Prescribing Competency Framework: Background

A Competency Framework for all Prescribers

Background information on the framework, such as why it was updated in 2021, what was updated, how it was updated, who was involved and who endorsed it.

Also included is the literature review and an archived version of the framework from 2016.

^{First Published: 01 September 2021

Reviewed: November 2022}

Background
Why the framework was updated
Summary of changes made to the framework
How the framework was updated
Who updated the framework - acknowledgments
Who endorsed the framework
Archive - 2016 version of the framework
Literature review

Background

31a Industry

To support all prescribers in prescribing safely and effectively, a single prescribing competency framework was originally published by the National Prescribing Centre/National Institute for Health and Care Excellence (NICE) in 2012.

NICE and Health Education England approached the RPS to manage the update of the framework on behalf of all the prescribing professions in the UK in 2015.

A Competency Framework for all Prescribers was first published by the RPS in July 2016. Going forward, the RPS will continue to maintain and publish this framework in collaboration with a multi-disciplinary group with representatives from professional regulators, professional organisations, prescribers from all prescribing professions, lay representatives and other relevant and interested stakeholder groups from across the UK.

What is the Competency Framework for all Prescribers?

The framework sets out what good prescribing looks like.
A structure which describes the demonstrable knowledge, skills, characteristics, qualities and behaviours central to a safe and effective performance in a prescribing role.
A generic framework for all prescribers but it must be contextualised to reflect different areas of practice, levels of expertise and settings.

Who is the framework for?

The framework is for all regulators, professional bodies, education providers, prescribing professions and patients/carers to use.
It can be used by any prescriber at any point in their career, regardless of their professional background or setting.
It applies equally to independent prescribers, community practitioner nurse prescribers and supplementary prescribers. However, it must be contextualised.

Why do we need a competency framework?

A common set of competencies should underpin prescribing regardless of professional background.
To support all prescribers in prescribing safely and effectively.
To inform and improve practice, development, standard of care and safety (for both the prescriber and patient).
To bring professions together and harmonise education for prescribers.

How can it be used?

As a self-assessment tool when expanding scope of practice, changing scope of practice or returning to practice.
Regulators, education providers, professional organisations and specialist groups can use it to inform standards, the development of education, and to inform guidance and advice.
Prescribing trainees can evidence the framework to demonstrate they are delivering the competencies required of their role.

Further uses can be found in the framework here.

Examples of use in practice can be found here.

Why was the framework updated?

The 2021 update of A Competency Framework for all Prescribers was a review of an existing 2016 edition widely used in practice, which was due for review in July 2020.

29 Validation

During the development of the sister Competency Framework for Designated Prescribing Practitioners in 2019, the project board and steering group provided concluded the 2016 Competency Framework for all Prescribers was broadly fit for purpose based on a literature view and extensive use of the framework in practice, and confirmed a need for an update and refresh.

Since the 2016 framework, there have been various changes, which needed to be included in the update of the framework these include:

Legislation changes introducing paramedic prescribers in April 2018
Current prescribing topics such as remote prescribing, social prescribing, psychosocial assessment and eco-directed sustainable prescribing. Further key themes can be found in the table below
Publication of the RPS Competency Framework for Designated Prescribing Practitioners in December 2019; for further information, please see 'A competency framework for designated prescribing practitioners'.

Summary of changes made to the framework

There have been improvements and amends to the 2021 framework including:

Light editing and updating the introduction, purpose and scope sections, for brevity and clarity
Light editing of competency titles and supporting statements for clarity or consistency of terminology
Restructuring some of the supporting statements where additions became apparent as the framework was updated
Splitting some supporting statements by moving further information/examples to new ‘further information’ sections for clarity of meaning, and to keep the supporting statements unique and in scope
Expanding on some competency statements by referring to the ‘further information’ section
Improving the wording of competency titles and supporting statements for clarity of meaning
Removing the professionalism section and integrated into the framework introduction
Deleting supporting statements where duplication became apparent as the structure of the framework was updated
Adding new statements or modifying existing supporting statements to include omissions identified through the Literature review
Improved navigation with hyperlinking to glossary terms, further information sections, footnotes and references.

