CENTRE FOR PHARMACYPOSTGRADUATE EDUCATION

Clinical pharmacists in general practice education

Pathway handbook

GENPRAC2PWAY-WBFebruary 2019

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Acknowledgements

Authors Helen Middleton, lead pharmacist - General practice education (London and South East), CPPEDeborah Howard, education supervisor, (North West), CPPEEmma Wright, lead pharmacist - General practice education (South), CPPE

ReviewerCeinwen Mannall, national lead, General practice and lead pharmacist, learning development, CPPE

EditorSarah Bromley, editorial assistant, CPPE

This version was published in February 2019. Originally published in August 2017 by the Centre for Pharmacy Postgraduate Education, Division of Pharmacy and Optometry Faculty of Biology, Medicine and Health, Stopford Building (1st floor), The University of Manchester, Oxford Road, Manchester, M13 9PT. www.cppe.ac.uk

Reg. No. 2113

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Welcome and contentsCongratulations on your new role as a clinical pharmacist in general practice and welcome to the Clinical pharmacists in general practice education programme.

Section 1 – Background to the NHS England programme for clinical 4 pharmacists in general practice

The NHS England programme for clinical pharmacists in general practice 4

The Clinical pharmacists in general practice education programme 5

About CPPE 6

Section 2 - Your learning pathway 7

Welcome to the Clinical pharmacists in general practice education programme 7

Multi-pathway approach 8

Induction 10

Modules 10

Local learning sets 14

Online learning 14

Portfolio 15

Clinical pharmacist in general practice role progression handbook 15

Assessment 15

CPPE statement of assessment and progression 17

Independent prescribing 17

Multiprofessional learning 18

Section 3 – Supporting you throughout the pathway 19

Support structure underpinning the learning pathway 19

Pharmacists requiring additional support (PRAS) 20

How to deal with issues of concern in the workplace 21

Appendix 1 – Curriculum for the Clinical pharmacists in general practice education programme 24

Appendix 2 – Personal development planning 40

Appendix 3 – Partner organisations 42

References 43

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Section 1

Background to the NHS England programme for clinical pharmacists in general practiceThe NHS England programme for clinical pharmacists in general practiceIn July 2015 NHS England announced a pilot to support the development of clinical pharmacists in general practice. NHS England describes the role of the clinical pharmacist in general practice as follows:

“Clinical pharmacists will work in general practice as part of a multidisciplinary team in a patient-facing role to clinically assess and treat patients using their expert knowledge of medicines for specific disease areas. They will be prescribers, or training to become one, and will work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex polypharmacy, especially for the elderly, people in care homes and those with multiple comorbidities.”

NHS England, General Practice Forward View1

The General Practice Forward View committed to over £100m of investment to support an extra 1500 clinical pharmacists in general practice by 2020/21. This is in addition to over 490 clinical pharmacists already working across approximately 650 GP practices as part of a pilot, launched in July 2015.2

Learning pathwayThe clinical pharmacist learning pathway is comprised of a number of different component parts:

Component parts Led by

Education and training programme – Led and delivered by CPPE and partners (see Clinical pharmacists in general practice education Appendix 3 for details of partner organisations)

Education supervision from a trained Led and delivered by CPPE pharmacist supervisor

Clinical supervision from a trained GP clinical Managed by Health Education England (HEE) supervisor within an environment appropriate for learning heads of primary care/GP teams

Organisational development (OD) Procured by NHS England

Independent prescribing (IP) Procured by HEE

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The Clinical pharmacists in general practice education programmeHealth Education England (HEE) has awarded the contract to deliver the training pathway for clinical pharmacists in general practice until 2020/21 to CPPE, following an open procurement process and the success of our education pathway for the 490 clinical pharmacists on the phase 1 pilot.

Vision The Clinical pharmacists in general practice education programme will train clinical pharmacists and senior clinical pharmacists who will:

n offer patient-facing and person-centred consultations

n work within a multidisciplinary general practice team, offering outcome-focused medication reviews for people with multimorbidities taking multiple medicines

n focus on high priority, common and long-term conditions or a broad range of medical conditions dependent on local needs

n improve access to primary care, which supports people to manage their own health, medicines and long-terms conditions

n deliver medicines optimisation and offer high-quality, safe and cost-effective prescribing expertise

n deliver clinics via patient appointments or as drop-in services

n support enhanced liaison and closer working with local community pharmacy

n deliver NHS England priorities and plans for medicines optimisation, health and wellbeing.

Core principles The core principles supporting this pathway will ensure the clinical pharmacists and senior clinical pharmacists will:

n be trained in a supervised setting supported by education providers and supervisors

n be given protected learning time (up to 28 days over the 18 month pathway) to attend residential courses, study days, learning sets and webinars. Study time is the same for full time and part time staff; not pro-rata

n be supported by an education supervisor, GP clinical supervisor, senior clinical pharmacist, clinical mentor and peers

n work towards an independent prescribing qualification at an appropriate time, if not already held

n build on existing models of pharmacist work in general practice

n use established frameworks alongside this pathway:

n NHS Healthcare Leadership Model3 and associated Royal Pharmaceutical Society (RPS) Leadership Development Framework 20154

n RPS: a competency framework for all prescribers5

n Consultation skills for pharmacy practice: practice standards for England.6

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About CPPE

The Centre for Pharmacy Postgraduate Education (CPPE) is part of the Division of Pharmacy and Optometry, within the Faculty of Biology, Medicine and Health at the University of Manchester. Our team of staff are committed to offering continuing professional development opportunities through high-quality services and learning materials. CPPE is leading the Clinical pharmacists in general practice education programme for clinical pharmacists on the NHS England programme for clinical pharmacists in general practice.

CPPE’s mission statement:

Provider of educational solutions for the NHS pharmacy workforce across England, to maximise their contribution to improving patient care.

We have made a commitment to meet the aims set out in our mission statement by:

n providing high-quality professional learning programmes

n delivering an excellent customer-focused service

n working successfully as part of the CPPE team.

CPPE’s corporate governance and how we operate is explained in CPPE: A guide to governance and quality which you can find under the About CPPE tab on the homepage of our website. To underpin our mission statement we have developed five core values.

CPPE values

n Commitment to improve and achieve

n Commitment to communication

n Commitment to encouraging others

n Commitment to openness and honesty

n Commitment to working together

Have a look at our CPPE values document to find out more: www.cppe.ac.uk/about-cppe/about-cppe

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Section 2

Your learning pathwayWelcome to the Clinical pharmacists in general practice education programmeCongratulations on your new role as a clinical pharmacist or senior clinical pharmacist in general practice and welcome to the Clinical pharmacists in general practice education programme. The 18-month pathway will equip you with the necessary knowledge, skills and experience to work in general practice as part of a multidisciplinary team in a patient-facing role. The pathway includes a range of different study methods to suit a range of learning styles, three stages of assessment and support from a CPPE education supervisor. Local support is also available from a GP clinical supervisor, senior clinical pharmacist and clinical mentor and the structure of the pathway is designed to develop strong networks and peer support. The figure below shows an overview of the pathway.

Overview of the Clinical pharmacists in general practice education programme

You should be given protected learning time (up to 28 days over the 18-month pathway) to attend residential courses, study days, learning sets and webinars. Study time is the same for full time and part time staff; it is not pro-rata.

Modules

Portfolio

Local learning sets

Clinical pharmacists in general practice role progression handbook

Study days, e-learning, webinars, enquiry-basedlearning, discussion forums

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Multi-pathway approach

The Clinical pharmacists in general practice education programme is a multi-pathway approach, with a range of modules linked to learning outcomes. We offer three learning pathways to meet the different learning needs and experiences of clinical pharmacists and senior clinical pharmacists. This innovative approach recognises existing capabilities and offers learners a continuous, relevant learning experience. Details of the curriculum can be found in Appendix 1.

You will have an early supportive discussion with your CPPE education supervisor to identify your individual learning needs in relation to the curriculum, discuss your role, and decide which of the three pathways best suits your needs. You will complete a learning needs analysis (LNA) tool to inform this discussion. You will be sent a copy of the LNA by email in your welcome pack and you must send your completed LNA to your education supervisor before the meeting.

At this early meeting you will also indicate preferences for the order and locations of your modules and discuss a suitable time and provider for your independent prescribing (IP) course (if needed).

You will be enrolled onto the most suitable pathway following the initial meeting with your education supervisor and your learning needs analysis. Your learning needs analysis will also support you to develop a personal development plan (PDP) for the 18 month learning pathway. You can find information on how to write your PDP in Appendix 2 of this handbook.

Pathway 1

This pathway is suitable for pharmacists who have not completed a Higher Education Institution (HEI) clinical pharmacy postgraduate qualification and cannot evidence equivalent knowledge/experience. Pathway 1 enables pharmacists to build a strong foundation of clinical knowledge (module 2 delivered by our HEI partners) before progressing through modules 3, 4 and 5 supporting role development and leadership. Module 5 focuses on clinical assessment skills relevant to long-term condition management. This will prepare learners for independent prescribing training which will usually be completed after all of the Clinical pharmacists in general practice education modules.

Pathway 2

This pathway is suitable for pharmacists who have a postgraduate diploma or equivalent knowledge and skills in clinical pharmacy. This pathway will focus on clinical pharmacy in primary care, leadership and advanced clinical assessment skills (modules 3, 4 and 6). Module 6 focuses on clinical assessment skills for acute and long-term conditions. Appropriateness and timing of independent prescriber training (during or at the end of the pathway) will be agreed at the first meeting with the education supervisor.

The senior pathway

This pathway focuses on clinical pharmacy in primary care, advanced clinical assessment skills, advanced leadership, education and wider clinical capability (modules 3, 6 and 7). It is expected that most senior clinical pharmacists will already hold an IP qualification or be working towards one.

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Modules Pathway 1 Pathway 2 Senior pathway

Module 1: Yes Yes Yes Induction/senior induction (senior induction)

Module 2: Yes No No Clinical pharmacy

Module 3: Yes Yes Yes Clinical pharmacy in primary care

Module 4: Yes Yes No Leadership and management

Module 5: Yes No No Clinical assessment skills

Module 6: No Yes Yes Advanced clinical assessment skills

Module 7: No No Yes Senior leadership

The table below lists the modules for each of the three pathways.

Overview of the modules for the three pathways

After deciding which pathway is most suitable for you and agreeing this with your education supervisor, you will enrol onto the agreed pathway on the CPPE website.

After completion of module 1 and module 2 (pathway 1) you will study for one module at a time and you can choose to complete the modules in any order depending on availability of modules. At the start of the pathway you will complete your preferences for modules including start date and geographical location. We cannot guarantee that you will be able to study in your preferred order but your preferences will help us plan delivery to match demand as closely as possible. You will be notified in due course which modules are available when and in which locations. You will then book your modules and your places on individual study days on the CPPE website. We will send regular communications via Canvas to ensure that we keep you updated.

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Learning set: Developing your patient-facing role

Induction residential day 1 and 2: Days 1 and 2 focus on patient engagement, developing your role in general practice, an introduction to leadership and consultation skills.

Induction residential day 3 and 4: Days 3 and 4 focus on clinical assessment skills and history-taking, medicines reconciliation, complex cases and resilience.

Learning set: Working with community pharmacy

Induction

Clinical pharmacists on pathways 1 and 2 will complete the induction module and the senior pharmacists will complete the senior induction module. The key components of module 1 are described here and in the tables below:

The induction residential (pathways 1 and 2) provides an intensive introduction to the core skills required for your role as a clinical pharmacist in general practice. The induction residential creates the opportunity for you to network with other clinical pharmacists and build strong collegiality to achieve success as part of the NHS England scheme.

The senior induction residential (senior pathway) provides an intensive introduction to clinical leadership in primary care and your role as a mentor for the clinical pharmacists on the pathway. There is also an optional introduction to the core skills required (consultation skills and clinical assessment skills and history-taking). The induction residential creates the opportunity for you to network with other senior clinical pharmacists and build strong collegiality to achieve success as part of the NHS England scheme.

Our General practice – the fundamentals of working with GPs e-course is available online. This e-course is an excellent introduction to working in a GP surgery. The e-course covers NHS structure and general practice, introduction to local general practice, medicines optimisation, medication review, prescribing and repeat prescribing, prescribing data, clinical information technology systems, audits, evidence-based use of medicines, working with the multidisciplinary team and patient-centred professionalism. All pharmacists who are new to general practice will be expected to complete this e-course as part of module 1. If you have previous experience of working in a GP practice, you will still find this e-course a useful resource. We have designed the course so that you can dip in and out and focus on the areas of learning that are most relevant to you. All pharmacists on all three pathways are expected to pass the fundamentals of working with GPs e-assessment.

The tables below and opposite describe how the pharmacists will study module 1.

Module 1 – pathway 1 and pathway 2Month 1 Month 2 Month 3 Month 4

The fundamentals of working with GPs e-course 13 weeks online, tutor-led, start dates available on the CPPE website

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Module 1 – senior pathway Month 1 Month 2 Month 3 Month 4

Optional: The fundamentals of working with GPs e-course 13 weeks online, tutor-led, start dates available on the CPPE website

After completing the induction module clinical pharmacists and senior clinical pharmacists will progress

through the other modules for their pathway of learning.

Module 2 – clinical pharmacy (pathway 1 only)Duration: four months

Module 2 will enable pharmacists to build a strong foundation of clinical knowledge before progressing through modules 3, 4 and 5 supporting role development and leadership. The focus of module 2 is on respiratory and hypertension in the context of the complexity of other conditions. On completion of the module pharmacists will be able to:

n apply pharmaceutical knowledge and skills to practice

n plan, manage, monitor, advise and review pharmaceutical care plans for patients

n make decisions requiring analysis, comparison of a range of options and interpretation of the evidence base

n understand the wider complexity of patient care, working with the patient.

Delivery structure:

Module 2 is a continuing professional development (CPD) module delivered by our partner HEIs. Pharmacists on pathway 1 will complete module 2 at a partner HEI of their choice. Detailed information about module 2 can be found on Canvas (our virtual learning environment) including flyers from each of our HEI partners explaining how they deliver module 2 and how to apply. CPPE will share names and contact details of pharmacists on pathway 1 with our partners for the purposes of enrolment onto HEI modules.

Learning set: Developing your patient-facing role

Optional: Induction residential: Senior clinical pharmacists can choose to attend a maximum of two days of the clinical pharmacists induction residential. This will be discussed at the initial meeting with the CPPE education supervisor.

Senior induction residential: The senior induction residential focuses on patient engagement, developing your senior clinical pharmacist role in general practice, mentoring, quality improvement, stakeholder engagement, influencing skills, resilience and developing peer support networks.

Learning set: Working with community pharmacy

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Quality improvement project: Creating and implementing a practice-based quality improvement project.

Myers-Briggs Type Indicator (MBTI) online e-workshops

Leadership study day 1: Leadership in general practice

Leadership study day 2: Lead, Manage, Thrive! (Red Whale)

Learning set: quality improvement project focus

Module 3 – clinical pharmacy in primary care (all pathways)Duration: four months

Module 3 focuses on building confidence in managing medical complexity and polypharmacy. The learning is led by experts and GPs on key areas for primary care.

Study day Delivery

Musculoskelatal and chronic pain update Red Whale

Mental health and wellbeing HEI partners

Medicines optimisation in care homes essential skills CPPE

Clinical pharmacist update Red Whale

Webinar

Red Whale and CPPE will deliver six interactive webinars focusing on long term conditions. Topics are chosen to compliment the content of the Clinical pharmacist update study day and may include the following: chronic heart failure, monitoring, polypharmacy, respiratory, atrial fibrillation, cancer and end of life care, acute kidney injury.

Online course

Red Whale will deliver a type 2 diabetes online course. This consists of one live webinar and three recorded webcasts.

Delivery structure:

You will attend one study day per month. Webinars and the diabetes online course are spread out through the module.

Module 4 – leadership and management (pathways 1 and 2)Duration: two months

Module 4 focuses on developing your leadership and management skills and introduces clinical pharmacists to tools to understand, improve and maintain professional relationships and manage change. During this module clinical pharmacists will lead on quality improvement projects for the benefit of patient care and develop personal resilience, wellbeing and effectiveness in their general practice role.

Delivery structure:

Pre-work Month 1 Month 2

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Senior clinical pharmacists will keep a reflective journal of their development and engage with discussions on Canvas.

Myers-Briggs Type Indicator (MBTI) online e-workshops

Two-day residential: Leadership of self and teams

Study day: System leadership

Write a case for change

Module 5 – clinical assessment skills (pathway 1 and pathway 2)

Pharmacists on pathway 2 can choose module 5 or module 6

Duration: two months

Module 5 focuses on clinical assessment skills and clinical decision-making applicable to caring for patients with chronic conditions and during medication reviews.

Module 5 consists of three study days focusing on general examination of the patient, dermatological conditions, infections, respiratory and cardiovascular assessment.

Delivery structure:

n study days led by medical tutors on acute and chronic presentations and associated clinical assessment skills, supported by professional medical actors

n self-directed e-learning on history-taking

n self-directed anatomy learning.

Module 6 – advanced clinical assessment skills (pathway 2 and senior pathway)Pharmacists on pathway 2 can choose module 5 or module 6

Duration: two to four months

Module 6 focuses on clinical assessment and clinical decision-making skills in the context of caring for patients with a wide range of conditions and during medication reviews.

Module 6 consists of five study days focusing on general examination of the patient, dermatological conditions, infections and examination and assessment skills in a range of systems including respiratory, cardiovascular, neurological, musculoskeletal and gastrointestinal.

Delivery structure:

n study days led by medical tutors on acute and chronic presentations and associated clinical assessment skills, supported by professional medical actors

n self-directed e-learning on history-taking and differential diagnosis

n self-directed anatomy learning.

Module 7 – senior leadership (senior pathway)Duration: two months

Senior clinical pharmacists are key to the success and sustainability of the Clinical pharmacists in general practice programme. Senior clinical pharmacists are a valuable resource to lead improvement and service transformation relating to medicines optimisation. Module 7 focuses on exploring the individual, the team and the wider NHS and care landscape. This will enable senior clinical pharmacists to become more confident leaders so that they can have a greater impact on patient outcomes. The study days are delivered by Alliance Manchester Business School in partnership with CPPE.

Delivery structure:

Pre-work Month 1 Month 2

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Local learning setsYou will attend monthly local learning sets which are facilitated by your education supervisor. Each learning set will last two hours followed by a one hour group supervision meeting or bid site meeting as decided locally. The learning sets will bring together pharmacists of different levels of experience and capability, offering support for each other’s learning and the opportunity to critically review and improve practice. We use structured learning materials to address key NHS England priority topics. You will be expected to complete pre-workshop activities prior to attending learning sets so the face-to-face time can be used to discuss cases and apply knowledge.

Learning set topics:

n Working with community pharmacy

n Developing your patient-facing role

n Antimicrobial stewardship

n Patient safety

n Learning disabilities

n Multimorbidity

n Type 2 diabetes

n Dementia

n Inflammatory arthritis

n Medicines related admissions

The learning sets also provide protected time for reflection on clinical practice and the opportunity to discuss individual cases from the pharmacists’ own practice in depth.

Online learningWe use online learning throughout the pathway as follows:

Online learning Module Pathway

General practice – the fundamentals Module 1 Pathways 1 and 2 of working with GPs e-course Optional for senior pathway

Webinars Module 3 All pathways

Portfolio Throughout the pathway All pathways

e-assessments Throughout the pathway All pathways

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PortfolioYou will build your online portfolio of evidence which demonstrates your education and practice achievements. A well-constructed portfolio should describe your learning journey towards the attainment of professional competence. The e-portfolio is an important part of the Clinical pharmacists in general practice education programme. The information in your portfolio is used to track your progress throughout the pathway and provides evidence of how you meet the learning outcomes, core capabilities and competences within the curriculum.

Clinical pharmacist in general practice role progression handbookThe role progression model for general practice pharmacists has been designed so that it is flexible for pharmacists with varying levels of medicines expertise and skills. There is no ‘one size fits all’ in relation to role progression for clinical pharmacists in general practice. Your rate of role progression will be influenced by your baseline experience and skills, the needs of your practice and the practice’s patients and the level of work-based clinical supervision for safe clinical practice. Therefore clinical pharmacists will progress at varying rates and will deliver a variety of roles.

The clinical pharmacist in general practice role progression handbook describes the skills that pharmacists can bring to general practice, the variety of roles that clinical pharmacists may perform and how these roles may progress over time and with training. The content of the role progression handbook has been crafted from experience and feedback from phase 1 of the General practice pharmacist training pathway delivered by CPPE.

The role progression model has been designed so that:

n roles that are needed within general practice are described

n medicines leadership roles are clearly defined from the first day in practice

n patient-facing clinical roles are of increasing complexity

n specific patient assessment skills that may need to be acquired have been outlined

n role progression occurs alongside training for safe clinical practice

n pharmacists perform roles that use their medicines expertise

n pharmacists with the appropriate experience and training become skilled in managing multimorbidity and polypharmacy.

The role progression handbook makes the essential link between practice and education. You will use this essential resource to identify the clinical knowledge and skills you require for role progression within your current and future role as a clinical pharmacist or senior clinical pharmacist working in general practice. The role progression handbook is designed to be used flexibly and to take into account each pharmacist’s experience, the needs of individual GP practices and the needs of patient populations.

Assessment There are three stages of assessment during the Clinical pharmacists in general practice education programme. We have provided a summary of the assessments at each stage of the pathway. More detail of the assessments is provided in the assessment handbook. There will be additional assessments for pharmacists who study module 2 and your chosen HEI will provide more information about these assessments.

You must complete all CPPE assessments and you cannot substitute these with local assessments or assessments completed as part of a diploma or independent prescribing course.

You should record your progress with assessments on the general practice activity series tracker on the CPPE website. Some assessments will be automatically populated in your trackers. You must sign up for all trackers to initiate the automatic recording of the assessments on the CPPE website.

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Assessment stage 1

You will complete assessment stage 1 as part of your induction.

Assessment Format

Safeguarding children and vulnerable adults* e-assessment

Consultation skills e-assessment

Equality, diversity and human rights (eLfH) e-assessment

Fundamentals of working with GPs e-assessment

*The purpose of completing this assessment is to prepare pharmacists for their patient-facing role in general practice. All clinical staff must pass a level 2 safeguarding assessment. The CPPE Safeguarding children and vulnerable adults e-assessment is level 2. Safeguarding assessments should be repeated every two years as a minimum to ensure knowledge is kept up to date.

Assessment stage 2

You will start assessment stage 2 within six months of starting the Clinical pharmacists in general practice education programme. However you do not have to complete all of the stage 2 assessments during the first six months on the pathway.

Assessment Format

Case-based discussion (CbD) CPPE CbD assessment tool. Assessed by clinical mentor during the learning sets.

Multisource feedback (MSF) Online questionnaire – feedback provided by clinical and non-clinical staff in the pharmacist’s practice(s).

Professional discussion with education supervisor.

Clinical examination and procedural skills Direct observation in the practice(s) by GPs, nurses, assessment record (CEPSAR)* senior pharmacist, completion of clinical

examination and procedural skills logbook, two case studies and a reflective essay.

Assessment stage 3

You will start assessment stage 3 between 6 and 12 months of starting the Clinical pharmacists in general practice education programme. You need to complete all of the stage 3 assessments within 15 months of starting the pathway.

Assessment Format

Case-based discussion (CbD) CPPE CbD assessment tool. Assessed by clinical mentor during the learning sets.

Multisource feedback (MSF)** Online questionnaire – feedback provided by clinical and non-clinical staff in the pharmacist’s practice(s).

Professional discussion with education supervisor.

Consultation skills assessment Direct observation of practice by GP clinical supervisor using the Medicines Related Consultation Assessment Tool (MR- CAT).

Reflection on patient feedback CPPE patient satisfaction questionnaire (PSQ) and reflective essay of the pharmacist’s learning from feedback from the PSQ.

*The clinical examination and procedural skills assessment record (CEPSAR) is linked to modules 5 and 6 so the timing of this assessment will depend on when the pharmacist completes these modules. As some pharmacists will choose to complete these modules early in the pathway we have included the CEPSAR as part of assessment stage 2.

**You should complete their second MSF approximately six months after your first MSF to allow sufficient time to action development needs identified in the first MSF.

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CPPE statement of assessment and progressionThere will be a process at the end of the pathway for you to receive a statement of assessment and progression from CPPE. The statement of assessment and progression will measure your progression in your role and your progression with the learning outcomes, core capabilities and competencies within the curriculum for the Clinical pharmacists in general practice education programme.

You will submit evidence for a statement of assessment and progression within 15 months of starting the pathway. Your evidence will be reviewed by a CPPE reviewer who will provide feedback on examples of good practice and suggestions for further development. More information can be found in the assessment handbook.

You can use your statement of assessment and progression as evidence when applying for jobs to demonstrate to future employers what knowledge, skills and experiences you have gained during the 18 month learning pathway and how you have applied the learning to develop your role in general practice.

Independent prescribingIndependent prescribing (IP) is a key part of the role of the clinical pharmacist in general practice. If you are not already an independent prescriber you will need to achieve IP status by 2020/21. Independent prescribing training will be commissioned separately by Health Education England (HEE) and your place on an IP course will be funded by HEE.

You can find more information about the IP courses that HEE is funding for pharmacists on this programme on the HEE website: www.hee.nhs.uk/our-work/pharmacy/pharmacy-integration-fund/pharmacy-integration-fund-courses-pharmacists

All pharmacists must complete the induction module before enrolling for an IP course. Pharmacists on pathway 1 must also complete module 2 before enrolling on an IP course. You will discuss and agree a suitable time to do your IP course with your education supervisor at your initial meeting. You must also discuss your preferred date for starting IP with your employer and gain agreement from them before you apply for an IP course.

If you are a qualified IP but not currently prescribing, you can attend the CPPE Return to Prescribing online course. This consists of a series of three 90-minute webinars over eight weeks with about an hour of pre-work in advance of each webinar. The whole programme will support clinical pharmacists to develop an action plan to get them back into prescribing. Courses will start in February, June and September each year.

If you are studying for an IP qualification you will require supervision from a designated medical practitioner (DMP). This is a separate role from the GP clinical supervisor. Further details about the role and responsibilities of a DMP are available from the HEI providing the IP course.

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Multiprofessional learningCPPE and GP deans and directors across England are working together to explore models for joint learning. There is potential to integrate educational activities between clinical pharmacists, GP educators and GP trainees. This might take the form of joint learning in surgeries, shared end-of-clinic debriefing and/or shared learning resources. In addition some shared sessions within the GP specialty half-day release programme may be appropriate. Learning together will enhance concordance of practice and a team-based approach. As learners from more disciplines at varying levels of experience are placed in primary care, educators and learners should develop interprofessional clinical education opportunities. Finally if GPs wish to further develop their skills, CPPE will work with local GP deans and directors to support access to further training and accreditation.

FAQs

Frequently asked questions about the Clinical pharmacists in general practice education programme can be found on the CPPE website: www.cppe.ac.uk/career/cpgpe/faqs#gpptpMenu

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Section 3

Support for the pharmacists throughout the pathway Support structure underpinning the learning pathway

A strong support structure underpins the learning pathway. Support will be provided by a CPPE education supervisor, senior clinical pharmacist, clinical mentor and workplace-based GP clinical supervisor.

You will have a named CPPE education supervisor who will ensure that you have an effective learning experience throughout the pathway. The education supervisor will support you to develop your initial and ongoing education plan, which will include deciding the most appropriate time for you to start your independent prescribing qualification if you are not yet a prescriber. The education supervisor will review your progress with the learning pathway, assessments and role progression quarterly. Supervision meetings may be face-to-face or by phone or Skype. Education supervisors will also conduct professional discussions with you to support you to learn and reflect on your MSF feedback reports.

You will be linked with a senior clinical pharmacist, who may also be learning and developing in their senior role. The senior clinical pharmacist will be able to oversee appropriate management guidance and professional development. The senior clinical pharmacist can advise the GP clinical supervisor and bid sites to ensure appropriate clinical work and clinical pharmacist role development. In future, as GP practices coalesce in to larger organisations, the senior clinical pharmacist will still be clinically active but they are likely to have a more managerial role, defining the service and the roles of other clinical pharmacists. Each senior clinical pharmacist will support up to five clinical pharmacists and will provide a minimum of one supervision session per pharmacist per month. The senior pharmacist does not need to be in the same geographical site as the clinical pharmacist but they need to be relatively available and to have the facility for instant messaging within the NHS Information Governance system to support clinical pharmacists when needed.

The clinical mentor is employed by CPPE on a sessional basis. The clinical mentor is a senior pharmacist who will either have experience in general practice clinical work or relevant clinical responsibilities in a primary care position. Clinical mentors will provide group mentoring at the start of the pathway to support you to become patient facing and assess your Case-based Discussions during learning sets. The clinical mentor will provide individual support and mentorship to senior clinical pharmacists and support for role progression for clinical pharmacists on referral from the education supervisor. The clinical mentor does not need to be immediately available or local, and will use standard communications tools such as email, phone and Skype.

Clinicalpharmacist

GP clinical supervisor

Educationsupervisor

Seniorclinical

pharmacist

SeniorClinical

pharmacist

GP clinical supervisor

Educationsupervisor

Clinicalmentor

Support for clinical pharmacists Support for senior clinical pharmacists

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20

You will have a named GP clinical supervisor who will supervise you in the workplace, providing a rapid response to issues as they arise. The GP clinical supervisor will support role development and integration into the practice, and work with you to ensure safe patient services and management of workload. The GP clinical supervisor will provide guidance and feedback in relation to your immediate clinical work. This will include debriefs, after surgery/clinics or other patient-facing activities and regular developmental conversations. They will provide support for workplace-based assessments, acting as an assessor when required, and will provide feedback on your progress to your education supervisor. The GP clinical supervisor must have intimate knowledge of the working environment and the service and be instantly contactable. Initially they will need to be on the premises, but as confidence grows, could be remotely available providing this is almost instantaneous; this could be, for example, via a confidential Skype for business link including messaging, face-to-face conferencing and desktop/presentation sharing.

It is good practice for surgeries where clinical pharmacists are based to be approved for education by the local HEE School of General Practice and for the GP clinical supervisor to be trained through HEE’s local office and be approved as a GP clinical supervisor. CPPE is working with HEE local offices to ensure appropriate support is available for GP clinical supervisors and bid sites.

Practitioners requiring additional support (PRAS)

The CPPE ‘practitioners requiring additional support’ (PRAS) system ensures consistent responses by education supervisors across a wide variety of learners and geographical locations. The PRAS system provides a consistent framework to identify and address variation in practice, an early alert to support requirements and an assurance that patient safety is maintained.

The CPPE education supervisors will work with GP clinical supervisors, practice managers/employers, senior clinical pharmacists and clinical mentors to support pharmacists requiring additional support. Additional local support will be accessed as appropriate.

The education supervisor will identify pharmacists requiring additional support and will assess the key and associated factors contributing to the issues the pharmacist requires support for. These issues are often multifaceted; for example, a pharmacist who has health issues alongside challenges developing their role in the practice. The education supervisor will work with the pharmacist to develop a support plan and will ensure regular review to monitor the effectiveness of the plan. Additional support may be provided by the GP clinical supervisor, senior clinical pharmacist and or the CPPE education supervisor. This may include referral to external organisations, eg, Pharmacist Support. Pharmacists may also be referred to the CPPE coaching service www.cppe.ac.uk/support/need-support.

Common reasons for PRAS are when pharmacists:

n are not integrated into the GP practice team and are working in isolation

n cannot establish or progress their patient-facing role in the practice

n have a lack of awareness about their professional competence

n are not receiving regular or honest clinical supervision from a GP

n have poor clinical knowledge leading to errors/patient safety concerns

n are experiencing issues of a personal nature, for example, relationship issues, bereavement or ill-health

n are struggling to progress with the education pathway

n have personal conduct issues.

While the CPPE education supervisor can provide initial triage and resolution of issues, significant issues regarding organisational concerns may need to be referred to NHS England. Significant issues impacting learners may require more specialist support. We will work with GP directors/deans and pharmacy deans to agree signposting and support mechanisms to trainees requiring additional support (TRAS) provision and local expertise.

Pathway handbook

21

How to deal with issues of concern in the workplace Things don’t always go smoothly when you move to a new job or take on a new role. The team at your practice might never have worked with a pharmacist before and may not know what to expect of your role, you may struggle to engage the team, have concerns about safe practice or feel that you don’t have sufficient support locally for your learning and development.

The table below lists some possible concerns that you might have in the workplace. Pharmacists who identify an issue listed below should follow the suggested course of action initially and then seek further support from the following people as appropriate:

n Senior clinical pharmacist

n GP clinical supervisor

n Practice manager

n CPPE education supervisor

Pharmacist has concerns that aspects of their practice induction programme are outstanding, eg, supervision arrangements or reporting procedures are unclear to the GP pharmacist or practice team.

Pharmacist has concerns regarding a lack of clarity amongst the practice team in relation to their role, training needs, need for protected time for learning sets and study days – resulting in a lack of support or engagement.

Pharmacist has concerns regarding poor rapport and/or lack of support from the wider practice team, especially if working with a number of practices.

Pharmacist has concerns that they are not managing to achieve an effective working relationship or rapport with their GP clinical supervisor or senior clinical pharmacist.

n Speak to the practice manager and/or GP clinical supervisor in the first instance and show them the induction checklist you need to complete.

n Speak to the senior clinical pharmacist.

n Remember your ‘lift pitch’ – make sure you can articulate the benefits of your role.

n Consider showing a video about the role of a pharmacist in general practice at a team meeting:

www.youtube.com/watch?v=-wS2IwWktNk www.youtube.com/watch?v=WpCjR8H65eA www.youtube.com/watch?v=jB_jsfAzHIU

n Share the pathway handbook with the team to help them understand what your training involves.

n Talk to all members of the practice team about your role and find out about their roles too so that you can work effectively together.

n Seek support from the senior clinical pharmacist or your GP clinical supervisor.

n You need to work on building rapport and a relationship with this person so whilst you might want to talk to someone else and ask them to intervene this could make things worse.

n Arrange to speak to the person and discuss your concerns and work together to try and resolve the issues; make sure you listen to their point of view.

n Speak to your practice manager for support.

n If unresolved speak to your education supervisor.

Engagement of GP practice team Suggested initial course of action with the pharmacist

Pathway handbook

22

Pharmacist has concerns that the scope and/or the quantity of work expected of them is unrealistic, unsafe or unachievable.

Pharmacist has concerns that their inexperience or unfamiliarity with the general practice environment is limiting their confidence and progress.

n Speak to the practice manager and your GP clinical supervisor.

n Use the clinical pharmacist role progression handbook to agree which roles you are able to undertake now and which you will work towards.

n Agree a training plan to develop your skills to take on new roles.

n If the quantity of work is too much review what you are currently doing. Are there things you could stop doing and delegate to someone else?

n If you have concerns about patient safety talk to your practice’s Freedom to Speak Up Guardian.

n Seek support from your senior clinical pharmacist.

Role and expectations of the pharmacist Recommended course of action within the practice

n Complete The fundamentals of general practice e-course.

n Arrange to spend some time shadowing your senior clinical pharmacist or another local practice pharmacist and other members of the general practice team.

Pharmacist has concerns that the practice is not supporting them to become patient facing.

n Use the guidance from the learning set on Developing your patient-facing role.

n Seek support from your senior clinical pharmacist, practice manager or GP clinical supervisor.

n Use the clinical pharmacist role progression handbook to agree how you can move into a patient-facing role starting with less complex patients.

Pharmacist has concerns that they are asked to get involved with signing all the repeat prescription requests for the practice; concerns about workload and signing prescriptions outside scope of practice.

n Explain your concerns to your GP clinical supervisor and/or practice manager. Be proactive and suggest that a more appropriate role would be for you to review the current systems and processes in place to increase efficiency and provide staff training to support these processes.

n Speak to your senior clinical pharmacist for advice.

Pharmacist is concerned that they are being asked to prescribe in areas outside their scope of practice.

n Explain your concerns to your GP clinical supervisor and/or practice manager regarding legal and safety implications of prescribing outside your scope of practice.

n Agree a plan with you GP clinical supervisor for how to develop competence and confidence to expand your scope of practice.

Pharmacist is concerned that they are being asked to focus on prescription management or cost-saving activities such as audit and switching which is preventing them from progressing to a patient-facing role.

n Speak to your GP clinical supervisor and practice manager about your concerns first to try to resolve the issue.

n Explain that the purpose of the NHS England programme is to develop clinical pharmacists in patient facing roles, eg, long-term conditions clinics.

n Ask for support from the senior clinical pharmacist.

