Examples of use of the framework in practice
Here are some ways prescribers, patients, regulators, professional bodies, education providers and organisation use the framework in their day to day practice.
Prescribers
“As a practitioner, I use the framework frequently to identify areas of my current practice that need strengthening or reviewing. I found the framework to be a great support whilst qualifying as an independent prescriber and especially useful when developing my scope of practice. It is reassuring to have a basis to build confidence in new areas and to identify areas that I need to prioritise to gain this competence.”
- Pharmacist prescriber and RPS Policy and Engagement Lead for Wales
“In my education role for independent prescribers; I use the framework in clinical practice to support competency maintenance and development.”
- Director of Postgraduate Studies, School of Pharmacy, University of Birmingham; Independent Prescriber
“The framework helps me to reference my own continuing professional development needs and when teaching others on independent prescribing courses (largely around decision making).”
- Associate Director, Medicines and Prescribing Centre, The National Institute for Health and Care Excellence
“Initially I used the framework when I first qualified as a practitioner. Now I use it to support my peers in becoming NMPs and in my own continuing professional development.”
- Pharmacy Professional Services Manager, Lead Pharmacist and Advanced Practitioner – Respiratory, Homecare Alder Hey Children's Hospital
“I use it for my role at Cardiff University for pharmacist independent prescribers; we use the competencies in the framework for all the students on the course to self-assess themselves, as a prescriber within the first 3 weeks of the course; they also do a document called scope of practice and together this information helps them to develop a personal development plan. This is feedback on by their tutor. We also use it for the end of the course, where they need to map their work to the competencies and ensure that each competency has some evidence.”
- Practice & Policy Lead – Wales, RPS and Programme Director, Independent Prescribing, Cardiff University
“I use the framework to help support curriculum development for our independent prescribing programme. using it as a common reference point e.g. mapping portfolio evidence for personal development plans and learning needs analysis. As a clinical team we encourage using the framework for reviewing scopes of practice, when changing roles or jobs and for those getting into difficulty, as a common tool to reference progress and learning needs to support a practitioner’s learning journey. In my own prescribing practice, I use it to help structure my professional reflection and revalidation.”
- Associate Professor of Clinical Education Director of Centre for Inter-Professional Postgraduate Education and Training (CIPPET), University of Reading
“In my role in academia, I ask independent prescribing students to supply evidence against each competence in the framework as part of their portfolio of evidence from the period of learning in practice.”
- Senior Lecturer in Pharmacy Practice. Course Leader MSc, Robert Gordon University Advanced Pharmacy Practice including Pharmacist Independent
“I use the framework for my own practice and for supporting trainee prescribers in practice.”
- Lead Pharmacist for GI Services, UCLH
“I use the framework for a few reasons: to help support new prescribers, to support any change in my prescribing and for continuing professional development use.”
- Skull Base Specialist and Neuro Review Radiographer, Bristol Cancer Institute, University Hospitals
“I use the framework in my organisation for regulatory purposes, we reference the framework in several General Pharmaceutical Council guidance, documents and we also use it to inform fitness to practise.”
- Chief Pharmaceutical Officer’s Clinical Fellow and Specialist Inspector, General Pharmaceutical Council
“Personally, I use the framework for my own assessment and development. For others, I use it in setting standards for independent prescribers in practice and assuring competence of prescribers at the Trust.“
- Associate Chief Pharmacist – Clinical Services, Kings College Hospital NHS Foundation Trust
Help prescribers identify strengths and areas for development through self-assessment, appraisal and as a way of structuring feedback from colleagues.
“I have used the framework as a tool for self-development while doing my independent prescribing course and also the Centre for Pharmacy Postgraduate Education (CPPE) General practice pathway. The statements allowed me to build portfolios for each programme. The CPPE pathway included cased-based discussions, multisource feedback, patient questionnaires, reflective essays. I was able to overlap these with the competencies in the prescribing framework, this helped me to identify gaps in my knowledge and also see how I had progressed from when I did my independent prescribing course to when I did the CPPE pathway.
