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‘Qualifications alone don't guarantee competence to prescribe'

"Experience and practice supervision are prerequisites for prescribing competence"

Pharmacists need mentoring and clinical experience to reach the necessary level of competence to provide services, says prescribing pharmacist Faheem Ahmed

I was recently featured in an article on C+D about how I put my qualifications as a non-medical prescriber into practice with the help of clinicians at MEDLRN, a company committed to the philosophy of delivering high-quality face-to-face training courses for clinicians delivering services in the healthcare sector.

The article explained how I set up a walk-in clinic within the pharmacy, treating a range of minor illnesses – similar to GP-led NHS urgent treatment centres – to ease pressures on the NHS and improve patient health outcomes.

As a result I received messages from my peers locally, nationally and, surprisingly, internationally. They congratulated me on my achievement and explained how they had not been able to utilise their prescribing qualifications because of: a lack of mentoring; infrastructure; inadequate hands-on experience in clinical history taking and physical examination; and a lack of high-quality continuing professional development (CPD) courses for support.

The issues highlighted by the pharmacists had already been identified in the General Pharmaceutical Council (GPhC) survey of independent prescribing pharmacists. They also provoked me to reflect on my journey as a prescriber, and I began to wonder if it really is my qualification that makes me competent?

As I reflected further, it appeared that what separated me from my peers was not qualification, but possibly my experience and the opportunity to be mentored by clinicians and educationalists at MEDLRN. As such, I began to question the idea that a qualification alone was a good measure of competence in prescribing, or indeed any other skills required for advancing my practice.

I undertook a review of the literature to determine whether this claim and the views of my peers could be substantiated with evidence. Anecdotally I was aware that the issues we – and other independent prescribing health professionals – cited are all valid reasons for the inability of pharmacists to use their prescribing qualification competently, because initially, I too had suffered these obstacles.

Unsurprisingly, I did find evidence that shared the same views of my non-medical prescribing pharmacist peers. I also found similar concerns among nurse non-medical prescribers, who mentioned the following as barriers to using their non-medical prescribing qualifications: lack of support; cuts to CPD; and lack of mentoring and high-quality interprofessional tailored CPD courses. This might help to explain why pharmacists and other non-medical prescribers are not able to utilise their qualifications in practice. In my case the MEDLRN team had provided quality mentoring, providing information and advice as I practised, which suggests a qualification alone does not guarantee competence.

How can we ensure competence?

So what does constitute competence? The Concise Oxford Dictionary defines ‘competent’ as being “adequately qualified, capable or effective”, while ‘competence’ is the “state of being competent”. Dr Patricia Benner in her landmark work From novice to expert: excellence and power in clinical nursing practice, proposed a theory to shed some light on the idea of competency and explains that “education provides you with a theoretical and practical knowledge base that can be tested and refined in actual situations, but education alone cannot generate clinical expertise or confirm one is competent in a given discipline such as medicine”.

In my opinion, as a prescribing pharmacist, it is experience, which can be defined based on Benner’s theory as both time in practice and reflection on encountered circumstances, which may be a better measure of competence than a qualification. The new education curricula standards for non-medical prescribing may no longer be a good measure of competence, because the learners undertaking these programmes have very different needs. Pharmacists need experience of clinically managing service users under mentorship of competent clinicians, and in community pharmacy this is difficult to achieve.

The programme should be centred in practice where the clinician will be working on completion of the qualification, supervised and assessed by competent clinicians in their place of work. For the advanced clinical practitioner role, institutions have adopted the programmes too quickly, in order to provide more services for patients by developing the non-medical prescribing role to fill the gap the shortage of doctors within the NHS has made. This short education programme should provide time for learning advanced skills in practice by devoting more time to gaining clinical experience, and it is experience as identified above coupled with practice supervision which, in my opinion, is a prerequisite to demonstrating advanced clinical practice and prescribing competence.

Faheem Ahmed is a prescribing pharmacist at Ahmey’s Pharmacy in Oxford, where he runs a private minor ailments clinic. This article was co-authored by Amanda Drye, a senior lecturer in healthcare at Anglia Ruskin University, and specialist community public health nurse practitioner and prescriber

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Mahesh Sodha, Superintendent Pharmacist

Absolutely correct analysis. Sadly we high lighted this back in 2005 but the profession did not pursue clinical training. Good solid foundartion in clinical knowledge together with clinical experience with a GP tutor is esential and there is alreday a tried and tested process that is used with GP registrars and can be extrapolated to Pharmacist prescribers.

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