Non-Medical Prescribing Practice Based Learning and Assessment

NMP Course Team Claire Callaghan, Programme Leader, based at Lancaster, Module Leader Principles of Prescribing Kay Donnellon, based at Lancaster Module Leader Work Based Learning and Consultation Skills modules Mark Magas, Pharmacist, based at Carlisle Module Leader Pharmacology, Co-ordinator for Carlisle cohort Mark Stigant, Physiotherapist, based at Carlisle

Applicants demonstrated... suitability to prescribe competence taking a history, clinical assessment and diagnosis, assessed by employer knowledge to apply principles of prescribing to own practice numeracy assessment pass (80%) - NW only clinical need to prescribe in their area of practice

Programme Learning Outcomes In relation to: 1.the patient 2.medicines 3.legal and ethical frameworks 4.the context 5.public health 6.children and young people or clinical governance and continuing professional development

Programme content Consultation and decision making Psychology of prescribing and influencing factors Prescribing in a team context Principles and application of pharmacology and therapeutics Methods of patient monitoring Evidence based practice and clinical governance Professional legal, political and ethical aspects Prescribing in a public health context

Points to consider… Generic course Theoretical knowledge base NOT therapeutics course Principles to be applied to student’s area of practice Blended learning course, students require to fulfil all elements totalling 38 days

Legal parameters for Non-Medical Prescribing Independent Nurse prescribers (V300) – BNF Independent Pharmacist prescribers – BNF Supplementary prescribing AHP Supplementary prescribers Independent Community Nurse (V100, V150) prescribers – Nurse Prescribers’ Formulary

Supplementary prescribing Independent Prescriber (doctor or dentist) Supplementary (non-medical) Prescriber Tri-partite agreement including patient Clinical Management Plan Template Supplementary Prescriber prescribes within range stated on CMP Review by Independent Prescriber

NMP course 26 days theoretical attendance 9 days classroom attendance 16 days virtual attendance 2 x ½ days examinations 12 days (90 hours) in practice Total 38 days over a 18/19 week period

Assessments Pharmacology (nurses and AHPs) Exam – numeracy and pharmacology or Consultation Skills (pharmacists) Written critique Work Based Learning (all) OSCE and viva Principles of Prescribing Practice (all) Portfolio and Competency Profile

What is a designated medical practitioner expected to do? (NPC, 2005) Establish a learning contract Plan a learning programme which will provide the opportunity for the trainee to meet their learning objectives and gain competency Facilitate learning by encouraging critical thinking and reflection Provide dedicated time and opportunities to observe how the DMP conducts a consultation / interview with patients and / or carers and the development of a management plan

What is a designated medical practitioner expected to do? (NPC, 2005) Allow opportunities for the trainee to carry out consultations and suggest clinical management and prescribing options, which are then discussed with the DMP Help ensure that the trainees integrate theory with practice Take opportunities to allow in-depth discussion and analysis of clinical management using a random case analysis approach, when patient care and prescribing behaviour can be examined further Assessment and verification of competence to assume the prescribing role

Role of the medical mentor Clinical supervisor Supporting appropriate levels of confidence Formative feedback Assess competency in practice by O.S.C.E. Assess competency in practice by Competency Profile

What do I do if I have doubts? Discussion with student Contact with the student’s Personal Tutor Formation of action plan in conjunction with PT and student Review of action plan at specified intervals Discussion with student’s manager and / or NMP Lead Failing to fail??

Non Medical Prescribing (NMP) Leads NMP Leads may be contacted to support student with issues regarding progress, attendance Students should keep NMP Leads informed of pass / fail outcomes Student with resubmissions should contact their NMP Lead to enable them to provide support NMP Leads are informed of student’s result

OSCE assessment in practice Patient consultation Assessed by DMP Video recorded Submit by 12 th April 2013 Programme team to review (viva) Write a prescription (marked by tutors)

Competency profile Developed by National Prescribing Centre Most recent publication in May, 2012 Competencies as: combinations of knowledge, skills, motives and personal traits related to effective performance

The single competency framework for all prescribers (NPC, 2012) - The consultation - Prescribing effectively - Prescribing in context

All competencies to be achieved Initial review by 28 th January 2013 Mid-way, formative assessment by 11 th March 2013 End, summative assessment by 7 th May 2013 Submission by 7 th May 2013 Is this completed appropriately for external scrutiny... (consider external examiners, investigating managers, courts...)? Student competency profile

Personal (P) formulary Negotiate and identify priorities for prescribing practice During the programme develop competence and confidence in prescribing these medicines Add to this list by continuing negotiation Registrant’s own boundaries to practice Cognisant of legal parameters for prescribing

Personal (P) formulary May identify specific drugs or groups No minimum or maximum number Formulary relates to role and competence Focus for learning during the programme Portfolio evidence should present only drugs identified in Personal formulary

Learning contracts Identify: What student already knows What they need to know How they will acquire knowledge How new knowledge / new skill will be recognised and evaluated May be easier to start with a learning contract for each of the Learning Outcomes Suggest start with Learning Outcome 1

DMP Mentor and Learning in Practice handbook The programme Learning outcomes Competency Profile OSCE criteria and guidelines NPC medical mentor’s guide (previously under review)

Contacts

Information sources Department of Health: Supplementary prescribing eNon-MedicalPrescribingProgramme/Supplementaryprescribing/index.htm eNon-MedicalPrescribingProgramme/Supplementaryprescribing/index.htm Prescribing controlled drugs changes  Pharmacist independent prescribing FAQ (online archive) eNon-MedicalPrescribingProgramme/Independentpharmacistprescribing/DH_ eNon-MedicalPrescribingProgramme/Independentpharmacistprescribing/DH_ Nurse prescribing FAQ (online archive) eNon-MedicalPrescribingProgramme/Nurseprescribing/DH_ eNon-MedicalPrescribingProgramme/Nurseprescribing/DH_ National Prescribing Centre: Frequently Asked Questions Training Non Medical prescribers in practice