Pathway handbook

23

Pharmacist has concerns that the GP clinical supervisor seems unable to allocate regular and protected time for reviewing progress and providing support.

Pharmacist has concerns about personal safety whilst in the practice.

n Speak to your GP clinical supervisor and practice manager about your concerns first to try to resolve the issue. Seek support from your senior pharmacist or education supervisor if the situation is not resolved.

Safe and effective clinical practice Recommended course of action

n Speak to your practice manager about your concerns first to try to resolve the issue. Seek support from your senior pharmacist or education supervisor if the situation is not resolved.

Pharmacist has concerns that workplace supervision is insufficient to develop competence and confidence or the process for seeking immediate advice about a patient during a consultation is unclear.

n Speak to your GP clinical supervisor and practice manager about your concerns first to try to resolve the issue. Seek support from your senior pharmacist or education supervisor if the situation is not resolved.

Pharmacist has concerns about or is aware of inappropriate behaviours by other practice members that could undermine professional confidence.

n Speak to your GP clinical supervisor and practice manager about your concerns first to try to resolve the issue.

n Seek support from your senior pharmacist or education supervisor if the situation is not resolved.

n Contact the whistleblowing helpline for support and advice: http://wbhelpline.org.uk.

n Contact the Freedom to Speak Up Guardian at your practice.

Pharmacist has concerns regarding a personal issue (such as their own or a family member’s health or relationship issue) that may affect their work or learning performance.

n Pharmacist self-referral to pharmacist support www.pharmacistsupport.org.

n Pharmacist self-referral to own GP.

n Seek support from your senior clinical pharmacist or education supervisor.

Pharmacist has concerns that the learning environment is not appropriate, eg, learning from critical incidents and near-misses is not shared openly and transparently.

Pharmacist has concerns regarding local opportunities within their training programme, eg, that they have limited access to multidisciplinary events or meetings at the practice.

n Speak to your GP clinical supervisor and practice manager about your concerns first to try to resolve the issue. Seek support from your senior pharmacist or education supervisor if the situation is not resolved.

Learning and development Recommended course of action

n Speak to your GP clinical supervisor and practice manager about your concerns first to try to resolve the issue. Seek support from your senior pharmacist or education supervisor if the situation is not resolved.

Pharmacist feels that they are falling behind with their learning.

n Seek advice from your education supervisor.

Pathway handbook

24 App

endi

x 1

– C

urri

culu

m f

or t

he C

linic

al p

harm

acis

ts in

gen

eral

pra

ctic

e ed

ucat

ion

prog

ram

me

Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

Kn

owin

g yo

urs

elf,

ge

ner

al p

ract

ice

and

re

lati

ng

to o

ther

s

Kn

owle

dge

for

th

is l

earn

ing

outc

ome

incl

ud

es a

n u

nd

erst

and

ing

of N

HS

str

uct

ure

an

d h

ow g

ener

al p

ract

ice

fits

in

to t

his

, th

e ro

le o

f p

har

mac

y re

gula

tors

an

d t

he

role

of

the

ph

arm

acis

t an

d o

ther

pro

fess

ion

als

wit

hin

th

e ge

ner

al p

ract

ice

team

. You

wil

l b

e ex

pec

ted

to

hav

e w

ritt

en a

nd

ver

bal

ski

lls

that

en

able

you

to

del

iver

eff

ecti

ve p

atie

nt

care

an

d s

ervi

ces.

You

wil

l kn

ow a

bou

t yo

ur

loca

l co

mm

un

ity

ph

arm

acy,

soc

ial

care

, an

d s

econ

dar

y an

d t

erti

ary

care

pro

vid

ers.

1. O

rien

tati

on t

o ge

ner

al p

ract

ice

Dem

onst

ratin

g kn

owle

dge

of G

P s

yste

ms

and

proc

esse

sD

emon

stra

tes

know

ledg

e of

the

gen

eral

pra

ctic

e co

ntra

ct f

ram

ewor

k an

d co

mm

issi

onin

g of

gen

eral

med

ical

ser

vice

s.

Iden

tifies

how

the

NH

S o

utco

mes

fra

mew

ork

and

care

out

of

hosp

ital i

s us

ed

to im

prov

e th

e qu

ality

of

care

in g

ener

al p

ract

ice.

Dem

onst

rate

s kn

owle

dge

of q

ualit

y dr

iver

s su

ch a

s th

e F

ive

year

for

war

d vi

ew r

epor

t1 an

d ne

w m

odel

s of

car

e in

nova

tion.

Iden

tifies

goo

d-qu

ality

rep

eat

pres

crib

ing

proc

esse

s an

d im

prov

e th

e lo

cal

repe

at p

resc

ribi

ng p

olic

y an

d pr

oces

s.

Dem

onst

rate

s ab

ility

to

use

Doc

man

, Pat

hlin

ks, t

empl

ates

and

oth

er p

ract

ice

IT s

yste

ms.

Est

ablis

hing

you

r po

sitio

n as

a m

embe

r of

the

gen

eral

pra

ctic

e te

am

Man

ages

for

mul

arie

s an

d ad

vise

s on

sof

twar

e to

sup

port

pre

scri

bing

de

cisi

ons.

Dem

onst

rate

s un

ders

tand

ing

of r

oles

and

res

pons

ibili

ties

for

each

mem

ber

of

the

gene

ral p

ract

ice

team

.

Inte

grat

es w

ith o

ther

mem

bers

of

the

mul

tidis

cipl

inar

y te

am, p

rovi

ding

en

hanc

ed p

atie

nt-c

entr

ed c

are.

Del

egat

es e

ffec

tivel

y.

Con

fiden

tly c

ontr

ibut

es t

o pr

actic

e m

eetin

gs.

Pathway handbook

25

2. C

omm

un

icat

ion

an

d c

onsu

ltat

ion

Est

ablis

hing

an

effe

ctiv

e pa

rtne

rshi

p w

ith p

atie

nts

and

care

rsA

dopt

s a

pers

on-c

entr

ed a

ppro

ach,

dem

onst

ratin

g ke

y co

nsul

tatio

n sk

ills

and

beha

viou

rs d

escr

ibed

in t

he n

atio

nal s

tand

ards

for

con

sulta

tion

skill

s.

Com

mun

icat

es w

ith a

wid

e va

riet

y of

pro

fess

iona

ls a

nd p

atie

nts

usin

g w

ritt

en

and

verb

al c

omm

unic

atio

n.

Can

exp

lain

and

dem

onst

rate

the

pri

ncip

les

of p

atie

nt-c

entr

ed c

are

and

shar

ed d

ecis

ion-

mak

ing,

incl

udin

g ex

plai

ning

ris

ks a

nd b

enefi

ts o

f tr

eatm

ents

to

pat

ient

s/ca

rers

in w

ays

mea

ning

ful t

o th

em.

App

lies

an o

pen

appr

oach

to

enco

urag

e ex

chan

ge o

f in

form

atio

n, e

stab

lish

unde

rsta

ndin

g an

d ex

plor

e pa

tient

’s id

eas,

con

cern

s an

d ex

pect

atio

ns.

Wor

ks in

par

tner

ship

with

pat

ient

s to

dis

cuss

opt

ions

. Whe

neve

r po

ssib

le,

adop

ts p

lans

tha

t re

spec

t th

e pa

tient

’s a

uton

omy.

Whe

n th

ere

is a

dif

fere

nce

of o

pini

on t

he p

atie

nt’s

aut

onom

y is

res

pect

ed a

nd a

pos

itive

rel

atio

nshi

p is

m

aint

aine

d.

Mai

ntai

ning

a c

ontin

uing

rel

atio

nshi

p w

ith

patie

nts,

car

ers

and

fam

ilies

Dem

onst

rate

s ab

ility

to

use

elec

tron

ic s

yste

ms

to g

ener

ate

lett

ers

to p

atie

nts

and

effe

ctiv

ely

com

mun

icat

e m

edic

al a

nd m

edic

ines

info

rmat

ion

in a

pa

tient

-cen

tred

man

ner.

Dem

onst

rate

s ab

ility

to

deci

de im

med

iate

tre

atm

ent

optio

ns, i

nclu

ding

re

ferr

al, a

nd n

egot

iate

with

the

pat

ient

reg

ardi

ng t

reat

men

t de

cisi

ons.

Sum

mar

ises

the

man

agem

ent

plan

(th

at h

as b

een

crea

ted

in p

artn

ersh

ip w

ith

the

patie

nt)

clea

rly

and

conc

isel

y. C

heck

s pa

tient

’s u

nder

stan

ding

of,

and

agre

emen

t to

the

pla

n.

Che

cks

patie

nt e

xpec

tatio

ns o

f ou

tcom

es a

nd n

ext

step

s. A

gree

s a

safe

ty-n

et

plan

and

ens

ures

all

patie

nt q

uest

ions

are

add

ress

ed.

Est

ablis

hes

bala

nced

equ

al d

iscu

ssio

ns t

o de

mon

stra

te p

artn

ersh

ip w

ith t

he

patie

nt in

con

sulta

tions

. Pat

ient

s ar

e en

gage

d th

roug

hout

con

sulta

tions

.

Dem

onst

rate

s ac

tive

liste

ning

ski

lls a

nd a

ppro

pria

te e

mpa

thy.

Out

com

es a

re

nego

tiate

d an

d pa

tient

-cen

tred

.

Pathway handbook

26 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

3. F

itn

ess

to p

ract

ise

Dem

onst

ratin

g at

titud

es a

nd b

ehav

iour

s ou

tline

d in

GP

hC

stan

dard

sD

emon

stra

tes

evid

ence

for

app

ropr

iate

pro

fess

iona

l ins

uran

ce a

nd li

abili

ty

cove

r.

Dem

onst

rate

s pa

tient

-cen

tred

pro

fess

iona

lism

.

Dem

onst

rate

s en

gage

men

t w

ith r

elev

ant

phar

mac

y pr

ofes

sion

al b

odie

s.

Adh

eres

to

info

rmat

ion

gove

rnan

ce p

olic

ies

and

proc

edur

es in

usi

ng

info

rmat

ion

and

com

mun

icat

ion.

App

lies

safe

guar

ding

chi

ldre

n an

d vu

lner

able

adu

lts’ p

rinc

iple

s.

Dem

onst

rate

s ab

ility

to

com

mun

icat

e in

a c

onfli

ct s

ituat

ion.

Man

ages

ris

k an

d im

plem

ents

cha

nge

to r

educ

e ri

sk a

nd p

rom

ote

a sa

fety

cul

ture

.

Mee

ts t

he p

rofe

ssio

nal s

tand

ards

set

out

by

the

GP

hC t

o en

able

reg

istr

atio

n to

pra

ctic

e as

an

inde

pend

ent

pres

crib

er.

Dem

onst

rate

s ab

ility

to

reso

lve

confl

ict,

repo

rt c

once

rns

and

deve

lop

w

hist

le-b

low

ing

polic

ies

for

the

prac

tice

or lo

calit

y.

Dem

onst

rate

s re

silie

nce

in p

rofe

ssio

nal s

ituat

ions

.

Man

agin

g th

e fa

ctor

s th

at in

fluen

ce y

our

perf

orm

ance

Iden

tifies

ow

n le

arni

ng n

eeds

, dev

elop

s cl

inic

al r

easo

ning

, adv

ance

s ow

n le

arni

ng t

o su

stai

n co

ntin

uing

pro

fess

iona

l dev

elop

men

t an

d w

orks

at

the

fore

fron

t of

the

pro

fess

ion.

Eng

ages

in p

eer

revi

ew.

Pri

oriti

ses

wor

kloa

ds a

nd n

egot

iate

s co

nflic

ting

resp

onsi

bilit

ies.

Man

ages

and

sur

vive

s ch

ange

.

Ap

ply

ing

clin

ical

kn

owle

dge

an

d s

kill

To

mee

t th

is l

earn

ing

outc

ome

you

wil

l h

ave

core

ph

ysic

al e

xam

inat

ion

, d

iagn

osti

c an

d p

atie

nt

mon

itor

ing

skil

ls.

