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PRACTICE ASSESSOR presentation Independent and Supplementary Non- Medical Prescribing

INTRODUCTION

Thank you for agreeing to act as a Designated Medical Practitioner (DMP), Designated Prescribing Practitioner (DPP) or Practice Assessor. This presentation is designed to provide you with information to support your allocated student undertaking the Non-Medical Prescribing (NMP) programme. There is more detailed advice available within the Practice Assessor Handbook.

Guidance from the Nursing and Midwifery Council (NMC) and the General Pharmaceutical Council (GPhC) has recently changed to allow suitably qualified and experienced healthcare professionals to support NMP students in an Assessor role. The HCPC plans to make similar changes, pending new guidance from the Royal Pharmaceutical Society. This role was previously only undertaken by DMPs. Therefore, the rest of this handbook will refer to all DMPs, DPPs and healthcare professionals who assess NMP students in clinical practice as Assessors.

The role of the Assessor is essential for the successful implementation of the educational programme leading to the professional qualification to prescribe. It is recognised that competence in practice is achieved by supported exposure to practical learning experiences and that reflective dialogue will help to ensure that theoretical concepts are used to support decision-making. It is the responsibility of the Assessor to make a judgement upon the student’s clinical competence to practice as a non-medical prescriber.

Please note that registrants who will be prescribing for children must be supervised by an Assessor who is experienced and competent in prescribing for children.

If at any time you require further information, please do not hesitate to contact our team. We look forward to working collaboratively to support our NMP students.

  • Beth Hawkes, Programme Lead (Plymouth) beth.hawkes@plymouth.ac.uk
  • Linda Duggan, Senior Lecturer (Plymouth) linda.duggan@plymouth.ac.uk

1. ROLES AND RESPONSIBiliTIES

The Assessor

As the Assessor you have a fundamental role in educating and assessing the student. The generic nature of the module content will facilitate students to apply their knowledge and understanding to safely prescribe within their own area of practice specialty. This will be further developed with the support and guidance from you. Your student will evidence their work to be at level 6 or 7 through their written assignments marked by the NMP academic teaching team. The clinical placement assessment documentation is the same for all students, and thus, there is no need for yourself to differentiate between levels 6 and 7.

You are responsible for:
  • Establishing a Learning Contact with your student.
  • Documenting progress on two occasions during supervised practice and provide any additional opportunities if required to achieve outcomes in a timely manner.
  • Planning a learning programme with your student, which will provide the opportunity for them to meet their learning outcomes and gain competency in prescribing.
  • Facilitating learning by encouraging critical thinking and reflection.
  • Providing dedicated time and opportunities for your student to observe how you conduct a consultation/interview with patients/ clients and /or parents/carers and the development of a management plan.
  • Allowing opportunities for your student to carry out consultations and suggest clinical management and prescribing options, which are then discussed with you.
  • Helping to ensure that your student integrates theory with practice.
  • Taking opportunities to allow in-depth discussion and analysis of clinical management using random case analysis approach, when patient/client care and prescribing behaviour can be examined further.
  • Facilitating, observing and assessing your students’ performance over the continuous period of supervised practice.
  • Assessing and verifying that, by the end of the course, your student is competent to assume the prescribing role. It is your responsibility to decide whether or not they are making satisfactory progress towards meeting the practice outcomes for non-medical prescribing. This decision will be based upon whether or not the practice outcomes have been met. If during the practice days students are deemed by yourself to be failing to make sufficient progress towards achievement of these outcomes you should inform both the student and programme in order to consider if strategies can be put in place to support your student.
  • Identifying and documenting any cause for concern’, for example, concerns regarding competence acquisition, or conduct, or unsafe practice, and discuss at the earliest possible stage with the programme lead. Unsafe practice can for example include repeated episodes of making incorrect diagnosis, recommending incorrect treatment options or incorrect completion of prescriptions.
The Supervisor

Practice supervisors must be health-care professionals currently registered with the NMC, GMC, GPhC or HCPC. Health and social care workers who are not registered with a professional body cannot be practice supervisors. Please note that within the new NMC guidance regarding assessment and supervision for nurses and midwives, the assessor and supervisor roles have been separated, unless in exceptional circumstances.

Practice supervisors may not be required to undertake ‘formal’ training, although they should be suitably prepared for undertaking this role. For example, many supervisors will already be highly trained and experienced in supporting students.

