For those preparing to become prescribers, a period of practice-based learning is a key part of training. This time spent in practice allows trainees to consolidate and contextualise the academic component of the prescribing course, put theory into practice, and develop and demonstrate competence as a prescriber. This practice-based learning is undertaken under the supervision of an experienced prescribing practitioner. Traditionally, this experienced prescribing practitioner has been a medically qualified doctor in the role known as the designated medical practitioner (DMP). This role has been described as critical and highly responsible for educating and assessing the trainee prescriber (Department of Health (DH), 2006). In 2019 professional regulatory changes expanded the number of professions able to take on this role. New standards from the General Pharmaceutical Council (GPhC), Health and Care Professions Council (HCPC) and the Nursing and Midwifery Council (NMC) now allow this role to be carried out by an experienced prescriber from any prescribing profession (NMC, 2018; GPhC, 2019; HCPC, 2019). These professional regulatory changes will impact on a range of groups involved in the training of non-medical prescribers (NMPs).
The role of this experienced prescribing practitioner is critical to the development of safe and effective prescribers able to provide high-quality patient care. They are responsible, along with the programme provider, for signing off a trainee as competent to prescribe in practice, and therefore assuring the quality of this role is essential. The most comprehensive guidance to date on this role was published by the National Prescribing Centre (NPC) (2005). A guide to help doctors prepare for and carry out the role of designated medical practitioner outlined eligibility criteria and a set of broad competency areas for the DMP role (NPC, 2005). Since publication, this guidance has been used by many accredited prescribing programmes to assess the quality of DMPs on their course. Following the introduction of the new regulatory standards, there was a need for guidance that reflects the expansion of this role to all prescribing professions. In addressing this need the Royal Pharmaceutical Society (RPS) led the development of a competency framework for those taking on this role.
This article will outline the development process, scope and structure of the competency framework for designated prescribing practitioners (DPPs) and consider how it may be implemented in practice.
Benefits and challenges
The new regulatory standards, in the context of expanding the DMP role, have potential benefits and challenges. The expansion of the role to include all prescribing professions may improve access to training opportunities for those eligible to become prescribers, with the potential to increase the numbers of NMPs.
As prescribing programmes are reaccredited to use DPPs, there may be a wider pool of experienced prescribers, which will support prospective NMPs in accessing a suitable practitioner. This may help to overcome the barrier encountered by some prospective prescribers of not being able to find a DMP. However, this is not just about access, it also means that a prospective NMP can identify the professional, or profession, who they feel they will benefit the most from as the designated practitioner during their practice-based learning. In some cases it may be the same profession, in others, choosing a practitioner from another professional group may be more appropriate. These changes to regulatory standards should allow this broadening of access. The changes may also support doctors through allowing a better distribution of the ever-increasing clinical supervision workload.
A possible risk may be losing the multidisciplinary team (MDT) element of NMP training, and the skills learnt from each of the professions. It is important that learning from all members of the MDT remains central to the period of learning in practice, with trainees having access to the most appropriate professional to learn specific skill sets. Other potential challenges could be the possibility of financial incentives offered for taking on the role in some areas and the potential implications this may have on the objectivity of assessment. It is also important to consider the risk that, with other prescribing professions taking on this role, we could see a reduction in the number of doctors engaging with NMP training. Doctors continuing to take of this role is key to the pipeline of future prescribers, using their wealth of knowledge and experience to support trainees, but also to provide support to other prescribers as they take on the DPP role for the first time.
A multi-professional framework
Since the introduction of NMP training, doctors have supported trainee prescribers through taking on the DMP role. Eligibility criteria for the role has often been based on NPC guidance (NPC, 2005). Moving forward, as doctors are joined in this role by the other prescribing professions, having the same competencies for the role across the board will help to support consistence in training. The individual responsible for the trainee during their practice-based learning should possess the relevant skills, knowledge and experience to support safe and effective prescribing, independent of their profession.
GPhC, HCPC and NMC each have a different title for the individual taking on this role in practice. These vary between titles specific to prescribing training, such as designated prescribing practitioner used by GPhC, and titles of a broader training role applied to the prescribing course such as practice assessor used by NMC. To facilitate a multi-professional approach an umbrella term has been used in the framework to describe the individual taking on the role. Throughout the framework, the term DPP acts as an umbrella term to bring a number of different profession-specific titles together. These titles include practice assessor, practice educator and DMP when applied in the context of prescribing training. This umbrella term is used for the purpose of facilitating a multi-professional framework, individual regulator's titles will be used to describe the role in practice.
Developing the framework
The development process began in January 2019. Stakeholder engagement and representation from all the relevant groups was key to developing a framework for multi-professional and multi-sector use. An independent steering group with representation from across the prescribing professions had editorial responsibility for the framework, with outputs tested by a validation group. A strategic overview was provided by a project board and a virtual reference network supported engagement. Following initial drafting and redrafting there was an open consultation period in Summer 2019, after which the framework was redrafted and finalised. Figure 1 outlines the stages of the development process.
Scope of the competency framework
The competency framework has been developed for multi-professional use and the competencies can be applied to a prescriber, in any profession or sector, taking on a role that falls under the DPP umbrella. In order to be applicable to this broad user group, the framework does not contain competency statements that relate to specific professions or sectors of practice. As such, the competencies within the framework need to be contextualised to reflect different environments and areas of practice. Some professional regulators require this role to be carried out by an individual, others by two individuals taking on different aspects of the role. The framework document provides some guidance on the profession-specific titles, which are considered to fall under the DPP umbrella. However, there will be local interpretation and variation in how the framework is used in practice.