1. D

ata

gath

erin

g an

d i

nte

rpre

tati

on

App

lyin

g a

stru

ctur

ed a

ppro

ach

to d

ata

gath

erin

g an

d in

vest

igat

ion

Ass

esse

s m

edic

ines

-rel

ated

que

stio

ns a

nd f

orm

ulat

es a

n an

swer

usi

ng

effe

ctiv

e co

mm

unic

atio

n.

Dem

onst

rate

s an

abi

lity

to t

ake

a cl

inic

al h

isto

ry u

sing

clin

ical

rea

soni

ng.

App

lies

info

rmat

ion

mas

tery

pri

ncip

les

to fi

ndin

g re

leva

nt a

nd v

alid

su

mm

arie

s of

hig

h-qu

ality

evi

denc

e.

Pathway handbook

27

Inte

rpre

ting

findi

ngs

accu

rate

ly t

o re

ach

a di

agno

sis

Use

s cl

inic

al r

easo

ning

to

deci

de im

med

iate

tre

atm

ent

optio

ns, i

nclu

ding

ap

prop

riat

e re

ferr

al, f

or c

omm

only

pre

sent

ing

cond

ition

s (i

nclu

ding

acu

te

and

long

-ter

m c

ondi

tions

) w

ithin

a r

ange

of

body

sys

tem

s.

Dem

onst

rate

s re

leva

nt d

iagn

ostic

ski

lls (

phys

ical

ass

essm

ent

tech

niqu

es,

ques

tioni

ng s

kills

, int

erpr

etat

ion

of n

orm

al a

nd a

bnor

mal

find

ings

, and

re

cogn

ition

of

com

mon

ly p

rese

ntin

g ac

ute

and

long

-ter

m c

ondi

tions

).

2. C

lin

ical

exa

min

atio

n a

nd

pro

ced

ura

l sk

ills

Dem

onst

ratin

g a

profi

cien

t ap

proa

ch t

o cl

inic

al a

sses

smen

tIn

tegr

ates

the

pri

ncip

les

of a

nato

my

and

path

ophy

siol

ogy

rele

vant

to

heal

th

prob

lem

s pr

esen

ting

in a

ran

ge o

f bo

dy s

yste

ms.

Con

trib

utes

to

urge

nt c

are

supp

ort

utili

sing

clin

ical

rea

soni

ng a

nd

exam

inat

ion

skill

s.

Mon

itors

med

ical

con

ditio

ns in

line

with

cur

rent

rec

omm

enda

tions

and

loca

l/na

tiona

l gui

danc

e.

Rec

ogni

ses

com

mon

ly p

rese

ntin

g co

nditi

ons,

bot

h ac

ute

and

long

-ter

m

cond

ition

s, in

a r

ange

of

body

sys

tem

s.

Dem

onst

rate

s ab

ility

to

mak

e a

clin

ical

ass

essm

ent

incl

udin

g in

pat

ient

gr

oups

whe

re c

omm

unic

atio

n m

ay b

e es

peci

ally

cha

lleng

ing.

Dem

onst

rate

s an

abi

lity

to p

erfo

rm a

n ex

amin

atio

n of

bod

y sy

stem

s in

ord

er

to m

anag

e a

rang

e of

med

ical

con

ditio

ns.

App

lies

the

prin

cipl

es o

f hy

gien

e an

d in

fect

ion

cont

rol i

n th

e cl

inic

al s

ettin

g.

Dem

onst

ratin

g a

profi

cien

t ap

proa

ch t

o th

e pe

rfor

man

ce o

f pr

oced

ures

Und

erst

ands

how

to

requ

est

and

inte

rpre

t pa

thol

ogy

repo

rts.

Und

erst

ands

how

to

requ

est

and

inte

rpre

t cl

inic

al b

ioch

emis

try.

Use

s ph

ysic

al a

sses

smen

t te

chni

ques

(in

spec

tion,

pal

patio

n, p

ercu

ssio

n an

d au

scul

tatio

n) a

nd a

pplie

s th

ese

to c

linic

al e

xam

inat

ion

of a

ran

ge o

f bo

dy

syst

ems.

Int

erpr

ets

norm

al a

nd a

bnor

mal

find

ings

on

phys

ical

exa

min

atio

n fo

r a

rang

e of

bod

y sy

stem

s.

Pathway handbook

28 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

3. M

akin

g d

ecis

ion

s

Dem

onst

ratin

g a

profi

cien

t ap

proa

ch t

o un

dert

akin

g m

edic

atio

n re

view

Dem

onst

rate

s un

ders

tand

ing

of t

he p

rinc

iple

s of

med

icat

ion

revi

ew a

nd t

he

evid

ence

for

med

icat

ion

revi

ew.

Iden

tifies

pat

ient

s w

ho w

ill b

enefi

t fr

om m

edic

atio

n re

view

.

Doc

umen

ts m

edic

atio

n re

view

and

app

ropr

iate

ly r

efer

s.

Com

plet

es a

str

uctu

red

clin

ical

med

icat

ion

revi

ew a

nd s

hare

s go

od p

ract

ice

with

oth

ers.

Pri

oriti

ses

med

icat

ion

revi

ew w

hen

a ne

w lo

ng-t

erm

con

ditio

n is

di

agno

sed,

fol

low

ing

an a

dver

se e

vent

and

whe

n m

ovin

g ca

re s

ettin

g.

Use

s cl

inic

al r

easo

ning

thr

ough

out

the

med

icat

ion

revi

ew p

roce

ss.

App

lies

med

icin

es o

ptim

isat

ion,

dep

resc

ribi

ng a

nd m

edic

ines

rec

onci

liatio

n to

impr

ove

patie

nt o

utco

mes

whe

n un

dert

akin

g m

edic

atio

n re

view

.

Mak

ing

appr

opri

ate

refe

rral

s to

sen

ior

colle

ague

s an

d se

ekin

g se

cond

opi

nion

sP

ract

ices

saf

ely,

app

ropr

iate

ly a

nd c

ost-

effe

ctiv

ely

as a

n in

depe

nden

t pre

scri

ber

Rec

ogni

ses

a si

tuat

ion

outs

ide

com

pete

nce

and

refe

rs p

atie

nts

appr

opri

atel

y w

ithin

the

mul

tidis

cipl

inar

y te

am, i

n a

timel

y m

anne

r an

d w

ith a

ppro

pria

te

safe

ty-n

ettin

g.

Ref

ers

patie

nts

to s

ervi

ces

and

othe

r pr

actit

ione

rs o

utsi

de t

he

mul

tidis

cipl

inar

y te

am a

s ap

prop

riat

e.

Dem

onst

ratin

g cl

inic

al r

easo

ning

and

judg

men

t, pr

oble

m s

olvi

ng

and

prio

ritis

atio

nD

evel

ops

a sy

stem

atic

, evi

denc

e-ba

sed

appr

oach

to

prac

tice.

Tak

es a

n ac

cura

te d

rug

hist

ory,

ass

esse

s ad

here

nce,

sup

port

s se

lf-c

are,

di

scus

ses

risk

s an

d be

nefit

s us

ing

deci

sion

aid

s as

app

ropr

iate

, neg

otia

tes

trea

tmen

t de

cisi

ons

and

disc

usse

s pr

ogno

sis.

Agr

ees

clin

ical

and

ref

erra

l pat

hway

s w

ith t

he G

P.

Use

s cl

inic

al r

easo

ning

to

asse

ss m

edic

ines

-rel

ated

que

stio

ns a

nd f

orm

ulat

e an

ans

wer

usi

ng e

ffec

tive

com

mun

icat

ion.

Iden

tifies

pat

ient

s w

ho w

ould

ben

efit

from

dep

resc

ribi

ng u

sing

clin

ical

to

ols

such

as

ST

OP

P/S

TA

RT

, inc

ludi

ng p

eopl

e ta

king

mul

tiple

med

icin

es

(pol

ypha

rmac

y), o

lder

peo

ple

and

peop

le w

ith lo

ng-t

erm

con

ditio

ns.

Dem

onst

rate

s ab

ility

to

nego

tiate

ten

sion

s be

twee

n co

st-e

ffec

tive

pres

crib

ing

and

med

icin

es o

ptim

isat

ion.

Und

erst

ands

and

app

lies

the

maj

or t

heor

ies

unde

rpin

ning

clin

ical

rea

soni

ng

in h

ealth

care

.

Pathway handbook

29

App

lyin

g an

evi

denc

e ba

sed

appr

oach

Und

erst

ands

and

app

lies

natio

nal d

rive

rs a

nd p

olic

y un

derp

inni

ng m

edic

ines

op

timis

atio

n.

Iden

tifies

and

app

lies

trus

ted

sour

ces

of e

vide

nce-

base

d in

form

atio

n to

pr

actic

e, u

sing

clin

ical

rea

soni

ng, i

nclu

ding

adv

ance

d kn

owle

dge

of e

vide

nce-

base

d tr

eatm

ent

to p

atie

nt c

are.

App

lies

the

prin

cipl

es o

f ev

iden

ce-b

ased

med

icin

es a

nd in

fluen

ces

the

mul

tidis

cipl

inar

y te

am t

o ap

ply

evid

ence

-bas

ed m

edic

ine

prin

cipl

es t

o pr

escr

ibin

g.

Rat

iona

lises

dru

g re

gim

ens

in li

ght

of c

linic

al in

dica

tors

and

rep

orte

d sy

mpt

oms

and

supp

orts

adh

eren

ce.

App

lies

evid

ence

-bas

ed m

edic

ine

prin

cipl

es t

o sp

ecifi

c pa

tient

s an

d po

pula

tions

to

impl

emen

t N

ICE

gui

delin

es, a

ct o

n au

dit

findi

ngs

and

redu

ce

vari

atio

n in

pre

scri

bing

.

Art

icul

ates

the

evi

denc

e ba

se f

or d

ecis

ions

and

neg

otia

tes

trea

tmen

t is

sues

w

hen

the

evid

ence

bas

e is

lack

ing,

con

flict

ing

or b

ased

on

opin

ion.

Influ

ence

s th

e m

ultid

isci

plin

ary

team

to

acce

ss t

rust

ed s

ourc

es o

f ev

iden

ce-

base

d in

form

atio

n.

Ass

urin

g an

timic

robi

al s

tew

ards

hip

Sup

port

s lo

cal i

mpl

emen

tatio

n of

the

UK

five

yea

r an

timic

robi

al r

esis

tanc

e st

rate

gy 2

013-

2018

2 in

clud

ing

taki

ng a

ctio

n to

opt

imis

e pr

escr

ibin

g pr

actic

e an

d im

prov

e pr

ofes

sion

al e

duca

tion

and

publ

ic e

ngag

emen

t.

Tak

es a

ctio

n to

red

uce

antim

icro

bial

res

ista

nce,

incl

udin

g pr

omot

ing

awar

enes

s of

pat

ient

s an

d pr

ofes

sion

als

abou

t ho

w t

o us

e an

tibio

tics

in a

re

spon

sibl

e w

ay.

Dem

onst

rate

s ab

ility

to

nego

tiate

pat

ient

exp

ecta

tions

and

influ

ence

pat

ient

s an

d co

lleag

ues

with

reg

ard

to a

ppro

pria

te u

se o

f an

tibio

tics

and

prom

otio

n of

se

lf-c

are.

Act

ivel

y pa

rtic

ipat

es o

r in

fluen

ces

the

mul

tidis

cipl

inar

y te

am t

o pa

rtic

ipat

e in

lo

cal p

resc

ribi

ng in

cent

ive

sche

mes

and

evi

denc

e-ba

sed

med

icin

e st

rate

gies

su

ppor

ting

med

icat

ion

revi

ew.

Pathway handbook

30 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

4. C

lin

ical

man

agem

ent

Pro

vidi

ng g

ener

al c

linic

al c

are

to a

ll ag

es a

nd b

ackg

roun

ds

incl

udin

g ca

re p

lann

ing

and

reco

rd k

eepi

ngU

ses

the

loca

l clin

ical

IT

sys

tem

to

acce

ss p

atie

nts’

clin

ical

rec

ords

, pra

ctic

ally

ap

plyi

ng k

now

ledg

e of

con

fiden

tialit

y, d

ata

prot

ectio

n, e

qual

ity a

nd d

iver

sity

, w

hist

le-b

low

ing

and

com

plai

nt-h

andl

ing.

Doc

umen

ts a

ctiv

ity in

the

clin

ical

sys

tem

in a

n ap

prop

riat

e fo

rmat

, usi

ng r

ead

code

s, a

vaila

ble

tem

plat

es a

nd f

ree

text

.