In your position as an Assessor, in partnership with the University, you must feel confident that any supervisor fully understands the learning outcomes that the student is trying to achieve, and only accept evidence around student competence from individuals whom you deem to possess the appropriate and up-to-date knowledge and skills to support an NMP student.

As further guidance around supervision of NMP students is published, this will be shared with you by the NMP Programme Lead. Proficiencies embedded within the new undergraduate curriculum will ensure that all Nurses and Midwives will be able to be assessors and supervisors in future.

We have produced some information for NMP supervisors which is available in the Assessor Handbook. Please do not hesitate to get in touch if you or any potential supervisors have any further questions. Information regarding the new NMC standards:

The Learner

The student’s role is to take responsibility for their own learning and demonstrate a willingness to develop both academically and in practice. They will be expected to articulate their learning needs, undertake honest self-assessment, and also seek and accept formative feedback from you. Your student will need to recognise and appraise their own abilities and limitations.

The University

If at any time you or your student has any difficulties with this process, the student’s personal tutor or the Programme Lead is available for clarification. Please do not hesitate to contact us in order that we can either arrange to visit or clarify issues over the phone. As each student has individual needs and the amount of support they require will vary, it is crucial that a learning contract is written and is reviewed by you and the student at least fortnightly. If a student is concerned that they are unable to gain the experience required to meet their learning needs, they have been advised that they should in the first instance discuss this with you. If the problem persists, they should then raise the concern with their personal tutor. Similarly, if you have any concerns regarding a student’s ability to meet the learning outcomes of the programme and in particular the competencies, the same process should take place. Throughout the taught component there will be opportunities to discuss issues in practice and peer discussion may assist students in meeting their learning needs.

If you are concerned a student is not making steady progress, or you have concerns about unsafe practice you should arrange a meeting between yourself, the personal tutor and the student. It is our intention to support students in practice so as to enable them to become competent and safe prescribers.

General / student support

Your contribution in relation to providing supervision, support and opportunities to develop competence in practice is crucial within the learner’s minimum of 90 hours in practice, whilst undertaking the programme. This need not constitute direct personal supervision of all of the hours, but will require:

  • Dedicated time and opportunities for your student to observe how you conduct a “consultation/interview” with patients and / or carers, and the development of a subsequent management plan.
  • Opportunities to allow in-depth discussion and analysis of clinical management using a random case analysis approach, when patient care and prescribing behaviour can be examined further.
  • Facilitate student learning by encouraging critical thinking and reflection with the use of their Practice Portfolio or Learning Log.
  • Opportunities for your student to carry out consultations and suggest clinical management and prescribing options, which are then discussed with you.

It is recognised that the demands of the module are challenging and that the intensity of the assessment is demanding. The programme team will provide substantial support to students both in academic and pastoral capacity. Students who require additional support will be signposted to the most appropriate student support services.

2. CONTEXT OF CURRENT DEVELOPMENTS & TERMINOLOGY

Non-medical prescribing is defined by the Royal Pharmaceutical Society (RPS) as ‘prescribing by specially trained nurses, optometrists, pharmacists, physiotherapists, podiatrists, radiographers and dietitians working within their clinical competence as either independent and/or supplementary prescribers’ (2016, p.16). In 2018, paramedics joined this group of eligible health professionals.

Independent prescribing is ‘prescribing by a practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing’ (RPS, 2016, p.16).

Supplementary prescribing is ‘a voluntary partnership between a doctor or dentist and a supplementary prescriber to prescribe within an agreed patient-specific clinical management plan (CMP) with the patient’s agreement. Nurses, optometrists, pharmacists, physiotherapists, podiatrists, radiographers and dietitians may become supplementary prescribers and once qualified may prescribe any medicine within their clinical competence, according to the CMP’ (RPS, 2016, p.16). Again, paramedics are now included within this group of eligible health professionals.

