The Pharmaceutical Journal
Vol 270 No 7246 p598
26 April 2003

Society summary

Preparing for CPD and prescribing

Two future developments affecting pharmacists — mandatory continuing professional development and supplementary prescribing — were the topics for an evening conference held by the Royal Pharmaceutical Society's Border region on 19 March in Chester-le-Street. Malcolm Goldie reports

Learning from experience makes all pharmacists more capable, said Dr PETER WILSON, the Society's consultant on continuing professional development. A past example of such learning was the introduction of non-prescription sales of emergency hormonal contraception (EHC). Although every community pharmacist had received a training pack, pharmacists almost certainly found the first sale fraught and worrying but then gained improved skills and confidence through further experience.

Dr Wilson defined CPD as "a way of recognising what you learn through work and then writing it down". The process was a circular one involving reflection, evaluation, planning and action. It could be divided into unscheduled learning and planned CPD. The former involved capturing the moment, reflecting on the situation, evaluating the experience and recording the outcome. The latter required a preplanned programme, however small, and an examination of its impact on the future of one's career. It was altogether a more structured experience.

Record-keeping is part of CPD because records increase understanding, identify further learning needs, become a source of satisfaction and provide proof of professional development, Dr Wilson said. Records can be kept on computer, on paper or on the Society's CPD website (www.uptodate.org.uk). Dr Wilson urged all pharmacists to visit the website and see what it offered.

Discussing misconceptions about CPD, Dr Wilson said that some people think it just means more hours of continuing education, some think it has to be done through approved courses, some think they can never do it because they would "fail", some think they will not have time for it because it will take hours to record, and some think that it will force older pharmacists to leave the profession. Of all these beliefs, only the last one might have some truth in it. Currently the Society cannot prevent a pharmacist working, but when CPD becomes mandatory — probably some time in 2004 or 2005 — the Society can and will prevent those who have not undertaken CPD from practising. Some pharmacists may choose to leave the profession at that point.

Introducing mandatory CPD is not bloody-mindedness on the part of the Society, said Dr Wilson. It is a direct result of various medical malpractice cases over recent years, which have focused the Government's mind. Although some pharmacists may be unhappy that past medical incompetence should cast unwarranted doubt on pharmacists' competence, the Society has to comply. However, pharmacists will not be subject to the annual revalidation that doctors will have to undertake.

If the Society fails to act, the Government will take the matter out of its hands and pass responsibility to the Health Professions Council, which is to oversee CPD for some smaller health care groups. For those groups, CPD will become mandatory by 2004 or 2005, and revalidation will be the norm.

Dr Wilson said that several pilot studies have shown that pharmacy CPD instills an awareness of developing needs and increases confidence. It is a practical process, needing no more than about 30 minutes a month to complete records of important activities.

CPD will be monitored, but at intervals of greater than 12 months. The Society will look for "good CPD practice" both in the context of the whole profession and in the field of each pharmacist's specific practice. Feedback will be provided to make the process more effective. The object is to ensure that pharmacists keep abreast of developments. The format of an individual's CPD is personal and pharmacists are at liberty to improve those parts of their knowledge that they believe are lacking by whatever means they so choose.

Answering a question, Dr Wilson said that it was yet to be decided whether CPD for non-practising pharmacists would have to encompass aspects of current clinical learning as well as covering their chosen field.

Asked whether it would be possible to fabricate a CPD record, Dr Wilson said that although it was possible it would almost certainly be easier to undertake the work and do the job honestly.

Supplementary prescribing

Supplementary prescribing offers benefits to patients in the form of convenience, choice and quicker access, said PAUL BROWN, a prescribing adviser involved in developing and supporting non-medical prescribing in three primary care trusts in the north-east. Supplementary prescribing is also safe and effective, he said. It benefits the National Health Service through increased efficiency and better targeting, and it benefits pharmacists and nurses by way of role expansion.

Mr Brown said that an agreed working definition of supplementary prescribing is: "A voluntary partnership between the responsible independent prescriber and a supplementary prescriber, to implement an agreed patient-specific clinical management plan with the patient's agreement, particularly but not only in relation to prescribing for a specific non-acute medical condition or health need affecting the patient."

The independent prescriber (IP) has to be a doctor or dentist and responsible for the initial assessment and diagnosis and for setting the parameters of a clinical management plan (CMP). The IP must agree a limit of responsibility with the supplementary prescriber (SP), and must provide advice and support to the SP and share information.

SPs must prescribe in accordance with the CMP, monitor and assess patient progress, and work within the limits of their clinical competence and professional code of practice. They must accept professional responsibility for their prescribing practice, recording their activities contemporaneously in a record shared with the IP — ie, joint working would be the order of the day.

The IP must be someone with whom the SP is able to communicate readily and who is willing and able to share access to common patient records and to share access to and use the same guidelines or protocol. Patient progress should ideally be jointly reviewed at agreed intervals.

The CMP is essential. It is a formal agreement between IP, SP and patient, and must be agreed before prescribing begins. It will be specific to the patient and the patient's condition and may be kept on paper or electronically. It must include reference to the classes of medicine that may be prescribed for the named patient, including strength, dose, frequency and formulation. It must specify the circumstances under which the SP may alter medicines and the circumstances under which the SP should refer the case back to the IP. It must also include details of relevant warnings, as well as start and stop dates.

All medicines other than Controlled Drugs and unlicensed drugs may be ordered under the scheme and will be supplied at NHS expense.

Mr Brown said that training for supplementary prescribers will be to degree level and consist of 25 taught days at an approved higher education institution plus 12 days of learning in practice. It will need access to a medical supervisor and will be Government-funded. Pharmacists or nurses will need to be able to find the time to attend the course, which will extend over three to six months. Assessment will include demonstrating ability and knowledge, including all aspects of supplementary prescribing. However, because 37 days cannot teach everything, entry to the course will assume a high level of skill and knowledge. CPD after completing the course is essential and will include clinical guidance frameworks, clinical supervision, peer review and mentoring.

During discussion it was pointed out that the presentation mad no mention of reward for undertaking a potentially onerous training schedule and providing additional services. Although the Government may not be anxious to place a financial millstone around its own neck, some indication of the value it would place upon such work would not be amiss.