While doing my independent prescribing course, I created a spreadsheet documenting the evidences against the competencies and would go through them with my Designated Prescribing Practitioner (DPP) during appraisals. I gained feedback, reflected and identified where there were gaps and what types of evidence would be needed to address these gaps.
When expanding my scope of prescribing, I was able to use the framework to make sure I demonstrated and had evidence of each competency to practise in my new area. This helped me identify if any previous learning overlapped or if I needed any refresher training. By evidencing, I was able to get sign off from my DPP/employer to deliver clinics safely and confidently within my new scope. This also helped with my indemnity insurance requirements.”
- GP practice-based pharmacist prescriber
Patients
Inform and assure patients about the competencies of a safe and effective prescriber
“The framework provides a straightforward and comprehensive set of guidelines for all prescribers to use alongside their own professional training and experience to ensure their prescribing is safe, appropriate and effective. The framework gives patients an insight into the many facets of prescribing. Patients who read it can have confidence that their prescriber has authoritative and comprehensive support at hand to provide the best care possible when it comes to issuing prescriptions and reviewing their treatment. It can also be used in the following ways:
- A resource for patients and carers to inform them of the competencies they can expect of a safe and effective prescriber
- A source of reassurance about the depth of training, resources and support for prescribers
- An authoritative guide for any patient or carer who may have concerns about the practice of their prescriber.
Where necessary, to assist patients or carers make an informed complaint if they believe they have received poor care from a prescriber.”
- Expert patient advisor
Professional regulators
“Educational - The General Pharmaceutical Council (GPhC) sets standards for the education and training of pharmacists to become prescribers. These standards require that the curriculum for independent prescribing embeds the GPhC's learning outcomes for independent prescribing. The GPhC took account of the prescribing competency framework when developing the learning outcomes. Our prescribing standards work in conjunction with the competency framework and other standard for pharmacy professionals, to help ensure consistency and quality in programme design.
Fitness to practise - We have also investigated cases where we have received concerns related to inappropriate prescribing practices; examples include:
- A registrant prescribing in new areas without demonstrating that they are competent to do so
- Failure to adapt the consultation model to suit the setting through which patient care is provided such as online or remote prescribing
- Failure to follow the appropriate safeguards when prescribing for vulnerable patients such as patients who are at risk of drug misuse and abuse
- Failure to follow the appropriate governance arrangements when prescribing unlicensed or off label medicines
- Failure to access and interpret available patient’s records and all relevant information to ensure an up to date knowledge of a patient’s clinical status
- Failure to collaborate with other healthcare professionals who are sharing responsibility for a patient’s care to ensure continuity of care
- Failure to follow best practice guidelines or failure to use validated prescribing tools; such as inappropriate antimicrobials prescribing or not using validated dosing/drug conversion calculators/table.
"Our In practice: Guidance for pharmacist prescribers sets out the key areas pharmacist prescribers should consider when applying the GPhC standards for pharmacy professionals and registered pharmacies to their prescribing practice. We also emphasise that our guidance should be read alongside other professional and regulatory guidelines such as the RPS competency framework. Not following our guidance, or not taking the appropriate steps to ensure safe prescribing, could result in the registration of the pharmacist prescriber being at risk.”
- General Pharmaceutical Council
“The Health and Care Professions Council (HCPC) has adopted the RPS competency framework for all prescribers as its standards for all prescribers. HCPC approved prescribing programmes must therefore demonstrate that they equip graduates to meet the framework once they have completed their prescribing training. Registrants must also continue to meet the competencies in this framework once in practice.
"HCPC registrants with non-medical prescribing qualifications can use the competency framework in their continuing professional development, to ensure they are keeping their skills and knowledge up to date. They can also use the Framework to evidence their training to employers and colleagues.”
- Health and Care Professions Council
“Educational - The NMC approves all prescribing programmes and modules that may be undertaken by registered nurses and midwives who wish to gain a prescribing annotation against their entry on the register and prescribe as part of their practice. The competency framework represents the course outcomes we require to be delivered by all of our approved programmes. As part of our approvals process, approved education institutions will have to clearly demonstrate how their programmes deliver the competencies set out in the framework. Those unable to do so will not be approved by the NMC.