When regulators accredit prescribing programmes against the new regulatory standards, programme providers may be asked to demonstrate their process for ensuring DPPs on their programme are competent to take on the role. The framework can support providers to develop processes to ensure the quality of DPPs on their programme, but they may also choose to build further eligibility criteria or competencies onto the framework.
In addition to the competencies within the framework the document also highlights some additional eligibility criteria required of those taking on the DPP role. These are the requirement that anyone taking on the role must have current professional registration with the relevant regulator and be annotated as a prescriber, where this is a requirement of their regulator in order to prescribe. The framework also refers to the Competency framework for all prescribers (RPS, 2016), recommending that any prescriber acting in the DPP role should demonstrate these competencies throughout their practice.
It is important to note that the framework has been developed to support the implementation of regulatory standards, and in using the framework it is important to ensure that regulatory standards for the relevant profession are followed.
Structure and content
The framework is in three sections, each containing key themes relating to the role. There are a total of eight themes across all sections of the framework as shown in Figure 2.
The first section: ‘The designated prescribing practitioner’ focuses on the individual, and the characteristics, behaviours, knowledge and skills they should have in order to take on the DPP role. Theme one focuses on personal characteristics, both in relation to recognising the importance of the DPP role but also in their practice more broadly. Theme two looks at the professional skills and knowledge that DPPs should demonstrate through their clinical practice. The third theme in this section relates to the teaching and training skills the DPP should have, whether from experience or formal training. The competencies in this section of the framework are not specific to the DPP role; a prospective DPP should be able to demonstrate these competencies prior to taking on the role. As such, the competencies within this section may be used by accredited prescribing programmes to support the assessment of prospective DPPs on their programme.
‘These regulatory changes could be a step toward securing the future pipeline of prescribers’
The second section ‘Delivering the role’ looks at the competencies that the DPP will need to demonstrate whilst in the role. This section is made up of three themes; working in partnership, prioritising patient care and developing in the role. Some of the competencies in this section are specific to the DPP role, therefore, new DPPs may not be able to demonstrate these the first time they take on the role. However, many of the competencies in this section could be applied to any supervisory or teaching role within a clinical setting. The third section ‘Learning environment and governance’ focuses on the competencies required of the DPP, whilst also recognising that many elements of the learning environment and governance will be outside their control. The document notes the responsibilities of the employing organisation (or equivalent) to create and resource an environment, with appropriate governance structures in place, to enable the DPP to effectively carry out their role. As with the other sections of the framework, the competencies here should be contextualised to reflect the practice setting, location, size and type of organisation the DPP is working within. As with section two, some of the competencies in section three are specific to the DPP role and therefore new DPPs may not be able to demonstrate these the first time they take on the role.
Implementation
This competency framework was developed by the RPS to underpin quality of training in practice. As a multi-professional framework it provides the opportunity to bring different professions together to ensure consistency in the competencies required of all healthcare professionals carrying out the same role. The framework has a range of uses and potential user groups, including; accredited programme providers, prospective and current DPPs, NMPs and employing organisations. Firstly, for programme providers, the framework can be integrated to support the application process and quality assurance of the DPPs on their course. This can be from the initial assessment of appropriateness to take on the role, to informing any training delivered, and to supporting the provision of feedback to DPPs. For DPPs themselves, uses include self-assessment against the competencies in section one, to decide if they are ready to take on the role. Where they meet the necessary competencies this may give confidence that they are able to take on the role. Where they are not able to meet the necessary competencies the framework should help identify target areas for development prior to taking on the role in the future. Sections two and three can be used by DPPs throughout the time in the role to ensure they meet the necessary competencies, and after completion of DPP role, to reflect on the experience and plan development for the future. Prospective NMPs may use the framework to understand the role of the DPP, and to help them identify a suitable DPP. Employers and organisations can use the framework to support governance processes around the period of learning in practice in their organisations. The framework may also be used by organsiations to identify potential DPPs for prospective NMP trainees.
Looking to the future
With ever increasing demand for prescribers in all healthcare settings, these regulatory changes could be a step toward securing the future pipeline of prescribers. How this will play out in practice remains to be seen; as with all changes it is likely to take time to imbed. As the first DPPs take on the role, sharing and learning from their experiences will be key. If successful, we may soon have a multi-professional group of experienced prescribers leading on the practice-based training and assessment of future prescribers.
Conclusion
The RPS has led the development of a competency framework for those responsible for assessing the competence of NMP trainees in practice. The framework is intended to support the implementation of changes to professional regulatory standards that impact on the period of learning in practice. It has been developed by representatives from across the prescribing professions and designed for multi-professional use. Some contextualisation of the content is needed and as such there will be local variation in how the framework is used by different professions and settings. The framework is available as an open-access document on the RPS website (RPS, 2019).
Key Points
- The framework has been developed for multi-professional use and uses the umbrella term designated prescribing practitioner (DPP).
- The competencies can be applied to a prescriber, in any profession or sector, taking on a role that falls under the DPP umbrella
- In order to be applicable to this broad user group the framework does not contain competency statements that relate to specific professions or sectors of practice. The competencies should be contextualised to reflect different environments and areas of practice.
CPD reflective questions
- Do you feel ready to take on the role of a designated prescribing practitioner?
- If you were to become a DPP, what support would you need to successfully deliver the role?
- Looking back on your prescribing training, what did your designated medical practitioner do well and not so well? How might you use this experience to inform your own practice as a DPP?