Sup

port

s po

sitiv

e ca

re p

lann

ing

for

curr

ent

and

futu

re h

ealth

nee

ds.

Dem

onst

rate

s ap

plic

atio

n of

tid

y an

d sa

fe p

atie

nt r

ecor

d m

anag

emen

t an

d tr

ains

indi

vidu

als

and

smal

l gro

ups

in p

atie

nt r

ecor

d m

anag

emen

t.

Doc

umen

ts a

ctiv

ity r

elev

ant

to t

he q

ualit

y an

d ou

tcom

es f

ram

ewor

k (Q

OF

) an

d ac

cura

tely

rec

ord

info

rmat

ion

usin

g re

ad c

odes

.

Pro

mot

es r

atio

nal a

nd p

ragm

atic

use

of

diag

nost

ic t

estin

g an

d m

anag

es

patie

nt e

xpec

tatio

ns, e

spec

ially

in p

eopl

e ov

er 7

5 ye

ars.

Ado

ptin

g a

stru

ctur

ed a

ppro

ach

to c

linic

al m

anag

emen

tA

bilit

y to

run

sea

rche

s to

iden

tify

grou

ps o

f pa

tient

s w

ith a

med

ical

con

ditio

n or

tak

ing

a sp

ecifi

c m

edic

ine.

Dem

onst

rate

s a

stru

ctur

ed p

roce

ss f

or u

nder

taki

ng m

edic

atio

n re

view

.

Dem

onst

rate

s ab

ility

to

use

prac

tice

syst

ems

to o

btai

n in

form

atio

n an

d do

cum

ent

cons

ulta

tions

.

Iden

tifies

red

flag

s an

d ag

rees

ref

erra

l pat

hway

s w

ith G

P.

Cle

ar e

xplo

ratio

n of

pat

ient

’s a

gend

a w

hich

is in

corp

orat

ed a

nd b

alan

ced

with

the

pha

rmac

ist’s

age

nda

for

the

cons

ulta

tion.

Cle

arly

str

uctu

res

cons

ulta

tions

and

sum

mar

ises

to

guid

e th

e di

scus

sion

w

hils

t al

low

ing

flexi

bilit

y fo

r th

e pa

tient

’s a

gend

a.

Mak

ing

appr

opri

ate

use

of o

ther

pro

fess

iona

ls a

nd s

ervi

ces

Dem

onst

rate

s ab

ility

to

nego

tiate

issu

es o

r re

ques

ts b

etw

een

the

GP

sur

gery

an

d ho

spita

l dep

artm

ents

.

Dem

onst

rate

s ac

tive

part

icip

atio

n in

dev

elop

men

t of

sta

ndar

d op

erat

ing

proc

edur

es a

nd/o

r gu

idel

ines

.

Dem

onst

rate

s ab

ility

to

activ

ely

wor

k w

ith lo

cal c

omm

on c

ondi

tion

serv

ices

an

d si

gnpo

st t

o ot

her

loca

l hea

lth p

rom

otio

n/ot

her

rele

vant

ser

vice

s, w

ith

appr

opri

ate

safe

ty-n

ettin

g.

Pathway handbook

31

Wor

king

as

a sa

fe a

nd e

ffec

tive

pres

crib

erD

emon

stra

tes

abili

ty t

o id

entif

y an

d ap

ply

the

feat

ures

of

good

-qua

lity

pres

crib

ing.

Act

s as

a n

on-m

edic

al p

resc

ribe

r an

d pr

escr

ibes

with

in c

ompe

tenc

y.

Dem

onst

rate

s un

ders

tand

ing

of t

he r

egul

atio

ns r

egar

ding

pre

scri

bers

and

pr

escr

ibin

g.

Pro

mot

es s

afe

elec

tron

ic p

resc

ribi

ng.

Dem

onst

rate

s un

ders

tand

ing

of p

roce

sses

and

reg

ulat

ions

for

con

trol

led

drug

s pr

escr

iptio

ns a

nd in

fluen

ces

proc

esse

s fo

r sa

fe a

nd le

gal c

ontr

olle

d dr

ugs

stor

age.

Dem

onst

rate

s ab

ility

to

nego

tiate

req

uest

s fr

om p

atie

nts

for

med

icin

es t

hat

are

clin

ical

ly u

nnec

essa

ry o

r no

t re

com

men

ded

for

NH

S p

resc

ribi

ng.

Act

s as

an

inde

pend

ent

pres

crib

er, p

resc

ribe

s w

ithin

agr

eed

loca

l for

mul

arie

s an

d ap

plie

s a

pers

onal

for

mul

ary

for

com

mon

con

ditio

n pr

escr

ibin

g, a

gree

d w

ith t

he G

P.

Dem

onst

rate

s ab

ility

to

appl

y na

tiona

l and

loca

l gui

delin

es t

o pr

escr

ibin

g an

d re

com

men

datio

ns f

or c

omm

on c

ondi

tions

.

Pathway handbook

32 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

Man

agin

g co

mp

lex

an

d l

ong-

term

car

eY

ou u

nd

erst

and

dis

ease

sta

te m

onit

orin

g fo

r lo

ng-

term

con

dit

ion

s, a

dvi

sin

g on

evi

den

ce-b

ased

tre

atm

ent.

You

id

enti

fy a

nd

m

anag

e lo

ng-

term

con

dit

ion

s fo

r sp

ecifi

c p

atie

nts

, eg

, th

ose

wit

h m

ult

imor

bid

ity,

an

d p

atie

nt

grou

ps,

eg,

old

er p

eop

le,

chil

dre

n

or t

hos

e w

ith

a m

enta

l h

ealt

h c

ond

itio

n. Y

ou a

dvi

se o

n m

anag

emen

t an

d/o

r av

oid

ance

of

dru

g in

tera

ctio

ns

and

ad

vers

e d

rug

reac

tion

s in

sp

ecifi

c p

atie

nts

.

1. M

anag

ing

com

ple

xity

, m

ult

imor

bid

ity

and

pol

yph

arm

acy

Ena

blin

g pe

ople

livi

ng w

ith lo

ng-t

erm

con

ditio

ns t

o im

prov

e th

eir

heal

thP

artic

ipat

es in

pro

fess

iona

l col

labo

ratio

n an

d lo

ng-t

erm

con

ditio

ns

impr

ovem

ent

prog

ram

me.

Adv

ises

on

the

evid

ence

-bas

ed t

reat

men

t of

long

-ter

m c

ondi

tions

.

Dem

onst

rate

s th

e ab

ility

to

invo

lve

patie

nts

in p

athw

ay d

esig

n.

Con

trib

utes

to

enha

ncin

g th

e qu

ality

of

life

for

peop

le li

ving

with

long

-ter

m

cond

ition

s.

Iden

tifies

and

man

ages

spe

cific

pat

ient

s w

ith lo

ng-t

erm

con

ditio

ns.

Dem

onst

rate

s un

ders

tand

ing

of d

isea

se s

tate

mon

itori

ng f

or lo

ng-t

erm

co

nditi

ons.

Man

agin

g co

ncur

rent

hea

lth p

robl

ems

with

in a

n in

divi

dual

pa

tient

Dem

onst

rate

s ab

ility

to

iden

tify

and

man

age

long

-ter

m c

ondi

tions

for

spe

cific

pa

tient

s w

ith m

ultim

orbi

dity

.

Adv

ises

on

the

man

agem

ent

and/

or a

void

ance

of

drug

inte

ract

ions

and

ad

vers

e dr

ug r

eact

ions

in p

atie

nts

with

con

curr

ent

heal

th p

robl

ems.

Ado

ptin

g sa

fe a

nd e

ffec

tive

appr

oach

es f

or p

atie

nts

with

co

mpl

ex n

eeds

Dem

onst

rate

s sa

fe a

nd e

ffec

tive

com

mun

icat

ion

and

clin

ical

rea

soni

ng s

kills

to

impr

ove

the

man

agem

ent

of c

ompl

ex p

atie

nts.

Suc

cess

fully

neg

otia

tes

com

plex

tre

atm

ent

issu

es w

ith p

atie

nts

and

the

mul

tidis

cipl

inar

y te

am.

Sup

port

ing

patie

nts

in li

ne w

ith N

HS

pri

oriti

es, e

g, le

arni

ng

disa

bilit

ies,

dem

entia

, dia

bete

s, e

nd-o

f-lif

e ca

re, c

ance

r an

d m

enta

l hea

lth

Dem

onst

rate

s th

e ab

ility

to

com

plet

e a

men

tal h

ealth

ass

essm

ent.

Pro

mot

es m

edic

atio

n re

view

of

psyc

hotr

opic

med

icat

ion

for

peop

le w

ith

lear

ning

dis

abili

ties.

Dem

onst

rate

s ab

ility

to

liais

e w

ith t

he s

peci

alis

t ps

ychi

atri

st a

nd m

enta

l he

alth

pha

rmac

y ne

twor

k re

gard

ing

psyc

hotr

opic

pre

scri

bing

for

peo

ple

with

le

arni

ng d

isab

ilitie

s.

Pathway handbook

33

Pro

mot

es a

ppro

pria

te u

se o

f an

tipsy

chot

ics

in d

emen

tia a

nd r

evie

ws

antip

sych

otic

pre

scri

bing

in p

artn

ersh

ip w

ith t

he m

ultid

isci

plin

ary

team

and

so

cial

car

e.

Pri

oriti

ses

revi

ew o

f ke

y m

edic

ine

issu

es a

risi

ng f

rom

nat

iona

l or

loca

l pol

icy

or r

esea

rch.

Dem

onst

rate

s ab

ility

to

iden

tify

and

man

age

long

-ter

m c

ondi

tions

in s

peci

fic

grou

ps o

f pa

tient

s, f

or e

xam

ple,

old

er p

eopl

e, c

hild

ren

or t

hose

with

a m

enta

l he

alth

con

ditio

n.

2. W

orki

ng

wit

h c

olle

agu

es a

nd

in

tea

ms

Wor

king

as

an e

ffec

tive

team

mem

ber

Dev

elop

s re

latio

nshi

ps w

ith t

he w

ider

mul

tidis

cipl

inar

y te

am a

nd p

rom

otes

ne

twor

king

opp

ortu

nitie

s.

Par

ticip

ates

in p

eer

revi

ew a

nd o

ffer

s su

ppor

tive

feed

back

to

othe

rs.

Dem

onst

rate

s ac

tive

part

icip

atio

n in

car

e-pl

anni

ng a

nd c

o-or

dina

tion

with

th

e m

ultid

isci

plin

ary

team

.

Ens

urin

g a

team

-bas

ed a

ppro

ach

to t

he c

are

of p

atie

nts

Dem

onst

rate

s ef

fect

ive

team

wor

king

and

the

pro

mot

ion

of s

kill

mix

.

Sup

port

s th

e m

ultid

isci

plin

ary

team

to

impr

ove

med

icat

ion

revi

ew.

Eva

luat

es a

nd m

akes

rec

omm

enda

tions

for

impr

ovin

g lo

cal r

epea

t pr

escr

ibin

g an

d re

peat

dis

pens

ing

base

d on

goo

d pr

actic

e pr

inci

ples

, aim

ing

to p

rom

ote

adhe

renc

e an

d pa

tient

-cen

tred

sys

tem

s.

Dem

onst

rate

s ab

ility

to

diss

emin

ate

good

pra

ctic

e in

sha

red

deci

sion

-mak

ing

with

the

mul

tidis

cipl

inar

y te

am.

Dem

onst

rate

s ac

tive

part

icip

atio

n in

mul

tidis

cipl

inar

y te

am m

eetin

gs,

disc

ussi

ng e

vide

nce-

base

d tr

eatm

ents

.

Dem

onst

rate

s ab

ility

to

liais

e w

ith c

olle

ague

s to

impr

ove

loca

l pat

hway

s of

ca

re a

nd im

prov

e pa

tient

car

e an

d ou

tcom

es.

Dem

onst

rate

s a

mul

tidis

cipl

inar

y te

am a

ppro

ach

to im

prov

ing

outc

omes

for

pe

ople

who

tak

e m

ultip

le m

edic

ines

(po

lyph

arm

acy)

and

hav

e lo

ng-t

erm

co

nditi

ons.

