Hospital Pharmacist
Vol 10 No 4 p143
April 2003

Review of circulars and official publications
by Alex Bower, MRPharmS

Supplementary prescribing by nurses and pharmacists within the NHS in England: a guide for implementation was issued in March 2003 by the Department of Health. The guide, which can be accessed here, sets out the administrative and procedural steps needed to enable registered nurses, registered midwives and registered pharmacists to act as supplementary prescribers. It also provides advice on good practice for supplementary prescribers and their independent prescribing partner. Supplementary prescribers (the term dependent prescribers has now been dropped) are those who have been clinically assessed by an independent prescriber and will be responsible for the continuing care of patients. Supplementary prescribing is defined as "a voluntary partnership between an independent prescriber (a doctor or dentist) and a supplementary prescriber to implement an agreed patient-specific clinical management plan with the patient's agreement". Two model templates are available to assist with the preparation of clinical management plans. Joint, formal clinical reviews by the independent and supplementary prescriber should normally be carried out at least annually. Supplementary prescribers must have completed appropriate training which, for pharmacists, amounts to 25 taught days at degree level plus at least 12 days learning in practice under a designated supervising medical practitioner. They should also ensure that they have their employer's agreement to act in this capacity and that they are covered by appropriate professional indemnity insurance. Pharmacists must be appropriately annotated as a supplementary prescriber on the register of the Royal Pharmaceutical Society of Great Britain and have at least two years' experience. Supplementary prescribing can apply for any medicine (ie, general sales list, pharmacy only, prescription only) except Controlled Drugs.

The introduction of supplementary prescribing is an important step towards extending the role of pharmacists and it will be interesting to note the way that these freedoms will be used by hospital pharmacists. The guide does not refer to payments to community pharmacists but these will, no doubt, need to be agreed if there is to be a significant uptake within that sector. Once there has been experience of supplementary prescribing, it is to be hoped that independent prescribing status will follow.

The National Prescribing Centre issued "Maintaining competency in prescribing: an outline framework to help pharmacist supplementary prescribers" in March 2003. This is a sister document to an earlier version produced for nurses. The document provides a guide to the competencies that pharmacists will need to acquire and maintain if they are to perform a supplementary prescribing role. The guide will help individual pharmacist prescribers and their managers identify gaps in knowledge and skills and thus lead to the identification of training and development needs, inform the commissioning, development and provision of continuing education and training, and support professionals locally by providing a framework to help recruitment and selection procedures and inform appraisal systems.

The competency framework is based on behavioural competencies and thus relate to the way that pharmacist supplementary prescribers should behave (as opposed to task-based competencies which relate to the outputs that need to be delivered). The behavioural competency approach will enable colleagues to answer the question, "How do I know I am carrying out my job or role effectively?".

The framework defines three areas of competency each with three competencies:

• The consultation : clinical and pharmaceutical knowledge, establishing options and communicating with patients

• Prescribing effectively: prescribing safely, prescribing professionally and improving prescribing practice

• Prescribing in context: information in context, the NHS in context and the team and individual context

Each of the competencies has an overarching statement to give a general flavour of what it covers followed by a number of behavioural indicators which are the key to understanding the type of behaviour that should be exhibited. For example, there are eight behavioural indicators for the "improving prescribing practice" competency within the "prescribing effectively" area, eg:

• Taking responsibility for one's own CPD

• Reflecting on own performance, learning (eg, from clinical incident monitoring) and changing prescribing practice

• Willingness to share and debate one's own prescribing practice and that of others

• Challenging inappropriate practice constructively

• Developing one's own networks for support, reflection and learning

• Understanding and using tools to improve prescribing (eg, audit, review of PACT data)

• Reporting prescribing errors and near misses

• Establishing professional links with practitioners working in the same professional area

The framework will provide an invaluable tool for potential supplementary pharmacist prescribers to assess their performance. It can be used on an individual basis or in discussion with colleagues as part of a group. The number of behaviour indicators in each competency varies from six to 12 and there are 83 in total. This represents a comprehensive overview of the way that pharmacist supplementary prescribers should behave. Those who use it to review their own performance may wish to consider each section as a bite-sized chunk so that the task does not become overly daunting. The framework can be downloaded from the National Prescribing Centre website.

"Guidance for R&D managers in NHS trusts and clinical research departments in the pharmaceutical industry" was issued by the Department of Health in January 2003. The guidance attaches a model for a "Clinical trial agreement for pharmaceutical industry-sponsored research in NHS trusts". The use of the model is not mandatory but it sets out the contractual principles for clinical trial work. The document will be of particular interest to hospital pharmacists or technicians engaged in clinical trial work and to those who are members of ethics committees. The report is available here.

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist