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Steve Tomlin is chairman of the Faculty of Neonatal and Paediatric Pharmacy
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In early 2006, history was made when two members of the board of the Faculty of Neonatal and Paediatric Pharmacy (FNPP) sat down with an associate of the faculty, having reviewed her portfolio for what should have been a 45-minute interview. Two hours later they all emerged with a sense of great achievement and a belief that a precedent had been set for the future. What had happened was that the interviewee had achieved membership
status of the faculty and had achieved it at the highest competence level
(consultant level) allowing her to become a fellow of the College of
Pharmacy Practice (CPP).
The FNPP was created in 2002 as a joint initiative between the CPP and
the Neonatal and Paediatric Pharmacists Group (NPPG). The NPPG wanted
to allow its members to be able to demonstrate their competence and continuing
professional development and the CPP was the obvious institution to facilitate
this, since it is recognised as an institution offering respected and
robust CPD and accreditation of events and people.
The initial drive to form the faculty arose out of the Kennedy report
in 2001 on paediatric cardiac surgery problems at Bristol Royal Infirmary.
The report highlighted the need for reassurances about health professionals’ level
of competence. “A patient is entitled to be cared for by health
care professionals with relevant and up to date skills and expertise,” the
reports stated.
The report focused on the need for regulation aimed at maintaining competence
of all health care professionals, through undertaking CPD and being periodically
reviewed or revalidated. This led to the question of how fitness to practise
could be demonstrated.
The first step was to define the basic areas of competency in terms of
knowledge, skills and professionalism that are required for all pharmacists
working with children; these became known as the “general paediatric
competencies”. With the increasing complexity of drug prescribing,
administration and provision, particularly for vulnerable paediatric
patients, it is crucial that people who can and will work effectively,
safely and proactively are employed and supported. This depends first
on having a clear picture of the kind of individual likely to be effective
currently and in the future. The general paediatric competencies aim
to help individuals and employers identify the necessary pattern of effective
behaviour resulting from knowledge, skills, abilities and motivations
to be effective in dealing with a paediatric medicines management agenda.
The role of pharmacists is becoming increasingly complex and diverse
(even within a clinical specialisation). Given this and the introduction
of Agenda for Change (AfC) for the managed sector workforce it is important
that we not only recognise competence, but also recognise that competence
is developmental and associated with different levels of practice. A
pharmacist submitting a portfolio who is recognised as working at a higher
level of practice may be recommended to submit directly for assessment
under the advanced and consultant level competency framework. This framework
was developed by the Competency Development and Evaluation Group and
has been adopted by the Department of Health as the framework for the
development and approval of consultant pharmacist posts in the NHS and
in both primary and secondary care. (NHS Scotland has slightly different
processes and terminology in place, but these are recognised by the FNPP
in the same way.)
It is essential to ensure that a sufficient number of leading edge practitioners
are constantly being encouraged in order to maintain the excellent standards
set by their predecessors to advance the profession and meet the increased
needs and expectations of young patients and their families. Ensuring
that there is a clear professional structure and career pathway in place
for these pharmacists, which promotes the characteristics of an advanced
level practitioner, will support the retention of leading edge practitioners,
as well as developing pharmacists to practise at an advanced level.
The FNPP board encourages members to apply for accreditation whether
they are at the beginning of a career in paediatric pharmacy, if they
are at the point of considering a consultant role or somewhere in between.
Success not only gives people a certificate to file in their portfolio,
but is also evidence of a robust demonstration of a level of practice
and a commitment to a specialty which will be highly ranked by their
peers. It provides confidence for employers that a candidate is genuinely
at the stated level of practice.
Competency-based practice and the knowledge and skills framework of AfC
have defined pathways for the workforce and levels to be reached, but
it has long been recognised that people learn in different ways. The
faculty has been involved in helping design and take forward two different
approaches to learning, while recognising that neither is essential or
desirable for some practitioners.
First, it is fortunate that NHS Education for Scotland (NES) created
a comprehensive distance-learning package for the management of medicines
in children. This was produced in line with the basic competencies set
by the FNPP. Then, in 2004, the National Service Framework for Children,
Young People and Maternity Services was published in England. This document
required that all professionals dealing with children must be competent
in their field and up to date. It also highlighted the significant contribution
pharmacists could (and should) play in the management of children’s
medicines. This concept was acknowledged by the Centre for Pharmacy Postgraduate
Education, which also took the basic competencies from the FNPP to develop
another similar distance learning pack for the management of medicines
in children, structuring it around the principles of the national service
framework. These packages are not only useful to all pharmacists involved
in any sort of paediatric care, but also represent a structured way to
fulfil the basic requirements for attaining membership of the FNPP.
Secondly, the University of London School of Pharmacy picked up on the
developing process of the FNPP and formulated a postgraduate module for
advanced practitioners. The course was constructed around problem-based
learning, self- and peer-directed learning, assessment at local base
and a viva examination. The different learning and assessment methods
used were of value to the students and tutors alike and it is hoped that
more work can be done to build on this
development.
The FNPP has been recognised and valued by a number of large paediatric
hospital pharmacy departments and Panels 1 and 2 contains quotes that
show the value attached to the work that has been done and the processes
of competency assessment that have been established.
