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Duncan McRobbie is principal clinical
pharmacist, Guy’s and St Thomas’ Hospital NHS Foundation Trust
Graham
Davies is director of clinical studies, School of Pharmacy,
University of Brighton, and associate director of clinical pharmacy
(South East)
Ian Bates is head of educational development, School
of Pharmacy,
University of London
David Webb is director of clinical pharmacy,
London, Eastern and South East Specialist Pharmacy Services |
NHS reports and
policy have driven the need to ensure that pharmacists are “fit
for purpose”. For over ten years we have been investigating methods
of evaluating the
competence of pharmacists in clinical practice. This work
programme has arisen from the lack of standardised
performance criteria for
pharmacists involved in direct patient care, a concern
regarding the lack of clarity of the clinical role of pharmacists and
a shortage of robust
objective assessment criteria to evaluate clinical practice. Much of
this work has been shared by
presentation at national
conferences and publication in pharmacy journals. However, we are concerned
that there is now a plethora of “competencies” being produced
with no objective data to support them. There is a risk that competencies
developed without a rigorous approach will not meet their aims.
The introduction of pre-registration competencies by the Royal Pharmaceutical
Society in 1992 served as a starting point. The original “competencies” described
behavioural descriptors, but in hospitals we did not have (and we believe
the Society still does not have) any test for the rigour with which these
were interpreted and assessed by the pre-registration tutors. We therefore
designed and tested an Objective Structured Clinical Examination (OSCE)
to ensure that the subjectivity of individual clinical tutors was minimised.
This OSCE was constructed of tasks that were deemed to be appropriate
to expect a newly registered pharmacist to be able to perform safely
by a consensus panel of practising pharmacists. Each task was tested
for reliability and reproducibility, and the assessors tested for inter-rater
reliability. The candidates and assessors satisfaction with the content
and methods was regularly assessed and they found it to be a useful and
effective method of assessment.
Frameworks
Subsequent work has shown that there may be a mismatch between the level
of expectation that employers have of their newly registered pharmacists
and what they can do. We therefore proposed a competence-based practitioner
development framework. This resulted initially in the development of
a general level framework for practice. So that individual service requirements
are recognised, as well as the individual pharmacist’s improvement
in efficiency over time, a performance scale was also incorporated. These
frameworks have been tested in a controlled educational trial and this
demonstrates that using the framework improves individual pharmacist’s
performance and achievement of the competencies.
As part of the early work it was noted that use of the framework by pharmacy
managers helped them identify the service delivery that was required
of their junior pharmacists. As yet, there is no national consistency
as to the level of clinical pharmacy that patients require.
The general level frameworks are now widely used across England, with
over 60 hospitals using them to identify and assess the expected level
of practice of junior pharmacists. The complete general level framework
is available to any NHS organisation wishing to use it (www.londonpharmacy.nhs.uk).
With the development of clinical requirements in primary care through
the new contract we have now adapted the general level framework
to support primary care and community pharmacists.
Using a different, but equally evidence based approach, we started the
development of advanced level frameworks. A literature review of published
competence frameworks from other health professions and non-health profession-related
competencies showed a significant amount of commonality in the core competence
clusters for advanced level practice, no matter what the area.
There was an obvious need to demonstrate some degree of expertise in
the area of practice, but this alone was not enough, and needed to be
combined with building relationships, leadership, management, research
and development and educational competencies. Using peer groups of recognised
experts, competencies and behavioural descriptors were defined for each
of these clusters.These were ranked so that different levels of expertise
could be recognised.
The advanced level framework has been validated through groups of specialty
pharmacists, both in the clinical and non-clinical areas. This work has
been useful in guiding deliberations at the Department of Heath regarding
the competencies required for consultant pharmacist practice.
While the behaviours for the generic clusters can be drawn from established
literature, there is still no consensus on what constitutes expert professional
practice. This area of expert practice equally applies to clinical specialties
and to other areas of pharmacy professional practice. We are relying
on the individual groups of specialty pharmacists to describe this. We
are aware that the Critical Care Group of the UK Clinical Pharmacy Association
(UKCPA) is taking this forward with the Department of Health using the
advanced and consultant level framework as a template.
Scientific approach
During this whole process we have attempted to take a robust scientific
approach to the development and evaluation of these competence frameworks.
We believe that we are the only group that has attempted to introduce
this level of rigour into this important process. We have strived to
be inclusive and our work has been supported by national organisations
like the Guild of Healthcare Pharmacists, UK medicines information pharmacists
group and the UKCPA. We also acknowledge the effort by numerous individual
pharmacists who have been involved in this project. We would be interested
in the Society’s view of these evidence based competencies and
how they would translate to all pharmacists delivering pharmaceutical
care, in whatever setting.
We call on all those involved in developing competencies to be aware
of the current literature and the effort that we have made to provide
an evidence base for the development of competencies in pharmacy. |
Hospital Pharmacist