Professional Body Requirements

The current course learning outcomes are mapped to the RPS ‘Competency Framework for all Prescribers’ (2016), which overarches the entire programme. However, we concur with the RPS in that (2016, p.7):

  • ‘It is a generic framework for any prescriber (independent or supplementary) regardless of their professional background. It therefore does not contain statements that relate only to specialist areas of prescribing’
  • ‘It must be contextualised to reflect different areas of practice and levels of expertise’
  • ‘It reflects the key competencies needed by all prescribers; it should not be viewed as a curriculum but rather the basis on which one can be built’

Additionally, the programme incorporates the most up-to-date standards, frameworks and guidance provided by the NMC (2018), HCPC (2013), AHPF (2018) and GPhC (2019). Nurses, Midwives, Physiotherapists, Podiatrists, Pharmacists, Paramedics and Therapeutic Radiographers can undertake and enjoy our multi-professional programme. It is also important that you familiarise yourself the the regulatory body and professional body stipulations of the student that you are assessing.

3. ABOUT THE PROGRAMME

This programme is undertaken over a six-month period. It is delivered via blended learning consisting of 10 face-to-face taught days, one day of examination and 16 self-directed days assisted by a distance-learning package. There are an additional 90 hours in practice supported by a suitably qualified assessor. Successful completion will lead to a recordable qualification as Independent and Supplementary prescriber with the appropriate regulatory body (NMC/HCPC/GPhC).

The programme will enable students to develop existing professional expertise, develop new clinical assessment / prescribing skills and includes aspects relating to pharmacology, psychology, ethics, legal aspects and governance issues relating to Non-Medical Prescribing.

In order to successfully complete the NMP programme and register as an Independent and Supplementary Prescriber, the student must complete the NMP programme, including the required number of study / practice hours and successfully pass all assignments.

This programme is designed to provide the student with the necessary skills and underpinning knowledge to become a safe, competent, and cost-effective prescriber. Examination, diagnostic skills and a generic framework for prescribing will be taught as part of the programme; however, it is the joint responsibility of the student and their assessor to ensure that this is embedded within the clinical setting and that very specialist knowledge required within the students’ scope of practice is incorporated into the students’ placement learning experience.

Single Competency Framework for All Prescribers.

Throughout the programme students will be expected to apply the Competency Framework for All Prescribers (RPS, 2016) within their areas of practice:

Assessed period of practice learning

This period of learning is to be overseen by the Assessor who will be expected to sign off the student as having completed the formative and summative period of learning in practice and state whether or not the required dimensions of competency have been met. The assessor will also be required to assess the student’s consultation and history taking skills in practice on five occasions using a Mini CEx assessment form. The competency document and Mini CEx assessments will be submitted within the student’s practice documentation. All required documentation can be found in the Assessor handbook.

Students will gain a wide variety of experience through observation and supervised practice. This must include:

  • Working alongside their assessor in practice, observing history taking and assessing patients, reflecting on prescribing practice
  • Taking histories and assessing patients as part of their practice assessment
  • Working alongside and observing other independent and supplementary prescribers e.g. Specialist Nurses
  • Reflecting on their own practice and critically evaluating prescribing practice
  • Attending Continuing Professional Development relevant to prescribing practice e.g. a conference
  • Making prescribing decisions

As soon as it is practically possible, please arrange a meeting with your student. In the meantime, give some thought to the student’s learning needs within the clinical setting and how these may be achieved. The competencies within the practice assessment document as outlined by the Royal Pharmaceutical Society, (2016) Competency Framework for All Prescribers and the learning outcomes for the programme should be used to determine the content for the student’s Learning Contract.

The stages of the assessment process
Learning contract / the first meeting:
  • Review the domains and competencies in the Competency Framework
  • Itemise the identified learning needs- what does the student need to learn to be competent?
  • Establish learning goals- How is the student to become competent?
  • Identify learning resources available and develop appropriate strategies
  • Agree a time scale
  • Both assessor and student to sign the learning contract
  • NB the learning contract is ongoing and should be re-visited and updated every time you and the student meet
  • Agree dates to complete formative and summative assessment of practice and mini CEx assessments
Formative assessment
  • This is an opportunity for on-going feedback
  • How is the student progressing?
  • What do they need to do to achieve competency?
  • Possibly revisit the learning contract
  • Set new goals if needed
  • There should be one than one formative review (as many as required)
Summative assessment
  • Final formal assessment
  • Verifies whether the student has passed or referred on the the competencies and leaning outcomes
  • Assessor records and signs that the student has achieved level 4 of the competencies (if achieved)
  • Assessor signs statement of completion and other practice documents (if achieved)

More detailed guidance and further information can be found in the PRACTICE ASSESSOR HANDBOOK

In addition to being on hand throughout the programme duration, you are also invited to meet with the programme lead afterwards for feedback.

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