"Revalidation and continuing professional development - All NMC registrants must revalidate every three years in order to remain on our register. Our revalidation processes and the Code require all registrants to complete ongoing training and continuing professional development activities in order to keep their knowledge and skills up to date, to maintain and develop competence and to improve performance. This ongoing training and development must reflect their scope of practice. The competency framework enables those of our registrants who are qualified prescribers to reflect on their performance in relation to this area of their practice, compare it to a document that reflects our stated proficiencies for safe and effective prescribing practice, and to identify any training and development needs they may have that would improve their practice in this area.
"Fitness to practise - The Nursing and Midwifery Council (NMC) has adopted the RPS competency framework for all prescribers as its standards of proficiency for all nurse and midwife prescribers. As such it represents the benchmark for safe and effective prescribing practice for all prescribers registered with the NMC. Should any of our registrants be referred to us for fitness to practise purposes on a matter relating to prescribing error or misconduct, it is the competency framework that we would refer to as our main indicator and guideline as to whether the actions taken were in line with what is required for safe and effective prescribing practice.”
- Nursing and Midwifery Council
Professional bodies and other organisations
Provide professional organisations or specialist groups with a basis for the development of levels of prescribing competency, for example, from recently qualified prescriber through to advanced prescriber.
“The College of Paramedics has recently undertaken a review of their ‘Practice guidance for paramedic independent and supplementary prescribers’. The colleges medicines special interest group used the RPS competency framework for all prescribers to ensure that the colleges guidelines aligned with the national standards for all prescribers.”
- College of Paramedics
“The Chartered Society of Physiotherapy (CSP) expects all of our members who are HCPC annotated prescribers to follow the RPS competency framework. This framework supports our ‘Practice Guidance for Physiotherapist Prescribers’. The CSP believes the competency framework offers a robust way in which physiotherapist prescribers can demonstrate their prescribing capabilities as well as identify areas for continuing learning in a way that supports both patient safety and professional development. “
- The Charted Society of Physiotherapy
“Our Trust runs a Prescribing Academy which provides focussed continuing professional development and active learning group sessions, conferences and career support for non-medical prescribers (NMPs). This is supported by a virtual faculty of senior clinical leaders and linked to the local NMP course providers The Academy works to promote prescribing portfolio development and has a range of easily accessed digital ‘standard operating procedures, guidance and tools. Through a ‘Preceptorship’ style support process, the Academy has guided NMP development and enabled the trust to meet the changes around NMP education/clinical standards and guidance including the development of new Designated Prescribing Practitioners all based on the principles of the prescribing framework.”
- NMP Lead at Dorset HealthCare
Help healthcare professionals prepare to prescribe and provide the basis for on-going continuing education and development programmes, and revalidation processes. For example, use as a framework for a portfolio to demonstrate competency in prescribing.
“As prescribers, we look at the competency as two parts of prescribing practice. These are to both support consultation and promote good governance. The patient is central in the prescribing process and the framework supports shared decision making. It facilitates a contract which is negotiated between the patient and the prescriber. The framework supports us to improve medication optimisation.”
- Community team delivering acute care at home to patients
“From a governance perspective, our non-medical prescriber (NMP). Register and revalidation process involves NMPs engaging with and understanding their responsibility by providing portfolio evidence of on-going continuing professional development, activity competence and learning. We encourage demonstrating competence by evidencing against the competencies in the framework. Annual revalidation and self-declaration of competence to prescribe is proactive and linked to the trust appraisal process and advancing career development.”
- NMP Lead Dorset HealthCare University NHS Foundation Trust
Inform the development of organisational systems and processes that support safe effective prescribing, for example, local clinical governance frameworks.
“During the pandemic, staff were being redeployed and changes in prescribing were ongoing in the bid to try and improve outcomes of COVID-19 patients. This situation had the potential to require non-medical prescribers (NMPs) to prescribe differently both in modality and pharmaceuticals. Our Trust pharmacist NMPs presented a session on the use of the Prescribing Framework to enable prescribers to safely expand their prescribing. By using the framework to look at the key areas that were different to their normal practice.
