Kent, Surrey and Sussex Pharmacy Annual Report 2015-16
Contents Executive Summary... 2 1 Introduction... 5 2 Delivering the HEE mandate and supporting the KSS Skills Development Strategy... 5 2.1 Urgent and Emergency Care... 5 2.2 Primary Care... 6 3. Developing tomorrow s workforce Investing in New Trainees... 8 3.1 Pre-registration Trainee Pharmacist Training... 8 3.2 Pre-registration Pharmacist Tutors (Educational Supervisors) 2015-16...15 3.3 Pre-registration Trainee Pharmacist Commissions 2016 2017...17 3.4 Pharmacy Undergraduates 2015...20 3.5 Pre-registration Trainee Pharmacy Technicians...22 3.6 Pre-registration Trainee Pharmacy Technicians Educational Programme Director Support...27 3.7 NVQ/QCF Infrastructure (KSS Only)...27 3.8 Trainee Pharmacy Assistants (KSS Only)...27 3.9 Apprenticeships Band 1-4 pathways...28 4 Developing the existing workforce supporting qualified staff... 29 4.1 Pharmacy Accreditations...29 4.2 Pharmacy Foundation Training (band 6 and 7 pharmacists) KSS only...35 4.3 Foundation Pharmacist Educational Supervisors and Programme Directors...37 4.4 Management Skills for Senior Pharmacy Staff...38 4.5 Safe Prescribing...38 5 Quality Management... 43 5.1 Visits and Reporting...43 5.2 Trainee Voice and Educational Support...45 5.2.3 Trainees requiring additional support (TRAS)...46 6 Delivering the service... 47 6.1 Ways of Working...47 6.2 Staff...47 6.6 Communications...51 1 P a g e
Executive Summary Health Education England s Kent Surrey and Sussex (HEE KSS) Pharmacy Team plays a major role in supporting the educational infrastructure to underpin the commissioning of training and development of the future and existing pharmacy workforce across Kent, Surrey, Sussex, Hampshire and Isle of Wight. Pharmacy Education Reform Health Education England Pharmacy Education Reform Team has been leading work streams to contribute to the vision of an integrated 5 year MPharm degree. The Head of HEE KSS Pharmacy has led the work stream on recruitment and has been working with local stakeholders to pilot and prepare for the new processes. More detail on these processes can be found in full the report. In addition, the HEE KSS Interim Head of Pharmacy has chaired the Skills for Health review of National Occupational Standards for Pharmacy Technicians on behalf of HEE. The Interim Head has also contributed to the development of Level 2 Trailblazer standards for apprenticeships and is a member of the drafting group for the GPhC review of Initial Education and Training Standards for Pharmacy Technicians. This work has been shared and visions scoped locally with Education Programme Directors to support implementation. HEE KSS Skills Development Strategy Through the KSS Pharmacy Workforce Group established in 2013 to support the wider remit of pharmacy education across sectors, we have ensured that pharmacy and medicines related perspectives and actions are included within programmes. This is particularly relevant in the Emergency Care and Primary Care programmes. Primary Care Programme I. Community Education Provider s Network (CEPN) Pharmacy Project This project is in its second phase with two work streams that have been implemented to support the primary care national drivers The first work stream aims to place pre-registration trainees from community pharmacies into GP practices, with a reciprocal arrangement for GP trainees. We have delivered against key milestones with 20 community pharmacy pre-registration pharmacist trainees undergoing training in GP surgeries. The second work stream aims to build and provide a regionally-managed and quality-assured tutor training programme for community pharmacy, incorporating tutors from multiple community pharmacy contractors. We were successful in bidding for additional funding to deliver a 2 P a g e
preregistration tutor training and development programme to 50 pharmacists working across London and the South East. The training and development programme was based on the model successfully piloted in Kent Surrey and Sussex for tutors supporting preregistration pharmacist trainees within the CEPN pharmacy project. Resulting in a total of 80 having been trained or are due to complete training. Urgent and Emergency Care Programme I. Pharmacist Prescribers in Emergency Departments Health Education England commissioned a study on pharmacists working within the emergency departments of acute trusts; four trusts in KSS supported this national pilot. The report on this study is available via the HEE website here: http://www.hee.nhs.uk/sites/default/files/documents/pied%20national%20report.pdf II. Community Pharmacy Supporting the Urgent and Emergency Care agenda A HEE KSS project group was formed to look at up skilling community pharmacy teams to support the Urgent and Emergency Care agenda working with the Academic Healthcare Science Network (AHSN). This resulted in CPPE being commissioned to develop distance learning packs for community pharmacies. Evaluation of this work led by Medway School of Pharmacy is due to be published and will support a second project