Del

iver

s m

edic

atio

n re

view

s in

car

e ho

mes

invo

lvin

g th

e re

side

nt/f

amily

m

embe

r/ca

rer

and

a te

am o

f he

alth

and

soc

ial c

are

prac

titio

ners

.

Pathway handbook

34 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

Wor

kin

g w

ell

in

orga

nis

atio

ns

and

sy

stem

s of

car

e

Fu

nd

amen

tal

know

led

ge o

f th

is l

earn

ing

outc

ome

incl

ud

es k

now

led

ge o

f au

dit

an

d f

orm

ula

ries

, p

olic

y an

d g

uid

ance

. It

als

o in

clu

des

com

mu

nic

atio

n t

o G

P p

ract

ice

and

ext

ern

al p

artn

ers

and

th

e w

orki

ng

pri

nci

ple

s of

ed

uca

tion

an

d s

afet

y.

1. M

ain

tain

ing

per

form

ance

, le

arn

ing

and

tea

chin

g

Con

tinuo

usly

eva

luat

ing

and

impr

ovin

g th

e ca

re y

ou p

rovi

deD

emon

stra

tes

know

ledg

e of

how

pre

scri

bing

dat

a is

pro

duce

d an

d th

e st

reng

ths

and

limita

tions

of

the

data

.

Acc

esse

s pr

actic

e-sp

ecifi

c pr

escr

ibin

g da

ta, i

nter

roga

tes

the

data

acc

urat

ely,

an

d us

es t

he d

ata

to id

entif

y pr

iori

ties

for

impr

ovin

g pr

escr

ibin

g an

d pa

tient

ca

re.

Dem

onst

rate

s un

ders

tand

ing

of t

he a

udit

cycl

e an

d de

rive

s cr

iteri

a an

d st

anda

rds

from

goo

d-qu

ality

gui

delin

es.

Pro

mot

es c

ost-

effe

ctiv

e us

e of

hea

lth r

esou

rces

and

und

erst

ands

the

ph

arm

acoe

cono

mic

s of

med

icin

es t

hat

unde

rpin

s N

ICE

rec

omm

enda

tions

.

Sup

port

s G

P a

udit

activ

ity.

Lea

ds q

ualit

y im

prov

emen

t in

res

pons

e to

aud

it an

d lo

cal/n

atio

nal p

rior

ities

.

Dem

onst

rate

s ef

fect

ive

deci

sion

-mak

ing,

incl

udin

g ta

king

fee

dbac

k fr

om

stak

ehol

ders

.

Ado

ptin

g a

safe

and

sci

entifi

c ap

proa

ch t

o im

prov

e qu

ality

of

care

Cho

oses

app

ropr

iate

aud

it to

pics

bas

ed o

n na

tiona

l gui

delin

es, h

igh-

risk

, hi

gh-v

olum

e or

loca

l pri

oriti

es.

Ove

rcom

es lo

cal b

arri

ers

to c

hang

e an

d su

ppor

ts s

ervi

ce im

prov

emen

t.

Influ

ence

s or

gani

satio

nal c

hang

e w

ith r

espe

ct t

o in

itiat

ives

suc

h as

key

th

erap

eutic

top

ics

and

supp

ortin

g pa

tient

acc

ess

to c

linic

ally

app

ropr

iate

m

edic

ines

app

rove

d by

the

Nat

iona

l Ins

titut

e fo

r H

ealth

and

Car

e E

xcel

lenc

e (N

ICE

).

Dem

onst

rate

s ab

ility

to

iden

tify

patie

nts

at r

isk

of d

rug-

rela

ted

adm

issi

ons

and

influ

ence

s th

e m

ultid

isci

plin

ary

team

act

ivity

to

redu

ce d

rug-

rela

ted

adm

issi

ons.

Dem

onst

rate

s ab

ility

to

desi

gn a

nd u

nder

take

aud

its a

gain

st n

atio

nal

stan

dard

s, e

valu

ate

chan

ge a

gain

st b

asel

ine

and

pers

uade

or

influ

ence

the

m

ultid

isci

plin

ary

team

to

impr

ove

prac

tice.

Pathway handbook

35

Sup

port

ing

the

educ

atio

n an

d de

velo

pmen

t of

col

leag

ues

Del

iver

s ed

ucat

ion

and

trai

ning

abo

ut r

epea

t pr

escr

ibin

g m

anag

emen

t fo

r cl

inic

al a

nd n

on-c

linic

al s

taff

.

Del

iver

s ed

ucat

ion

and

trai

ning

abo

ut s

afe

and

effe

ctiv

e m

edic

ines

use

for

th

e ge

nera

l pra

ctic

e te

am.

Con

side

rs d

iffe

rent

lear

ning

sty

les

and

uses

app

ropr

iate

tec

hniq

ues

and

tech

nolo

gies

to

addr

ess

diff

eren

t le

arni

ng s

tyle

s w

hen

deliv

erin

g ed

ucat

ion.

Dem

onst

rate

s ab

ility

to

pres

ent

to s

mal

l and

med

ium

-siz

ed g

roup

s of

pr

ofes

sion

als

usin

g ef

fect

ive

verb

al a

nd v

isua

l pre

sent

atio

n sk

ills.

Dem

onst

rate

s ab

ility

to

deliv

er e

duca

tion

for

indi

vidu

als

and

smal

l gro

ups

to im

prov

e sy

stem

s an

d pr

actic

e.

Dem

onst

rate

s or

gani

satio

nal r

espo

nsib

ility

for

the

med

icin

es r

econ

cilia

tion

proc

ess

and

offe

rs e

duca

tion

and

trai

ning

to

supp

ort

othe

r co

mpe

tent

hea

lth

prof

essi

onal

s to

del

iver

qua

lity

med

icin

es r

econ

cilia

tion.

Is s

ough

t as

an

expe

rt t

o ad

vise

the

mul

tidis

cipl

inar

y te

am a

bout

med

icin

es-

rela

ted

ques

tions

.

Invi

tes

and

acts

on

feed

back

.

Dem

onst

rate

s ab

ility

to

men

tor

othe

rs.

2. O

rgan

isat

ion

, m

anag

emen

t an

d l

ead

ersh

ip

App

lyin

g le

ader

ship

ski

lls t

o im

prov

e yo

ur o

rgan

isat

ion’

s pe

rfor

man

ceIn

fluen

ces

the

gene

ral p

ract

ice

team

with

res

pect

to

orga

nisa

tiona

l cha

nge,

pr

escr

ibin

g de

cisi

ons

and

impl

emen

tatio

n of

the

sev

en p

rinc

iple

s of

m

edic

ines

opt

imis

atio

n.3

Dem

onst

rate

s ab

ility

to

prod

uce

wri

tten

bus

ines

s ca

ses

and

activ

ely

part

icip

ate

in im

plem

entin

g ch

ange

and

ser

vice

dev

elop

men

t.

Dem

onst

rate

s ac

tive

invo

lvem

ent

in s

trat

egic

dec

isio

ns a

bout

med

icin

es a

nd

deve

lopi

ng c

are

path

way

s th

at in

volv

e m

edic

ines

use

.

Dem

onst

rate

s aw

aren

ess

of t

he a

rea

pres

crib

ing

com

mitt

ee a

nd u

ses

its

deci

sion

s ro

utin

ely

to in

form

pra

ctic

e an

d sh

are

with

col

leag

ues.

Rai

ses

awar

enes

s of

red

am

ber

gree

n (R

AG

) or

equ

ival

ent

sche

mes

and

are

a fo

rmul

arie

s in

fluen

cing

ado

ptio

n in

pra

ctic

e.

Dem

onst

rate

s ab

ility

to

man

age

proj

ects

with

in t

he p

ract

ice

and

the

loca

lity.

Pathway handbook

36 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

Mak

ing

effe

ctiv

e us

e of

info

rmat

ion

and

com

mun

icat

ion

syst

ems

Acc

esse

s lo

cal i

nfor

mat

ion

rela

ting

to f

orm

ular

ies

and

med

icin

es a

ppro

ved

for

use.

Cre

ates

eff

ectiv

e co

mm

unic

atio

n ch

anne

ls w

ith c

omm

unity

pha

rmac

y,

incl

udin

g pa

tient

ref

erra

ls.

Pro

mot

es a

nd f

acili

tate

s th

e ro

le o

f co

mm

unity

pha

rmac

y an

d su

ppor

ts

refe

rral

s fo

r co

ntra

ctua

l and

add

ition

al s

ervi

ces.

Dem

onst

rate

s ab

ility

to

pers

uade

or

influ

ence

usi

ng a

cade

mic

det

ailin

g an

d so

cial

mar

ketin

g.

App

ropr

iate

ly r

efer

s m

edic

ines

info

rmat

ion

enqu

irie

s to

UK

med

icin

es

info

rmat

ion

and

supp

orts

com

mun

ity p

harm

acy

to a

ppro

pria

tely

acc

ess

info

rmat

ion.

Co-

ordi

natin

g m

edic

ines

opt

imis

atio

n ac

ross

the

pha

rmac

y se

ctor

sD

eter

min

es w

hich

pat

ient

s an

d w

hich

med

icin

es a

re s

uita

ble

for

repe

at

disp

ensi

ng.

Dem

onst

rate

s ab

ility

to

desc

ribe

the

pri

ncip

les

of m

edic

ines

rec

onci

liatio

n an

d to

app

ly t

his

to p

atie

nts

tran

sfer

red

acro

ss a

n in

terf

ace,

for

exa

mpl

e,

disc

harg

ed f

rom

hos

pita

l.

Dem

onst

rate

s w

orki

ng a

cros

s th

e in

terf

ace

to b

uild

rel

atio

nshi

ps a

nd s

hare

in

form

atio

n pl

ans

and

reso

urce

s w

ith o

ther

pha

rmac

y pr

ofes

sion

als.

Dem

onst

rate

s ab

ility

to

nego

tiate

issu

es o

r re

ques

ts w

ith h

ospi

tal p

harm

acy

team

s.

Com

plet

es m

edic

ines

rec

onci

liatio

n fo

r sp

ecifi

c pa

tient

s w

hen

they

tra

nsfe

r be

twee

n ca

re s

ettin

gs in

a t

imel

y m

anne

r an

d ta

kes

actio

n to

impr

ove

adhe

renc

e.

Dem

onst

rate

s ab

ility

to

wor

k w

ithin

exi

stin

g ne

twor

ks o

r cr

eate

a p

rofe

ssio

nal

netw

ork

to s

uppo

rt m

edic

ines

opt

imis

atio

n.

Dem

onst

rate

s un

ders

tand

ing

of t

he li

mita

tions

of

Scr

ipts

witc

h an

d eq

uiva

lent

sc

hem

es a

nd n

egot

iate

s te

nsio

ns w

ith t

he m

edic

ines

opt

imis

atio

n ag

enda

.

Dem

onst

rate

s ab

ility

to

influ

ence

and

impl

emen

t in

itiat

ives

to

redu

ce w

aste

.

Pathway handbook

37

Lea

ding

on

med

icin

es s

afet

yD

emon

stra

tes

know

ledg

e of

mon

itori

ng r

equi

red

for

com

mon

and

hig

h-ri

sk

med

icin

es.

Influ

ence

s go

od-q

ualit

y pr

escr

ibin

g an

d sa

fe a

nd e

ffec

tive

repe

at p

resc

ribi

ng.

Mon

itors

med

icin

es in

clud

ing

iden

tifyi

ng h

igh-

risk

dru

gs a

nd s

hare

d ca

re

mon

itori

ng.

Cre

ates

pro

cedu

res

for

casc

ade

to t

he m

ultid

isci

plin

ary

team

and

act

ion

requ

ired

by

drug

saf

ety

upda

tes

and

natio

nal p

atie

nt s

afet

y al

erts

, with

in

spec

ified

or

loca

lly a

gree

d tim

efra

mes

and

pro

mot

es a

saf

ety

cultu

re.

Dem

onst

rate

s a

wor

king

kno

wle

dge

of s

hare

d ca

re a

gree

men

ts a

nd e

ffec

tivel

y su

ppor

ts im

plem

enta

tion.

Dem

onst

rate

s th

e ab

ility

to

advi

se a

bout

the

saf

e pr

escr

ibin

g, p

rocu

rem

ent,

supp

ly a

nd u

se o

f sp

ecia

ls a

nd a

dvis

es o

n ch

oice

of

high

-qua

lity

spec

ials

tha

t ar

e ap

prop

riat

e to

pat

ient

nee

ds a

nd c

ost-

effe

ctiv

e.