Specific section changes

Introduction	Section on 'How the framework was updated' updated and moved to the RPS website.
Purpose	Updated and expanded to include further groups and uses (e.g. use as a self-assessment tool when expanding/changing scope of practice or returning to practice), for prescribing trainees to evidence competencies, and to inform and assure patients/carers about the competencies of a safe and effective prescriber. Examples of uses of the framework in practice have been updated and moved to the website.
Scope	Updated and expanded - addition of ‘setting’ in bullets points 1 and 2.
The Competency Framework for all Prescribers	There are now 75 supporting statements (12 new - 1.1, 1.2, 1.3, 1.4, 1.5, 1.8, 4.6, 4.12, 9.4, 9.5, 9.6, 9.7). Deleted competency statement 4.5 and merged with 4.3. Amended competency titles 2 and 3. Added new ‘further information’ sections for the supporting statements with further information and examples to clarify meaning. Previous footnotes removed and information moved to further information sections or glossary. Section on 'The role of professionalism' merged here - includes the importance of using own professional codes of conduct, standards and guidance alongside the framework. Introduction sets out the aim and importance of the framework for all prescribers, structure of the framework, and further notes for consideration. New figure 1 diagram - still presented as two domains, content is the same. For further details please see below.
Glossary	Deleted terms: Inappropriate polypharmacy, Appropriate polypharmacy, Non-medical prescribing and Independent prescribing Added new terms: Adherence, Antimicrobial stewardship, Carer, Competency framework, Designated Prescribing Practitioner, Independent prescriber, Material risk, Non-medical prescriber, Off-label, Patient, Prescribing trainee, Psychosocial, Scope of practice, Unlicensed.
References	Deleted previous references 1-6 Added new references 8-10 and 12-16
Website	New web version of the framework New Welsh language version (PDF) New supporting tools page New supporting resources section – hyperlinks to useful sources of information New summary of changes made section New ways to demonstrate/evidence competencies section.
Further details of changes to the framework
Competency 1 Assess the patient	Added: New competency statements: 1.1, 1.2, 1.3, 1.4, 1.5 and 1.8 New further information section for competency statements 1.1, 1.2, 1.4, 1.5, 1.6, 1.7, 1.8 and 1.13 Moved: Previous footnote 1 expanded and moved to 1.6 further information Previous competency statement 1.1 now 1.6, 1.2 now 1.7, 1.3 now 1.9, 1.4 now 1.10, 1.5 now 1.11, 1.6 now 1.12, 1.7 now 1.13, and 1.8 now 1.14 Edited/expanded competency statements: 1.6 included ‘and documents’ and replaced ‘social’ with ‘psychosocial’ 1.7 included ‘documents’ 1.11 included ‘and documents’ 1.13 included ‘and non-adherence’ 1.14 replaced ‘prescribing information’ with ‘appropriate information’ New key themes: Appropriate setting, patient dignity, capacity, consent and confidentiality, consultation skills and building rapport, introducing yourself and your role, confirming patient identity, assessing communication needs and adapting appropriately, psychosocial history, documentation, identifying and addressing potential vulnerabilities (e.g. mental health and safeguarding issues).
Competency 2 Identify evidence-based treatment options available for clinical decision making	Added: New competency title for clarity New further information section for competency statements 2.1, 2.4, 2.6 and 2.8 Moved: Previous footnote 2 expanded and moved to glossary Examples in competency statements 2.4, 2.6 and 2.8 expanded and moved to further information section Edited/expanded competency statements: 2.1 included ‘treatment approaches’ and deleted ‘modifying disease and promoting health’ 2.4 replaced ‘mode of action’ with ‘pharmacodynamics’ and added ‘individual patient factors’ 2.5 included ‘intolerances’ and replaced ‘medication’ with ‘medicines’ 2.6 included ‘choice of medicines’ and replaced ‘Takes into account’ with ‘Considers’, restructured for clarity 2.7 replaced ‘Identifies’ with ‘Accesses’ and restructured for clarity 2.9 replaced ‘Takes into account’ with ‘Considers’. New key themes: Social prescribing and wellbeing/lifestyle changes, patient factors, choice of medicines, audit.