plan. Safe Prescribing This programme is an enabling project for other Skills Development Strategy programme. I. Non-medical prescribing A total of 230 non-medical prescribing places have been commissioned (October 2015 January 2017) to enable Nurses, Midwives, Podiatrists, Physiotherapists, Pharmacists and Radiographers to become supplementary and independent prescribers. Those applying for the course must meet minimum experience and numeracy requirements, which enables recruitment of the candidates with the right skills that are able to successfully pass and go onto be safe prescribers in practice. These places have been offered to members of staff providing NHS services in both primary and secondary care to support the use of non-medical staff in advanced roles e.g. in urgent and emergency care and general practice. II. Diagnostic Prescribing Assessment The multidisciplinary Prescribing Assessment Group (PAG) refined the Foundation Doctors diagnostic prescribing assessment which consists of five scenario based written prescribing questions and 12 electronic multiple choice questions. The written assessment was carried out in all 11 trusts in KSS and 5 trusts in London and was undertaken by 753 F1 s which is an increase of 3 P a g e
231 (44%) on the previous year. The MCQ was available to all STFS trainees and 851 completed it. Pre-registration Pharmacists and Trainee Pharmacy Technicians The summer registration exam pass rate for the 60 HEE KSS managed pre-registration pharmacists continues to exceed the national average (83% vs. the national rate of 74%). Following the September 2015 GPhC exam the 2014-15 cohort pass rate was 60%. Retention within the NHS for KSS/HIOW 2014-15 pre-registration pharmacists has increased from last year to 85.45%, in comparison to 74.5% in 2014. 45 pre-registration trainee pharmacy technicians (PTPT) completed their qualification by August 2015. Of these, 80% were retained within the NHS which is up from last year s 73.6%. Foundation Pharmacists To assist with the facilitation of the workplace element of the Foundation Pharmacist programme, we have implemented e-portfolio for the 42 stage one trainees who started in January 2016. Managing and Enhancing Quality Multi-professional quality management processes are currently in national development with local offices feeding into the process. We have been working with colleagues to further develop our pharmacy processes to support a multi professional approach. During the period of April 2015 March 2016 we carried out four routine quality visits and one follow up visit. 4 P a g e
1 Introduction The Health Education England Kent, Surrey and Sussex (HEE KSS) Pharmacy Team play an integral role in the delivery of the HEE mandate. We have led or been actively engaged in several national projects and pilots to support the delivery of local and national priorities for HEE. In addition we continue to support the commissioning, training and development of preregistration pharmacists, preregistration pharmacy technicians and foundation pharmacists to ensure that adequate numbers are trained and to a high standard. In the report below we will describe this in more detail. 2 Delivering the HEE mandate and supporting the KSS Skills Development Strategy All HEE KSS pharmacy activity links to the strategic vision of HEE. Of greatest direct significance is the national programme to reform pharmacy education. We continue to refine and develop our preregistration recruitment and quality management systems to ensure they are well prepared for a new model of initial pharmacy education and training. The following are an example of our inputs: HEE KSS has developed and invested in a Skills Development Strategy which aims to address the key strategic workforce needs in Kent Surrey Sussex. We have supported these initiatives either directly or via the KSS Pharmacy Workforce Group. Further detail is outlined below:- 2.1 Urgent and Emergency Care 2.1.1 Integrating community pharmacy into urgent and emergency care pathways: a skills development programme This project aimed to increase the contribution community pharmacy makes to delivering safe, sustainable and effective care, by improving the capabilities of pharmacists and their teams, particularly during the GP out of hours periods. Increasing the contribution made by community pharmacy will increase capacity in primary care and reduce pressure on other emergency and urgent care services. The project was funded by Health Education England working across Kent Surrey Sussex and is managed by a consortium of local pharmacy network leads, other key stakeholders and the Kent Surrey Sussex Academic Health Science Network (KSS AHSN). The project involved up-skilling community pharmacists to understand the urgent and emergency care pathways and confidently respond to patients with minor ailment queries, referrals from NHS 5 P a g e
