Practitioner development in Pharmacy- The way forward

1. Practitioner development in Pharmacy- The way forward Dr Catherine Duggan Associate Director of Clinical Pharmacy London, South East and Eastern andSenior Clinical Lecturer, School of Pharmacy, University of London Chair of United Kingdom Clinical Pharmacy Association

2. Content • Drivers for change • The competency agenda • Pharmacist development strategy • General level practice • Development of higher level practice

3. Drivers for change

4. Policy trends… Self-care Disease management Patient safety Access to medicines Dislocation between education & practice Non-competency based approaches No clear practitioner development Recruitment and retention Fitness for purpose

5. The real issue…patient outcome Competency → Competence → Performance → Fit to practise? = safe, health improvement

6. The Words

7. performance assessment in vivo performance assessment in vitro clinical context assessment factual assessment Miller’s pyramid From UG to post-registration development Does Shows how Knows how Knows

8. Why competency-based approach? • National health policies • Governance; Patient safety; service quality • Evidence • Accelerated and sustained performance • Operationalise “science into practice” • Sustainability • defines and makes explicit development needs

9. Pharmacist development strategy – principles: • Recognise different level of practitioner • Embraces all facets and sectors of practice • Linked to two recognised competency frameworks to link to KSF • Educational quality assurance structures to provide rigour

10. Graduation One year later Pharm Care Competencies(OSCE) 70% 60% 60% 50% 40% 30% 30% 20% 10% 1996/97 1997/98 1998/99 2001/02 McRobbie et al

11. Consultant Pharmacist Consultant Practitioner Consultant Pharmacist Advanced Advanced Practitioner Advanced Practitioner Competency Framework Advanced Level Pharmacist Specialist Senior or Specialist Practitioner Specialist Practitioner Competency Framework General Level Pharmacist Registered Qualified Practitioner Practitioner Pharmacist Pre-registration Healthcare Scientists Making the Change Allied Health Professions Meeting the Challenge PAM(PTA)2/2001 Pharmacist Development Strategy

12. Behaviours Behaviours Behaviours Behaviours Values attitudes Values attitudes Values attitudes Values attitudes Competency Competency Competency Competency Knowledge Knowledge Knowledge Knowledge Skills Skills Skills Skills Competency…a complex construct

13. Competencies have their critics… “Expert practice is beyond competency” • not a tenable stance post-Bristol Reflective practice (Schön 1983) • necessary quality of expertise - but cause or effect? • not a sufficient characteristic Novice-to-expert progression (Dreyfus & Dreyfus 1986) • no mechanism to identify ‘expert’ • insufficient account of competence

14. General Level Practice

15. Higher Level Development Phase 2 Higher Level Development Phase 1 General Level Development Phase Undergraduate & Pre-registration Phases Advanced Practitioner & PhwSI General Level Practitioner General Level Framework Higher Level Framework: Advanced & Consultant Pharmacist development strategy Consultant Practitioner

16. Whiddett and Hollyforde 1999 McRobbie, Webb, Bates, Davies, Wright 2001

18. Controlled trial GLF in junior pharmacists .7 .6 Intervention = GLF n = 30 hospitals .5 Intervention .4 Logrank P = 0.0048 Probability .3 .2 .1 Non-intervention 0.0 -.1 -2 0 2 4 6 8 10 12 14 Time - months

19. Reasons to be cheerful… • It is straightforward and practitioners understand it • It manages performance independent of sector • It makes “CPD” a realistic and useful activity ! • It is being used by employers because it works

20. Educational Quality NHS Specialist Services Specialist groups Senior Managers HE Universities London Brighton Kings Medway Portsmouth UEA Reading Kingston PG Diploma in General Pharmacy Practice Statement of Completion General Training Service Perspective Collaborative programmes

21. School Pharmacy Univ Brighton Univ East Anglia Univ Portsmouth Medway School King’s London Univ Reading Kingston Univ NHS Early implementation – Joint Programme BoardGeneralist Training (3 years) • Government funding – national model ? • PG Diploma in General Pharmacy Practice -Core - MI, Technical, Patient & Clinical Services Common Validation by HEIs in collaborative Currently 350 junior practitioner-students

22. Module 1 (M1) (60 Credits) Principles of Practice Technical / MI / Pt Services/Clinical 12 months Portfolio review – AfC gateway Assessment 1 (60 credits) 6 months Summed credits (60) = PG Cert GPP Defined Area of Practice I (20 Credits) 6 months Assessment 2 (20 credits) Defined Area of Practice II (20 Credits) Assessment 3 (20 credits) 6 months Defined Area of Practice III (20 Credits) Assessment 4 (20 credits) 6 months Summed credits (120) = PG Dip GPP