Competency 3 Present options and reach a shared decision	Added: New competency title for clarity New further information section for competency statements 3.1, 3.2 and 3.4 Moved: Previous footnote 3 expanded and moved to glossary Examples in competency statements 3.1 and 3.4 expanded and moved to further information section Edited/expanded competency statements: 3.1 included ‘actively involves’ and ‘agree a plan’ 3.2 replaced ‘Identifies’ with ‘Considers’ included ‘background, personal values’ and ‘supporting the values of equality, inclusivity and developing cultural competence. 3.3 included ‘material risks and benefits’ and ‘informed choice’. New key themes: Shared decision making, informed choice, material risks and benefits, respecting patient background, supporting the values of equality, inclusivity and developing cultural competence
Competency 4 Prescribe	Deleted: Previous competency statement 4.5 deleted and merged with 4.3 Added: New competency statements: 4.6 and 4.12 New further information section for competency statements 4.1, 4.3, 4.6, 4.7, 4.10, 4.13 and 4.14 Moved: Previous competency statement 4.6 now 4.5, 5.2 now 5.1, 4.12 now 4.13 and 4.13 now 4.14 Previous footnote 4 expanded and moved to further information section 4.1 Previous footnote 5 amended and moved to further information section 4.3 Previous footnote 6 merged with competency statement 4.11 Examples in competency statement 4.10 expanded and moved to further information section Edited/expanded competency statements: 4.1 included ‘device’, replaced ‘unwanted’ with ‘adverse’, removed ‘only’ and ‘adequate’ 4.2 restructured for clarity 4.3 replaced ‘Prescribes within’ with ‘Understands and uses’ and included ‘national, regional and local’, and restructured for clarity 4.7 replaced ‘Considers’ with ‘Recognises’ and included ‘minimises risk and manages using appropriate processes’ 4.8 restructured for clarity 4.9 included ‘and/or’ 4.11 restructured for clarity included ‘where legally permitted, and unlicensed medicines only’, removed ‘or outside standard practice’ 4.13 replaced ‘Makes’ with ‘Documents’, removed ‘notes’ and restructured for clarity 4.14 included ‘Effectively and securely’ and ‘to other healthcare professionals involved in the patient’s care’ and ‘within and across all care settings. New key themes: Medical devices, adverse effects, prescribing appropriate quantities and intervals, reducing waste, following appropriate safeguards if prescribing medicines that are unlicensed/off-label/outside standard practice, recognising/minimising/ managing risk, using appropriate reporting processes, documentation, using relevant national/regional/local frameworks for medicines use, prescribing unlicensed/off label if legally permitted, data protection, securely communicating information within and across all care settings, awareness and avoidance of potential system errors.
Competency 5 Provide information	Added: New further information section for competency statements 5.1, 5.2, 5.2, and 5.4 Moved: Previous competency statement 5.1 now 5.2 and 5.2 now 5.1 Edited/expanded competency statements: 5.1 included ‘Assesses health literacy of the patient/carer and adapts appropriately’ 5.2 included ‘the discussions had, actions needed’ and ‘management plan’ 5.3 included ‘condition’ 5.5 removed ‘when possible’ New key themes: Assessing health literacy, checking patient’s/carer’s understanding of the discussions had and actions needed, safety netting, signposting, referral, management plan, providing information on condition(s).
Competency 6 Monitor and review	Added: New further information section for competency statements 6.1, 6.2 and 6.4 Moved: Previous competency statement 6.3 now 6.4 and 6.4 now 6.3 Edited/expanded competency statements: 6.2 included ‘Establishes and maintains a plan to monitor’ 6.4 replaced ‘Detects’ with ‘Recognises’ and ‘drug reactions’ with ‘events to medicines and medical devices‘ New key themes: Monitoring, recognising adverse events to medicines and medical devices.
Competency 7 Prescribe safely	Added: New further information section for competency statements 7.3, 7.4 and 7.6 Moved: Examples in competency statements 7.3 and 7.4 expanded and moved to further information section Edited/expanded competency statements: 7.2 included ‘prescribing errors’ and replaced ‘prevent, avoid and detect them’ with ‘knows how to minimise their risk‘ 7.3 included ‘minimises’ and replaced ‘media’ with ‘methods’ 7.4 restructured for clarity to recognise and minimise risks when safe prescribing processes are not in place 7.6 restructured for clarity, included ‘medication and prescribing errors using appropriate reporting systems, whilst regularly reviewing’ New key themes: Remote prescribing and minimising risks associated, prescribing errors and minimising risk associated, minimising risk using governance processes, using appropriate reporting systems, learning from errors, audits.
Competency 8 Prescribe professionally	Added: New further information section for competency statements 8.2, 8.3 and 8.5 Moved: Examples in competency statement 8.3 and 8.5 expanded and moved to further information section Edited/expanded competency statements: 8.2 included ‘accountability’ and ‘clinical decisions’ 8.4 replaced ‘personal considerations’ with ‘personal views’ 8.5 replaced ‘deals’ with ‘responds’ New key themes: Accountability for prescribing and clinical decisions (e.g. under a shared care protocol/agreement), prescribing for self, close family and friends, factors that affect prescribing (e.g. cognitive bias, financial gain, prescribing incentive schemes, switches and targets).
Competency 9 Improve prescribing practice	Added: New competency statements 9.4,.9.5, 9.6 and 9.7 New further information section for competency statements 9.2, 9.3, 9.4 and 9.6 Moved: Examples in competency statement 9.3 expanded and moved to further information section Edited/expanded competency statements: 9.1 replaced ‘Reflects’ with ‘Improves by reflecting’ and ‘acts’ with ‘by acting’ 9.2 removed ‘colleagues’ and replaced ‘mechanism’ with ‘processes’ 9.3 included ‘prescribing practice’ New key themes: Taking responsibility for own learning and CPD, raising concerns, networking, encouraging and supporting others (e.g. mentoring, becoming a DPP or leadership), sustainability, reducing the carbon footprint and environmental impact of medicines, tools to improve prescribing practice (e.g. supervision, observation of practice and clinical assessment skills, portfolios, workplace competency-based assessments, questionnaires, prescribing data analysis, case-based discussions and personal formularies).
Competency 10 Prescribe as part of a team	Added: New further information section for competency statements 10.1 and 10.4 Edited/expanded competency statements: 10.1 replaces ‘Acts’ with ‘ Works collaboratively’ and included ‘the transfer and continuity of care (within and across all care settings)’ 10.2 replaced ‘in relation to prescribing’ with ‘in relation to the patient’s care’ 10.3 replaced ‘Negotiate’ with ‘Agrees’ and included ‘for their role’ New key themes: Working collaboratively, transfer of care, being respectful of all those involved in the patient’s care, agreeing appropriate level of support and supervision needed.

How the framework was updated

The review involved strategic support and engagement with wider stakeholders through a multi-disciplinary, external task and finish group from across the UK. The task and finish group concluded the 2016 framework was broadly fit for purpose, based on a literature view and extensive use of the framework in practice and confirmed a need for an update and refresh. The process used to update the framework is proportionate to that view and reflects an iterative development of the competencies.

The process used to update the framework is illustrated below:

Multi-disciplinary engagement

The framework is used by a range of healthcare professions.

A multi-disciplinary external task and finish group comprising representatives from professional regulators, professional organisations, prescribers from all prescribing, lay representatives and other relevant and interested stakeholder groups from across the UK was created to review and update the framework. The group was chaired by Angela Alexander and all members of the task and finish group were asked to declare conflicts of interest which were managed in line with RPS policy.

The review consisted of three virtual discussions during the duration of 10 months aligned to key milestones (see timeline below). Meetings were held with the group to keep members of the group informed about progress and to stimulate discussion about improvements to the framework, and how the framework might be promoted and used once published.

For further information on the members of the task and finish group, please see ‘Acknowledgments’.

Development process and timeline

Timeline

Literature review

A literature review was undertaken in November 2020 to identify key changes and evidence relating to competency and good practice in prescribing since the publication of the 2016 framework.

For further information please see ‘Literature review'.

Task and finish group

The task and finish group consisted of representatives from:

British Dental Association
Chartered Society of Physiotherapy
College of Paramedics
General Pharmaceutical Council
Health and Care Professions Council
Health Education and Improvement Wales
National Institute for Health and Care Excellence
NHS Education for Scotland
Nursing and Midwifery Council
Representatives from across all prescribing professions, academia, primary and secondary care, and lay representatives
Royal College of General Practitioners
Royal College of Nursing
Royal Pharmaceutical Society
Society and College of Radiographers
The College of Optometrists
The Royal College of Midwives
We also had colleagues from across England, Scotland, Wales and Northern Ireland.

The group discussed proposed changes by RPS and provided strategic oversight in the update of the framework to ensure the competencies are still current, in scope and fit for purpose for all prescribers.

The task and finish group used a consensus process to review and update the framework in the context of the literature review.

The multidisciplinary nature of the group ensured the generic nature of the framework was maintained. The group ensured the changes were in line with current prescribing practice and were understandable to prescribers.

For further information on the updates and changes made, please see 'Summary of changes made to the framework'.

Consultation

A draft copy of the revised framework was posted on the RPS website for six weeks for open consultation from 26 March 2021 to 7 May 2021. The task and finish group were all asked to draw attention to the availability of the framework for comment.

There were 25 questions and 273 responses to the consultation received. Results were analysed and comments from the consultation were reviewed by the task and finish group. Those that were in scope and relevant were incorporated into the framework. The group used a consensus process to agree all final amendments to the framework.

Endorsement

Organisations who endorsed the 2012 version of the framework were invited to continue to endorse the framework. Other relevant organisations were also invited to endorse the framework.

For further information on who endorsed the framework, please see 'Who endorsed the framework'.

Supporting tools

In response to the consultation feedback and to support the uptake of the framework, we have produced the following:

Examples of uses of the framework in practice
Ways of demonstrating/evidencing competencies
Word template of the framework
PowerPoint presentation about the framework
Supporting resources for the framework - useful links to further information
Competency Framework for Designated Prescribing Practitioners
Welsh translated version
Updated website - improved navigation and open access.

For further information on the supporting resources and tools please see 'Supporting tools'.

Promotion

RPS will work with the pharmacy profession to encourage uptake of the framework in practice.

We will also liaise with the professional bodies and organisations of the other prescribing professions and would expect them to work with their stakeholders to encourage uptake.

Where opportunity for joint working across the professions arises we will contribute.

Statement of funding

The update to this framework has been wholly funded by the RPS who has not received any payment from a third party for its development.

For further information on how the RPS is funded, please see our Professional standards, guidance and frameworks process development manual.

Consensus statement

The task and finish group used a consensus process to agree the final version of A Competency Framework for all Prescribers. Consensus was achieved.

Who updated the framework - acknowledgments

We are grateful to the following persons who have provided expert advice and information during the update of A Competency Framework for all Prescribers as part of the task and finish group.