111, requests for repeat medication out of hours and other issues that could be dealt with in community pharmacy but often take patients to their GPs. The development and delivery of the curriculum and a distance learning pack was undertaken by the Centre for Pharmacy Postgraduate Education (CPPE), each pharmacist and pharmacy technician living in Kent, Surrey and Sussex received a pack. The impact of this learning pack was evaluated by Medway School of Pharmacy and the distance learning pack is going to be used by CPPE for its national campaign in 2016. 2.2 Primary Care 2.2.1 The CEPN Pharmacy Project Within the context of a national drive for closer working practices and increased collaboration within primary care, the Community Education Providers Network (CEPN) pharmacy project is now in its second phase. The project consists of two main work streams. The first work stream aims to place pre-registration trainees from community pharmacies into GP practices, with a reciprocal arrangement for GP trainees. The second work stream aims to build and provide a regionally-managed and qualityassured tutor training programme for community pharmacy, incorporating tutors from multiple community pharmacy contractors. The project features multiple stakeholder collaboration across the KSS region, and has achieved a number of milestones to date. For the initial piloting phase, a group of five GP surgeries which employ practice pharmacists was enrolled. Six trainees from multiple community pharmacy contractors were identified to undergo these placements, before which they attended a GP Introduction Day run by the Programme Director and Senior Practice Pharmacist Lead for the GP group. A regional tutor training programme was devised. The provider of a quality-assured tutor training e-learning programme was recruited, and piloting of the modules by existing community pharmacy tutors was undertaken. The pilot stages for both work streams were evaluated. The full report can be found on http://tinyurl.com/zl2h24t. The evaluation informed a wider rollout. Placements for 20 community pharmacy trainees in GP surgeries which do not employ practice pharmacists began in April 2016, with a number of GP trainees undertaking a reciprocal placement in community pharmacies. All pharmacy tutors with trainees undergoing the placements were enrolled on a regionally-managed tutor training 6 P a g e
programme, consisting of face to face training, e-learning modules and peer evaluation. This programme has now been extended to include a further 60 pharmacists across the KSS geography under the CEPN project banner, and has provided the template for further tutor training opportunities through the HEE tutor training programme (see section 3.2.3). In addition, two sister projects have begun in North, Central and East London. The first mirrors the KSS project, with the second following the trainee programme template but involving qualified GPs and pharmacists. Increased participation means an increasing portfolio of community pharmacists with in-depth knowledge and pre-existing links with many more GP practices, with the potential to massively enhance the role of community pharmacy in the future. 2.2.2 Health Champions A successful programme of recruitment in South London has so far trained over 800 frontline pharmacy staff to be Health Champions. This network is helping to deliver and support public health initiatives within the local population, and has recently been extended to the KSS geography. Currently approximately 200 staff members have been recruited, with training being rolled out in localities once sufficient numbers have signed up. Recruitment is ongoing and an end target of 600 trained individuals is planned. It is hoped that these Champions will form local networks to collectively deliver public health messages to their populations, providing a unified message and highlighting the role of pharmacy as the first port of call for patients seeking healthcare help and advice. A similar programme is seeking to train 200 Health Champions in North West London, further extending this initiative across the London and South East region. 2.2.3 Practice Pharmacist Scoping Exercise and Training Needs Analysis There is awareness that a number of pharmacists currently work in patient-facing roles in GP surgeries, but no clear indication of how many there are. These pharmacists probably have a need for educational support, but no recognised route of provision for this support. Therefore a scoping exercise across the London and South East geography to ascertain their number and identify their educational needs was conducted. A full report of the findings can be found here: http://tinyurl.com/h9ev64c. A task and finish group to formulate an action plan to deliver the support required has been established, and will report outcomes in due course. 7 P a g e