- Prescribing a new drug or looking at polypharmacy involving new drugs/drugs used in a different way
- Prescribing in a different way e.g. remotely, due to increase in telephone and video appointments as a result of reducing hospital visits and change in resources due to the pandemic.
"With this approach NMPs were able to focus on key elements within the framework to focus their continuing professional development to extend their prescribing practice safely and confidently.”
- Skull Base Specialist and Neuro Review Radiographer, Bristol Cancer Institute, University Hospitals Bristol NHS Trust. Society and College of Radiographers
Stimulate discussions around prescribing competencies and multidisciplinary skill mix at an organisational level.
“Our Trust runs a Prescribing Academy for non-medical prescribers (NMPs) where we use the competency framework for training and development purposes. The success of our Academy model has meant that the NMP membership is growing rapidly and now benefiting from a range of NMP education programmes and resources including specialist mental health, public health and community focussed education and uses a related trust developed career development framework to support clinicians from a range of professions.
"Recognition of the Prescribing Academy has meant opportunities for NMPs to share ideas regionally and the model to be used as the basis for the Health Education England Wessex publication of the Red Green and Blue NMP guidance books, to ensure a standardised approach to NMP governance, education, experience, expectation and value.
"Our Academy is also looking toward establishing development links to inform, merge and progress towards a single recognised advanced community care joint NMP/Advanced clinical practice strategy“
- NMP Lead Dorset HealthCare University NHS Foundation Trust
Inform organisational recruitment processes to help frame questions and benchmark candidates prescribing experience.
“We use the framework as part of our independent prescriber course application form where we ask applicants to rate their current level of competence in ten of the competencies. We also use the framework as part of our Designated Prescribing Practitioner (DPP) application form where we ask prospective DPPs to explain how they will facilitate their trainee prescriber in developing ten of the competencies during their course.”
- Senior Lecturer in Pharmacy Practice, Course Leader MSc Advanced Pharmacy Practice including Pharmacist Independent Prescribing, Robert Gordon University
Education providers
Inform the design and delivery of education programmes, for example, through validation of educational sessions (including rationale for need), and as a framework to structure learning and assessment.
“The Northern Ireland Centre for Pharmacy Learning and Development (NICPLD) has embedded the competency framework into a practice portfolio which forms part of our accredited independent pharmacist prescribing programme. All pharmacists use the practice portfolio to document their developing competency over the course of the programme with the expectation that pharmacists document their competency against most statements in the competency framework before qualifying as a prescriber. The practice portfolio is submitted to NICPLD for assessment and must be passed independently of all other elements of the course to qualify as a prescriber.”
- Associate Postgraduate Pharmacy Dean, The Northern Ireland Centre for Pharmacy Learning and Development
“In my work as an active non-medical prescriber (NMP) and NMP clinical Lead for Dorset HealthCare, I have come across many examples of where the RPS Prescribing framework supports NMPs and provides quality and safety in prescribing practice. In our Trust we have, for a number of years, been running a Prescribing Academy which functions via a Governance and Educational arm both designed and delivered using the prescribing framework to provide continuous learning and assurance in prescribing”
- NMP Lead Dorset HealthCare University NHS Foundation Trust
Inform the development of education curricula and relevant accreditation of prescribing programmes for all prescribing professions.
“The framework underpins the curriculum for the multi-disciplinary independent prescribing programme to develop core skills ensuring safe and effective prescribing practice. It's use in the reflective portfolio supports professionals in their journey to becoming an independent prescriber during the course and provides a foundation for ongoing learning and development throughout their career.”
- Director of Postgraduate Studies, School of Pharmacy, University of Birmingham; Independent Prescriber
“I have used the competency framework for all prescribers in a mapping document prepared for the Nursing and Midwifery Council. It showed that the learning outcomes of an educational course covered all the essential elements required to become a prescriber. The mapping will also be of use to the course provider to reassure them that all aspects are covered. It is also of benefit to the students to see how the programme maps to the required competencies.”
- Professor Emerita, University of Reading