Dem

onst

rate

s ab

ility

to

advi

se o

n pa

tient

saf

ety

incl

udin

g re

gard

ing

reca

lls,

audi

ts a

nd in

cide

nt r

ecor

ding

and

adv

ise

on a

ppro

pria

te s

yste

ms

to p

rom

ote

a sa

fety

cul

ture

, for

exa

mpl

e, D

atix

or

equi

vale

nt.

Lea

ds im

plem

enta

tion

of p

roce

sses

to

iden

tify,

rep

ort,

prio

ritis

e, in

vest

igat

e an

d le

arn

from

med

icin

es-r

elat

ed s

afet

y in

cide

nts

loca

lly.

Dem

onst

rate

s ab

ility

to

man

age

intr

oduc

tion

of n

ew m

edic

ines

saf

ely

and

in

line

with

NIC

E r

ecom

men

datio

ns a

nd lo

cal g

uida

nce.

Ass

esse

s th

e tr

aini

ng n

eeds

of

the

mul

tidis

cipl

inar

y te

am t

o he

lp p

atie

nts

and

prac

titio

ners

to

iden

tify

and

repo

rt m

edic

ines

-rel

ated

pat

ient

saf

ety

inci

dent

s an

d ob

tain

reg

ular

fee

dbac

k on

pro

gres

s.

Pathway handbook

38 Lea

rnin

g ou

tcom

e C

ore

cap

abil

itie

s an

d c

omp

eten

ces

Des

crip

tion

Car

ing

for

the

wh

ole

per

son

an

d t

he

wid

er

com

mu

nit

y

Th

is l

earn

ing

outc

ome

is u

nd

erp

inn

ed b

y th

e u

nd

erst

and

ing

of t

he

imp

orta

nt

role

th

at g

ener

al p

ract

ice

pla

ys i

n s

up

por

tin

g an

d

del

iver

ing

the

pre

ven

tion

an

d p

ub

lic

hea

lth

age

nd

a. I

t re

lies

on

th

e ab

ilit

y to

com

mu

nic

ate

acro

ss b

oun

dar

ies

bet

wee

n h

ealt

h a

nd

so

cial

car

e.

1. P

ract

isin

g h

olis

tica

lly

and

pro

mot

ing

hea

lth

Dem

onst

ratin

g a

holis

tic m

inds

etU

nder

stan

ds t

he im

port

ant

role

tha

t ge

nera

l pra

ctic

e pl

ays

in s

uppo

rtin

g an

d de

liver

ing

the

prev

entio

n an

d pu

blic

hea

lth a

gend

a.

Dem

onst

rate

s ab

ility

to

com

mun

icat

e ac

ross

bou

ndar

ies

betw

een

heal

th a

nd

soci

al c

are.

Act

ivel

y en

cour

ages

and

hel

ps p

eopl

e to

mak

e he

alth

ier

choi

ces

to a

chie

ve

long

-ter

m b

ehav

iour

cha

nge

(usi

ng M

akin

g E

very

Con

tact

Cou

nt a

ppro

ach)

.

Res

earc

hes

prac

tice

popu

latio

n de

mog

raph

ics

and

dise

ase

prev

alen

ce.

Dem

onst

rate

s ab

ility

to

iden

tify

the

psyc

holo

gica

l asp

ects

of

long

-ter

m

cond

ition

s an

d of

fer

a ho

listic

ass

essm

ent.

Use

s a

holis

tic a

ppro

ach

to e

xplo

re a

nd d

iscu

ss a

ll ex

tern

al f

acto

rs w

hich

may

in

fluen

ce h

ealth

and

med

icin

es u

se.

Sup

port

ing

peop

le t

hrou

gh e

xper

ienc

es o

f he

alth

, illn

ess

and

reco

very

Del

iver

s pu

blic

hea

lth in

terv

entio

ns t

o su

ppor

t th

e he

alth

and

wel

lbei

ng o

f pa

tient

s an

d th

e pu

blic

.

Dem

onst

rate

s ab

ility

to

refle

ct o

n pa

tient

-cen

tred

car

e an

d su

ppor

t pa

tient

s to

ach

ieve

bet

ter

outc

omes

.

Del

iver

s pe

rson

alis

ed c

are

whi

ch u

nder

stan

ds a

nd s

uppo

rts

the

indi

vidu

al a

s an

exp

ert

in t

heir

con

ditio

n.

Dem

onst

rate

s ab

ility

to

offe

r su

ppor

t an

d re

sour

ces

from

cha

ritie

s an

d pa

tient

gro

ups.

Pro

mot

es a

co-

ordi

nate

d se

rvic

e de

liver

ing

cons

iste

ntly

saf

e an

d hi

gh

stan

dard

s of

car

e.

Pathway handbook

39

2. C

omm

un

ity

orie

nta

tion

Ens

urin

g m

edic

ines

opt

imis

atio

n ac

ross

you

r lo

cal c

omm

unity

, in

clud

ing

care

hom

esD

emon

stra

tes

unde

rsta

ndin

g of

the

ter

m m

edic

ines

opt

imis

atio

n an

d ho

w

this

can

be

used

to

impr

ove

patie

nt o

utco

mes

rel

atin

g to

med

icin

es.

Sup

port

s sy

stem

s fo

r m

onito

ring

med

icin

es p

resc

ribe

d un

der

shar

ed c

are

prot

ocol

s.

Dem

onst

rate

s kn

owle

dge

of t

he r

ole

of c

omm

unity

pha

rmac

y in

med

icin

es

optim

isat

ion.

Dem

onst

rate

s ab

ility

to

man

age

pres

crip

tion

accu

racy

and

hos

pita

l let

ters

an

d ad

dres

s pr

oble

ms

rais

ed d

urin

g m

edic

ines

rec

onci

liatio

n.

Pro

mot

es a

nd e

mbe

ds t

he r

ole

of p

harm

acis

ts in

car

e ho

mes

, with

ove

rall

resp

onsi

bilit

y an

d ac

coun

tabi

lity

for

med

icin

es a

nd t

heir

use

.

Sup

port

s co

mm

unity

pha

rmac

y in

its

role

to

trai

n ca

re h

ome

prov

ider

s to

de

liver

saf

e m

anag

emen

t an

d ad

min

istr

atio

n of

med

icin

es a

nd r

educ

e w

aste

.

Dem

onst

rate

s pa

rtic

ipat

ion

in d

omic

iliar

y an

d ca

re h

ome

visi

ts, e

ffec

tivel

y w

orki

ng w

ith s

ocia

l car

e an

d th

e m

ultid

isci

plin

ary

team

.

Dem

onst

rate

s ab

ility

to

iden

tify

any

impa

ct o

n lo

cal p

rovi

sion

of

care

re

gard

ing

spec

ialis

ed s

ervi

ces

deliv

ery.

Act

ivel

y pa

rtic

ipat

es in

the

NH

S E

ngla

nd m

edic

ines

opt

imis

atio

n pr

ogra

mm

e.

Bui

ldin

g re

latio

nshi

ps w

ith t

he c

omm

uniti

es in

whi

ch y

ou w

ork

Dem

onst

rate

s ef

fect

ive

wor

king

acr

oss

the

inte

rfac

e an

d w

ith o

ther

car

e pr

ovid

ers

such

as

care

hom

es.

Sup

port

s an

d si

gnpo

sts

to o

ther

loca

l pub

lic h

ealth

ser

vice

s vi

a he

alth

care

pr

ovid

ers

such

as

com

mun

ity p

harm

acy.

Dem

onst

rate

s un

ders

tand

ing

of t

he s

ervi

ces,

clin

ics

and

spec

ialti

es e

xist

ing

in a

loca

l gen

eral

pra

ctic

e an

d th

e ne

twor

k of

hea

lthca

re p

rofe

ssio

nals

and

se

rvic

es in

a lo

calit

y.

Dem

onst

rate

s pa

rtic

ipat

ion

in d

evel

opin

g in

itiat

ives

with

com

mun

ity

phar

mac

y an

d pr

omot

ing

new

way

s to

del

iver

car

e to

impr

ove

acce

ss,

outc

omes

and

qua

lity.

Pro

mot

es t

he p

rofe

ssio

nal r

ole

of p

harm

acis

ts in

the

wid

er h

ealth

care

en

viro

nmen

t.

Insp

ires

and

man

ages

the

loca

l tea

m, u

tilis

ing

a co

llabo

rativ

e le

ader

ship

ap

proa

ch.

Pathway handbook

40

Appendix 2 – Personal development planning

What is a personal development plan?A personal development plan (PDP) is “a structured and supported process undertaken by an individual to reflect upon their own learning, performance and/or achievement and to plan for their personal, educational and career development”.7

The purpose of the PDP is to encourage you to develop and plan for the future by becoming more aware of your capabilities and the opportunities around you. You will create a PDP at the start and end of the learning pathway and another PDP at the end of the pathway as part of your statement of assessment and progression.

The personal development planning cycle

Self-evaluation: where am I now?Your learning needs will be influenced by your previous experience, your role as a clinical pharmacist or a senior clinical pharmacist and the priorities of the GP practice where you are working. Therefore it is important to develop a PDP to prioritise your learning throughout the duration of the training pathway. Your first meeting with your education supervisor will include a learning needs analysis which will be used to identify the most suitable pathway for your needs. The learning needs analysis will also help you to identify specific learning and development needs for your PDP. Another useful method to help you identify your learning needs is undertaking a SWOT (strengths, weaknesses, opportunities and threats) analysis in relation to your job description.

Target setting: where do I want to be?The curriculum for the Clinical pharmacists in general practice education programme describes the learning outcomes and core capabilities and competences for clinical pharmacists working in general practice. You will be working towards achieving these capabilities and competences throughout the 18 month training pathway. Think about your role as defined in your job description and identify what you can do now and which aspects of the role are developmental. Use the clinical pharmacist role progression handbook to set targets for your learning and development to support your role progression.

Self-evaluation:where am I now?

Target setting:where do I want to be?

Set SMART objectives

Action planning:how will I get there?

Undertake learningand develop skills

Evaluation andreview:

How did I do?

Pathway handbook

41

Set objectives/goalsn Ensure your objectives are SMART: specific, measurable, achievable, relevant and timely.

n Think about how you will apply your learning to practice.

Action planning: how will I get there? n Identify how you can meet learning needs and objectives.

Undertake learning: develop knowledge and skillsn Undertake Clinical pharmacists in general practice education learning programme, eg, modules, study

days, workshops, learning sets, e-learning, etc.

n Undertake learning in the workplace, eg, work shadowing, case-based learning, being observed and receiving feedback on your practice.

n Apply your learning to practice.

n Reflect on your learning.

n Document your learning and experiences in your portfolio.

Evaluate and reviewn Reflect on outcomes of your learning.

n Evaluate your achievements.

n Review progress in relation to your objectives.

n Record your achievements in your portfolio.

The personal development planning cycle mirrors the CPD cycle of reflection, planning, action and evaluation. Throughout the cycle remember to record your learning as CPD.

Pathway handbook

42

Appendix 3 – Partner organisationsThe education pathway is led by CPPE and includes HEI partners and a national GP education provider. All of our partners have expertise in delivering GP pharmacist education.

Pathway handbook

43

References1. General Practice Forward View April 2016.

www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

2. NHS England Clinical Pharmacists in General Practice. www.england.nhs.uk/gp/gpfv/workforce/building-the-general-practice-workforce/cp-gp

3. NHS Healthcare leadership model: the nine dimensions of leadership behaviour. 2013. www.leadershipacademy.nhs.uk/wp-content/uploads/dlm_uploads/2014/10/NHSLeadership-LeadershipModel-colour.pdf

4. RPS Leadership development framework: developing leadership, wherever you are. January 2015. www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Development/rps---leadership-development-framework-january-2015.pdf

5. RPS A competency framework for all prescribers. July 2016. www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf

6. NHS Consultation skills for pharmacy practice: practice standards for England. March 2014. www.consultationskillsforpharmacy.com/docs/docc.pdf

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Email info@cppe.ac.uk

Telephone 0161 778 4000

By post Centre for Pharmacy Postgraduate Education (CPPE)Division of Pharmacy and Optometry1st Floor, Stopford BuildingThe University of ManchesterOxford RoadManchester M13 9PT

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