Task and Finish Group

Professor Angela Alexander (Chair) - Professor Emerita, University of Reading
Chris Bell - Standards Development Specialist, The Nursing and Midwifery Council
Dr Paramdeep Bilkhu MCOptom - Clinical Adviser and Independent Prescriber, The College of Optometrists
Olivia Bird - Policy Manager, The Health and Care Professions Council
Hazel Boyce - Skull Base Specialist and Neuro Review Radiographer, Bristol Cancer Institute, University Hospitals Bristol NHS Trust (also representing Society and College of Radiographers)
Dr Rachel Bruce - Principal Lead (Prescribing and Clinical Skills), NHS Education for Scotland
Kat Hall - Associate Professor of Clinical Education Director, Centre for Inter-Professional Postgraduate Education and Training (CIPPET)
Peter Hawkes - Lay representative
Parbir Jagpal - Director of Postgraduate Studies, School of Pharmacy, University of Birmingham; Independent Prescriber
Caroline Lecky - Associate Senior Professional Officer, Northern Ireland Practice and Education Council
Andrew Lilley - Pharmacy Professional Services Manager, Lead Pharmacist and Advanced Practitioner – Respiratory, Homecare Alder Hey Children's Hospital
Carmel Lloyd - Head of Education and Learning, The Royal College of Midwives
Dr Frances Lloyd - Associate Postgraduate Pharmacy Dean, Queen's University Belfast, Northern Ireland
Simon Matthews - Associate Chief Pharmacist – Clinical Services, Kings College Hospital NHS Foundation Trust
Dr Trudi McIntosh - Senior Lecturer in Pharmacy Practice. Course Leader MSc, Robert Gordon University Advanced Pharmacy Practice including Pharmacist Independent Prescribing
Andrew Mikhail - Chief Pharmaceutical Officer’s Clinical Fellow and Specialist Inspector, The General Pharmaceutical Council
Eleri Mills - Association for Prescribers Committee member, Programme Leader NMP, Glyndwr University
Adele Mott - Lead Pharmacist for GI Services, University College London Hospitals
Catherine Picton - Competency Framework Author and Health Policy Consultant
Heather Randle - Professional Lead for Education, The Royal College of Nursing
Debra Roberts - Associate Dean (Pharmacy), Head of Programme Development and Advanced Practice, Health Education and Improvement Wales (HEIW)
James Rodger - Musculoskeletal Extended Scope Practitioner, Musculoskeletal Sonographer
David Rovardi - Pharmacist Independent Prescriber and Registered Paramedic, College of Paramedics
Peter Saul - Joint Chair, Royal College of General Practitioners Wales
Debbie Sharman - Consultant Podiatrist – Diabetes, Professional lead for Podiatry Visiting Lecturer (University of Southampton), Dorset HealthCare University Foundation Trust
Katherine Timms - Head of Policy and Standards, The Health and Care Professions Council
Wendy Thompson - Academic general dental practitioner at University of Manchester, also representing The British Dental Association
Jonathan Underhill - Associate Director, Medicines and Prescribing Centre, The National Institute for Health and Care Excellence
Nigel Westwood - Lay representative
Pip White - Professional Adviser, Chartered Society of Physiotherapy

RPS staff

Regina Ahmed (Lead Author) - Senior Guidance Pharmacist and Independent Prescriber
Dr Karen Hodson - Practice & Policy Lead – Wales, RPS. Programme Director, Independent Prescribing, Cardiff University
Jonathan Lloyd Jones - Policy and Engagement Lead – Wales
Annamarie McGregor - Head of RPS Local
Wing Tang - Head of Professional Support and Guidance
Stuart Carter - Digital Content Lead (External Comms)

Who endorsed the framework

The framework has been endorsed by professional bodies representing other prescribers. In future, we will continue to publish and maintain the updated framework in collaboration with the other prescribing professions.