Panel 1: Founding of the faculty
was a significant milestone in paediatric pharmacy
The founding of the Faculty of Neonatal and Paediatric
Pharmacy was a significant milestone in supporting the educational
development of pharmacists providing services for children. At
a time when health professionals are increasingly expected to prove
their competency by continuing professional development (CPD) attaining
membership of the faculty will hopefully be seen as an independent
method of indicating a minimum level of competency for pharmacists
working with children.
Employers can be reassured that staff achieving membership of the
faculty have reached a standard level of knowledge and skills in
paediatric and neonatal pharmacy. Although clinical diplomas deliver
a general level of competency, the paediatric content of these
courses varies and cannot be interpreted as giving the candidate
the detailed pharmaceutical understanding for working with children.
Membership of the faculty moves this on to the next level.
I envisage that in the future employers appointing pharmacists
to senior positions in paediatric pharmacy will expect membership
of the faculty in the same way that senior medical staff are expected
to be members of their Royal Colleges. It is important that the
faculty links in with other developments such as the Knowledge
and Skills Framework and consultant pharmacists.
At the Sheffield Children’s NHS Trust we have been running
a series of evening workshops for staff. These are also open to
and attended by pharmacists in surrounding hospitals working in
paediatric and neonatal pharmacy. The workshops have been based
on the paediatric competencies published some time ago and have
well received. Sessions like these can also be used for supporting
the Royal Pharmaceutical Society’s CPD requirements. The
publication of the workbook and material from NES and the CPPE
will offer significant support to these sessions. All pharmacists
at the trust have been registered as associate members of the faculty
with the understanding that they will progress to full membership
in due course.
John G. Timmins
Clinical Director of Pharmacy and Medicines Management
Sheffield Children’s NHS Trust
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Panel 2: Membership of the faculty
is key to success
I am a firm believer in continuing education.
However, believing in it is one thing doing something about it
is quite another, and
facilitating others is quite another thing again. Key aims for
encouraging my staff to join the Faculty of Neonatal and Paediatric
Pharmacy include:
• Supporting staff in pursuance of continuing
professional development
• Gaining accreditation for in-house education initiatives
• Demonstrating to those outside the department that the clinical
pharmacists who work within the department have reached or are
working towards a standard of expertise in paediatric clinical
pharmacy
I was fortunate to be able to obtain a one-off education
grant through the generosity of the regional chief pharmacist’s
education subcommittee to kick-start the programme. This paid for
the first year’s associate membership for my staff. The department
is developing an active education programme; it holds weekly education
meetings and permits staff some time to update their CPD portfolios.
I see membership of the faculty as key to the success of this programme.
Anthony
Sinclair
Head of Pharmacy
Birmingham Children’s Hospital |
All paediatric pharmacists must be encouraged to join the FNPP, and
to work towards becoming members by demonstrating their skills through
the
paediatric competency framework outlined in Panel 3 (below). This could
provide the career progression, prospects and satisfaction that all
paediatric pharmacists deserve, allowing them to develop further their
competence
and confidence in providing the care that children and their families
deserve.
Panel 3: The FNPP’s paediatric
competency framework
The Faculty of Neonatal and Paediatric Pharmacy’s
paediatric competency framework has been broken down into four sections
which may be applied to practice:
• Entrance level Entrance level
is essential for any pharmacist dealing with paediatric patients,
usually under the guidance of a
more senior paediatric practitioner. This is the minimum requirement
for any pharmacist to achieve within the first year of becoming
an associate of the faculty and an advisable minimum level of competence
for anyone having paediatric clinical input.
• Level 1 Level 1 demonstrates a commitment to paediatric pharmacy
and is desirable for any pharmacist practising within the field
of paediatrics without the lead of a more experienced paediatric
pharmacist.
Demonstration of the competencies required for level 2 enables
the pharmacist to become a member of the faculty and use the title “paediatric
pharmacy practitioner”. Level 2 will generally need to be demonstrated
over a period of two to three years of clinical practice, depending
on the exposure to the paediatric clinical setting. Demonstration
of competence will be via an approved portfolio, plus a formal interview
assessment. Completion of an accredited paediatric pharmacy clinical
module (in line with the faculty framework) or completion of the
Centre for Pharmacy Postgraduate Education or NHS Education for Scotland
paediatric distance learning packs, plus at least one to two years
of dedicated paediatric practice will help demonstrate competence
at membership level.
• Level 2 Level 2 provides the opportunity to be recognised as
a specialist in paediatric pharmacy practice. Pharmacists will
normally
have been in practice for at least five years with a minimum of
three years of dedicated paediatric practice for the pharmacist
to gain
the advanced award of the College of Pharmacy Practice. Practitioners
will have demonstrated their knowledge base at Level 2 and this
level requires demonstration of application and competence at advanced
level against the advance and consultant level competency framework
(see below).
• Level 3 Level 3 is the highest level that can be awarded by the
faculty. Pharmacists will normally have been in practice for at
least eight years with a minimum of five years’ dedicated
paediatric practice for the pharmacist to become a fellow of the
College of
Pharmacy Practice. Practitioners will have demonstrated their knowledge
base at Level 3 and this level requires application and competence
at consultant level against the advanced and consultant level competency
framework (see below).
The advanced and consultant level competency
framework has three levels — foundation, excellence and mastery — each made
up of different clusters. The profile for an advanced practitioner
is to have most competencies within each cluster at “excellence” level.
For a consultant, a majority of competencies within the clusters
of expert practice, building relationships and leadership should
be at “mastery” level, while the majority of competencies
within management, education and development, and research should
be held at “excellence” level. |
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The
Pharmaceutical Journal