes through, the Society can do little to force people to participate in the scheme. Once it does, the switch from voluntary to mandatory could happen very quickly. Continuing education vs continuing professional development Pharmacists will have to think continuing professional development (CPD) not continuing education (CE). It will no longer be enough for them to collect their 30 hours of CE credit per year and rest on their laurels. Despite the change in emphasis, continuing education will continue to be a core element of CPD. Pharmacists will be encouraged to think of any learning they undertake in terms of CPD. The College of Pharmacy Practice has produced a form which explains how to turn CE into CPD and is giving it out to pharmacists attending its events. Rose Marie Parr, director of the Scottish Centre for Post- Qualification Pharmaceutical Education, says that CPD is an important part of the NHS clinical governance agenda and, as such, should be encouraged, facilitated and managed. "It is important to define and explain the differences between CE and CPD for pharmacists because we know from other professions that mandatory CE does not work to change behaviours or improve practice." Ms Parr believes an emphasis on CE can lead to a "credit" mentality of collecting points, certificates or hours, and encourages attendance rather than facilitating learning. Mandatory CPD will require pharmacists to think in a different way so that they can identify their learning needs and find activities to meet those needs. "Encouraging reflection and evaluation of needs, activities and outcomes in learning would be a major step forward for pharmacists." Guy Thompson, deputy director of the Welsh Centre for Postgraduate Pharmaceutical Education, says that most pharmacists are used to a passive uptake of continuing education, where they attend a course and enjoy it but do not do anything with it afterwards. Pharmacists still view courses as the essence of CPD when in fact there are many other learning opportunities such as analysing critical incidents at work and structured reading. "Some degree of pain is involved in going to an evening course and so the course is more valued. There is a barrier to other forms of learning because there is no such pain," he says. As a result, the WCPPE has developed its own CPD programme to help pharmacists get used to the concept of CPD and to other learning opportunities. WCPPE will remain a prolific education provider. It offers 30 to 35 two-hour courses and 150 to 175 evening course per year across the five health authorities that it serves. However, Mr Thompson is not sure of the fate of the 30-hour CE requirement stated in the Society's Code of Ethics. He expects it will form part of the CPD requirement, in a similar way to the doctors and dentists who have a CPD requirement which includes a minimum number of hours of CE. The Centre for Pharmacy Postgraduate Education says it will not be dropping the CE number of hour measurement for the time being. "It is a notional figure and is something we're well practised in when developing our material. It provides a little tool to help people make a judgement of activities within CPD. After two to three years we may well come up with different guides and ways of tracking CPD to reflect what people are doing. For now it is something simple to record and monitor." Evaluation and revalidation The evaluation process is a fundamental part of this CPD framework as it provides pharmacists with constructive feedback on their personal development. An evaluation system will also be necessary for mandatory CPD as proof of completion of CPD. In its draft proposals, the Council has already stipulated that, for pharmacists to be revalidated or relicensed under the mandatory scheme, they will have to submit satisfactory evidence of CPD. Although there was talk originally about pharmacy postgraduate colleges getting involved in the evaluation process, this is not part of the plans. Dr Dewdney says that evaluators will not necessarily be pharmacists, as they will be assessing learning behaviours rather than clinical knowledge. Evaluators could include other health care professionals, other well-educated people and even patients and representatives of patient groups. However, for professional ownership there will need to be a reasonable quota of pharmacists. The Centre for Pharmacy Postgraduate Education (CPPE) agrees that it does not see itself as being part of the monitoring or evaluation process that the Society is putting into place. CPPE assistant director Angela Triki´c says: "We see ourselves as key education providers. It is a role we are performing and we're pretty good at doing that. A monitoring role would involve a change in function and we have no plans to undertake that." As far as enforcing mandatory CPD and linking it to revalidation is concerned, the CPPE imagines that employers will have a role to play here and will demand it of their employees as part of the contractual arrangement. The Scottish Centre for Post-Qualification Pharmaceutical Education (SCPPE) believes that linking CPD to revalidation may mean in the longer term having a register for practising pharmacists linked to specialist areas and core competencies for that specialist practice. However, pharmacists will need to be supported before these changes materialise. SCPPE director Rose Marie Parr believes it is important to allow ring-fenced time for learning in working hours, and to promote personal development plans and encourage a more "learning organisation" mindset in the NHS and the profession. Guy Thompson, deputy director of the Welsh Centre for Postgraduate Pharmaceutical Education (WCPPE), is not convinced that mandatory CPD and formal assessment is the way forward. His view is that it is not practical and that other health care professions have already tried and failed. "All we want is evidence that a person is undertaking CPD. I don't believe you can assess the finer details of a CPD portfolio." He also adds that the WCPPE would find it very difficult to adopt an assessment role because it would undermine the nature of the relationship it has with Welsh pharmacists. Instead, he believes that CPD should come from within the profession and should be driven by pharmacists wanting self-improvement. Mr Thompson believes the insistence on mandatory CPD is simply a smoke-screen put up by the profession and is in response to society's current dissatisfaction with the medical profession. "If you can demonstrate that the profession is doing what it should do, you divert away the gaze of the Government." Rather than using the CPD portfolio for revalidation, Mr Thompson believes that it can better be used as evidence of competence to practise in defence of pharmacists hauled up before the Statutory Committee. Implications of mandatory CPD The implications of such a fundamental strategy will reach every corner of pharmacy. Pharmacists, pharmacy postgraduate bodies, education providers, employers and health care companies will all be involved. The most obvious and immediate issue is that of funding. Setting up the framework and evaluating pharmacists' CPD will require money. This may be partly funded by pharmacists themselves through their Society retention fees. In August, the Council sought a 31 per cent increase from £142 to £186 "to resource constitutional change and new areas of professional