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Letters to the Editor
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Prescribing
Have more confidence in prescribers
From Mrs J. Kinsey, MRPharmS, and others
As a provider of the education and training preparatory programme for
pharmacist supplementary prescribers, we were interested to read Brian
Hynam’s letter on “measuring prescribing competence” (PJ,
28 May, p645).
Dr Hynam is rightly concerned about prescribers acting outside their area
of therapeutic competence and he questions the current arrangements for
assessing the competence of prescribers. We are able to contribute to this
debate.
One of the key messages repeated throughout Keele’s supplementary
prescribing preparatory course, is that prescribers should only prescribe
in areas where they are competent to do so. We believe that the skills
the trainees develop in reflective learning and reflective practice, through
their extensive reflective portfolio and prescribing competencies workbook,
are vital. They help establish and develop attitudes of professional and
personal responsibility in relation to “knowing one’s own limitations” and
continuing professional development, in their future role as prescribers.
Keele’s portfolio and prescribing competencies workbook are based
on the competencies published by the National Prescribing Centre and the
learning outcomes as directed by the Royal Pharmaceutical Society.
Competence in prescribing (including prescription writing), and therapeutics
in the pharmacist’s chosen areas, is also assessed through oral and
written case presentation, work-based audit, and practical examination
(objective structured clinical examinations), as well as by the trainee’s
designated medical practitioner during their supervised period of learning
in practice.
Dr Hynam also raises concerns over the therapeutic knowledge of pharmacist
and nurse supplementary prescribing trainees. It is not the intention that
the supplementary prescribing course should attempt to cover all therapeutic
areas or specialties, nor could it do so. On the Keele course, students
focus (through open-learning materials specially produced by a team of
pharmacists and doctors) on two therapeutic areas of their choice, which
are those for which the pharmacist is most likely to prescribe after qualifying.
Not only does this reinforce and extend the pharmacist’s existing
knowledge, but it also provides a model for preparing for learning a new
therapeutic area after qualifying.
Health professionals across all disciplines are credited with having the
skills and knowledge to practise once they have qualified to do so, and
CPD is mandatory. We see no need for pharmacist supplementary prescribers
to be treated differently and be “put on licence”. We suggest
that there can be confidence in the combination of the employer selection
process, the course and formal assessment developed by the education provider,
and the professional integrity of the qualified prescriber, to practise
safely within their limitations, through clinical governance and CPD.
We believe that the many other providers of supplementary prescribing courses
for pharmacists are likely to agree that pharmacists who have so far completed
the course, are dedicated professionals. They are excited and challenged
by this new role and the opportunity that has been offered to them to contribute
to patient care. Not only do they recognise the additional responsibilities
that it brings but they take those responsibilities extremely seriously
and have shown huge commitment.
We suggest that there is no need to imply that introducing pharmacist supplementary
prescribing might make the NHS less safe. As a minimum, pharmacist prescribing
is likely to be as safe as previous arrangements and we believe it is more
likely to improve safety and patient care than to diminish it.
Jacqui Kinsey
Patricia Black
Alison Blenkinsopp
University of Keele, Staffordshire |
The
Pharmaceutical Journal