23. The bigger picture… • Growing higher level practice • Recognising advanced to consultant practitioners • …an evidence-based approach In other words, a practitioner development strategy from junior to Consultant

24. Higher level practice

25. Higher Level Development Phase 2 Higher Level Development Phase 1 General Level Development Phase Undergraduate & Pre-registration Phases Advanced Practitioner & PhwSI General Level Practitioner General Level Framework Higher Level Framework: Advanced & Consultant Pharmacist development strategy Consultant Practitioner

26. Attributes of higher level practice? • Expert in clinical practice • Able to work in multidisciplinary teams • Dissemination and contribution to evidence • Training, support and mentorship of staff • Managing a team and a caseload • Leadership skills

27. ADVANCED LEVEL renal pharmacists?

29. Specialist in training Leading-edge practitioner Experienced practitioner Advanced level practitioners HOMALS Quantification Expert PP 6 Leadership Management F E & T 4 R & E n = 390 Practice level F 2 M F M M F M F 0 M E E E E E -2 -2 -1 0 1 2

30. Expert Practice 3.0 Working relationships Leadership 2.5 Management E&T and Development 2.0 Research & Evaluation Mean cluster score 1.5 1.0 0.5 0.0 Experienced practitioners Leading-edge practitioners Specialists in training Current level of practice

31. Knowledge and Skills Personal attributes Pragmatic, ownership, individual working Humility, initiative, communication Confidence, flexibility, iteration Pro-activity, concentration Management skills Managing people, team working, influencing others Motivational skills, organisational skills, time management Organisational skills, task prioritisation Writing, meetings, identifying knowledge gaps Literature searching, presentation skills, protocol writing, administrative skills Writing, form filling, computer literacy, scientific language, obtaining funds, Data collection, data management, audit and research Technical skills Interpretive skills Charting progress, task prioritisation, writing (iteration), Critical appraisal, identifying knowledge gaps Reading literature, selection of research methods, statistics and interpreting data: analysis, credibility issues Conceptual skills Big picture: concepts into practice, identifying research questions Thinking: critical, conceptual, teaching Selecting approach, implementation of research in practice Interpersonal skills Mentoring, Role model, teaching Communication, negotiation, team working

32. ACLF Cluster Foundation F - E Excellence E - M Mastery Expert Practice Building Relationships ? Second cycle Third cycle MSc(Adv) DClinSci/PhD/MRes Leadership Management E&T and Development Research and Evaluation

33. ACLF

34. Higher Level Development Phase 2 Higher Level Development Phase 1 General Level Development Phase Undergraduate & Pre-registration Phases Advanced Practitioner & PhwSI General Level Practitioner General Level Framework Higher Level Framework: Advanced & Consultant Pharmacist development strategy Consultant Practitioner Not just clinical Aspirational for all specialties Leadership and Mentors essential Higher levels – M and D programmes We need to think big

35. New D Clin Sci [or mod map to professional D] (Specialism) & critical adjacencies MSc Adv Pract Awarded Master in Adv Practice (University / JPB accredited- RC recognised ?) L / M / E&D / R&E Statement of completion of Practice (University / JPB accredited- RC recognised ?) EPP / BWR PG DipGPP Award (or equivalent)

36. Challenges…? • Equivalence between specialist and generalist • Practicalities of rotations & placements • Maintenance of the service • Curriculum & assessments • Supply and demand

37. Syllabus & curriculum determined by and set by expert practitioners- Recognised (accredited) training centres EPP / BWR Assessment? Eg: Experience, Portfolios, learning Evidence Statement of completion of Practice Element (University / JPB accredited- RC recognised ?) Learning sets All linked to the assignments & learning outcomes- academically robust L & M Assessment? Eg: Change management assignment E&D Assessment? Eg: Teaching portfolio Awarded Master in Adv Practice (University / JPB accredited- RC recognised ?) Assessment? Eg: Ethics submission/ audit work R&E

38. “Royal College” All sectors specialism specialism specialism JPBs (locality based) Accreditation infrastructure, assessment, QA, evidence Practitioners who need registering at Foundation, Advanced, PwSI

39. Practitioner in training Key skills & Knowledge Cognitive skills Consultation skills Problem solving Professionalism CONTEXT Applied Therapeutics Practitioner Skills Applied Pharmaceutical Sciences Clinical Governance & Risk Competence Medicines expert Intellectual practitioner Decision maker

40. Where to find information JPB and CoDEG websites www.postgraduatepharmacy.org www.codeg.org

41. Practitioner development in Pharmacy- The way forward Dr Catherine Duggan Associate Director of Clinical Pharmacy London, South East and Eastern andSenior Clinical Lecturer, School of Pharmacy, University of London Chair of United Kingdom Clinical Pharmacy Association