and regulatory activity that meet the Government's quality agenda and modern public expectation of health professionals". This includes CPD and lifelong learning. Another issue, which pharmacists will probably see as even more contentious, is the possible linking of mandatory CPD to revalidation. Pharmacists will need to start thinking seriously about CPD and what it means for them in practice. How will it fit into the normal functions of their job? When will they do it? How much time will they spend on it? Who can they turn to for guidance? The changing roles of postgraduate pharmacy bodies Many changes have taken place since the four main postgraduate pharmacy bodies were established. So how are they changing? CPP Following the launch of the NHS plan the College of Pharmacy Practice recognised that prompt action was required if pharmacists were to meet the Government's targets. As a result the Pharmacy Education Collaborative (PEC) was set up at the beginning of the year, overseen by the CPP. The umbrella organisation included representatives from the Royal Pharmaceutical Society, the National Pharmaceutical Association, pharmacy education bodies, universities, NHS and pharmacy multiples. The role of PEC largely involves horizon-scanning and scoping educational need, sharing ideas on programmes, using networks to test ideas and optimising efficiency. The group's remit is to liaise with the modernisation agency at the Department of Health on key elements of the pharmacy programme. The collaborative group takes a strategic view of education and training provision, suggesting the most appropriate providers for specific tasks. Part of the group's role is to define the education and training required to prepare pharmacists to meet the key objectives of the Government. All training objectives would have to be met by 2004. CPPE The Centre for Pharmacy Postgraduate Education, now in its 10th year, has already seen a substantial increase in demand for learning material over the past two years and assistant director Angela Triki´c puts this down to a lot of pharmacists gearing themselves up to positively developing their skills. With the new CPD changes, the CPPE is preparing itself for a further increase in the demand for open learning packs and workshops. Thinking ahead, the CPPE is looking at developing new opportunities for learning and supporting pharmacists in their learning. The CPPE is moving away from a system of ad hoc contact with pharmacists (through workshops and distance learning packs) to a system that involves continuous support. This will involve giving them access to a comprehensive national network of key bodies and experts who can help with their learning. CPPE will also be exploiting the internet for this purpose and using it for more of its training material. "We're trying to apply an evidence-based approach to open learning using examples from other fields of health care," explains Ms Trikic. The CPPE is also working with the Society on the second phase of the CPD pilot and is planning to employ additional facilitators to help support pharmacists involved in the pilot. SCPPE In the future, the Scottish Centre for Post Qualification Pharmaceutical Education may be more involved in facilitating learning and CPD in addition to providing courses. In Scotland, the Government is encouraging "learning together" for professionals and other staff in the NHS. This focus on multidisciplinary education, team working and building better services through learning and will affect on providers of education to the NHS. The formation of a new special health board for education for NHS Scotland staff will, from 1 April 2002, merge the medical, dental, nursing and pharmacy advisory boards. This will form the basis of a shared learning agenda for these professionals in the first instance, and in due course will include education and learning for all NHS staff in Scotland. WCPPE The Welsh Centre for Postgraduate Pharmaceutical Education will be looking at modifying the material used in courses, developing a resource inventory and using interactive learning. It also plans to change the job description of its tutors so that they spend more time with pharmacists who need to be guided initially through the CPD process. Mass exodus? There has been speculation that it will result in a mass exodus of pharmacists and add to the shortage of pharmacists. Some pharmacists nearing retirement may decide to hang up their boots early rather than have to go through what they see as a patronising rigmarole of providing evidence of CPD. The system may filter out, or even bring into line, pharmacists who are not committed to the ethics and morals of excellence and clinical governance. Pharmacists will be expecting support for CPD from the Society, postgraduate education bodies, health care companies and, particularly, from their employers. If this is not forthcoming, they are likely to feel abandoned. Boots and Lloyds have already produced CPD portfolios for their employees. Guidance is essential in easing pharmacists into the mindset of CPD and it may mean instilling the concept as early as possible, among preregistration trainees or even among undergraduate pharmacy students. Another issue is what should pharmacists do if they want to switch from one area of practice to another. The CPD advisory group is investigating this and it is likely that the register will not be divided according to the sector in which pharmacists work, but will instead indicate the roles that people fit into and the jobs that are within their competence. This is because there are a lot of roles that overlap. In a practical setting, pharmacists who decide to move from community to hospital will need to prove they are competent to practise within the new environment. They would use the CPD cycle and take on the training needed to fulfil the new roles. Pharmacists who switch fields of practice may become a priority group for CPD review by the Society. Whether this is done retrospectively or prospectively is one of the issues that have yet to be decided. Opportunities Employees will be looking with greater scrutiny at the commitment that employers show to training and personal development. With the current shortage of pharmacists, employers have recognised this and have started to look at training and CPD support as a perk to pull in new employees. Pharmacists can also make the most of the training and education that health care companies are getting involved in. However, they will need to be more discerning in which ones they take up. Material that is pitched at the right level and fulfils a genuine learning need will be invaluable. Training and education that supports medicine management initiatives will also be valued. Independent pharmacists often lack the support and network that multiples have and that includes support from a training department. The National Pharmaceutical Association, wholesalers and buying groups have recognised that they have a role to play here and are increasingly getting involved in education and training as part of their service to independents.

Fawz Farhan, co-director of the pharmacy education and training consultancy Mediapharm and visiting lecturer in pharmacy practice at King's College, London, considers what pharmacists should be ready for in terms of personal professional development

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