3. Developing tomorrow s workforce Investing in New Trainees 3.1 Pre-registration Trainee Pharmacist Training Unlike other health professions, the pharmacy undergraduate degree programme is funded through the Higher Education Funding Council (HEFCE) and therefore is not linked to NHS workforce planning. At present, the rate limiting step between completion of a pharmacy degree and registration as a pharmacist is completion of a pre-registration year in practice. This is primarily achieved through one of two routes NHS funded programmes in hospitals and clinical commissioning groups or community pharmacy programmes funded through a Department of Health Training grant paid directly to community pharmacy contractors. Health Education England, working across Kent Surrey and Sussex (HEE KSS) Pharmacy team manages NHS funded pre-registration training in Kent, Surrey, Sussex, Hampshire and the Isle of Wight. This service comprises:- Advice to HEE s Kent, Surrey & Sussex and Wessex local teams contracts and commissioning managers on the capacity and capability of organisations to train preregistration pharmacists. Marketing of NHS careers to pharmacy students. Participation in a national clearing house and centralised recruitment into pre-registration posts. Maintaining a database of trainees in post. Access to study days and training resources to supplement training provided at base hospitals. Formative assessment of the clinical competence of preregistration pharmacists. Troubleshooting training problems and supporting trainees in difficulty. Training new pre-registration pharmacist tutors. Facilitating a pre-registration tutor network. Quality Management of Local Education Providers. 3.1.1 Pre-registration Trainee Pharmacist Intake August 2014-2015 63 pre-registration pharmacist training places were commissioned; 20 in Hampshire & IOW and 43 in Kent, Surrey & Sussex. One trainee at Western Sussex Hospitals NHS Foundation Trust declined their post before starting; one trainee at Hampshire Hospitals NHS Foundation Trust failed the MPharm degree; one trainee at NHS Isle of Wight commenced training but resigned from employment on 1 st November and returned overseas. 8 P a g e
Table 1 Pre-registration Trainee Pharmacist commissions and exam results 2014-15 HEE KSS HEE Wessex (H&IOW only) No of commissions 2014/15 43 20 Number in training 42 18 Number sitting June 2015 exam 41 18 Number passing June 2015 exam 33 16 Number sitting Sept 2015 exam 1 st time 1 0 Number passing Sept 2015 exam including re-sits 5 1 Overall exam pass 38/42 (90%) 17/18 (94.4%) Number eligible to register 38/42 (90%) 17/18 (94.4%) KSS Exam Failures One trainee who failed the June exam did not sit the September exam (passed equivalent exam in Greece) One trainee who sat the September exam for the first time was given a three month extension; failed 1 st attempt. One trainee who failed both exams has secured a 6 month community pharmacy placement and is considering taking exam in either June or Sept 2016. Five trainees passed on 2 nd attempt. H&IOW Exam Failures One trainee who failed the June and September exam is undertaking a 6 month placement within HIOW. This individual had an appeal upheld and the second attempt was nullified and they will be resitting their second attempt in June 2016. One trainee passed on 2 nd attempt. 9 P a g e
3.1.2 Retention/ First Destination Employment for Pre-registration trainee Pharmacists First destination employment for pre-registration trainee pharmacists First destination for the 55 pre-registration trainee pharmacists that are now registered is shown below in tables 2 and 3 with a comparison included for NHS retention figures. Table 2 Retention Data Year % stayed in NHS within region % stayed in NHS 2014/15 61.81% 85.4% 2013/14 52.6% 75.4% 2012/13 51.7% 62% 2011/12 45.2% 54.8% NHS Destinations 2015 % placement hospital 49.1% other NHS hospital in region 12.7% other NHS hospital elsewhere 23.6% 10 P a g e
Table 3 First Destination Employment for pre-registration trainee pharmacists Destination Number/55 (%) National/616 (%) NHS Hospital 47 (85.45%) 450 (73.1%) Community Pharmacy - 6 (1%) Locuming (any sector) 1 (1.82%) 19 (3.1%) Another field of pharmacy 1 (1.82%) 9 (1.8%) Alternate career and other study (including Medicine) 2 (3.64%) 11 (2.9%) Postgraduate research - 12 (1.9%) Travelling 2 (3.64%) 13 (2.1%) Other including permanent move out of country and employment break 4 (7.27%) 28 (4.5%) No data or lost to follow up - 68 (11%) 3.1.3 HEE KSS Pharmacy Training Support for Pre-registration trainee Pharmacists Trainees complete an exit questionnaire to provide feedback on their training experience. Returns were submitted by all 60 (100%) Pre-registration Trainee Pharmacists. Feedback regarding opinions of training at base hospital is reported in section 7, Quality Management. Support and facilitation provided by HEE KSS Pharmacy The majority of trainees felt that HEE KSS Pharmacy communications were clear and helpful with 90% (n=54) agreeing or strongly agreeing that members of the team were accessible. 95% (N=57) found the pre-reg update bulletins useful. The five study days rated the most useful were First Aid, Exam Syllabus Support Day, Community Pharmacy Experience, Induction and Recruitment and Selection. Least useful days were Introduction to Commissioning and Clinical Communication. The three top rated e-activities on the Moodle platform were Calculation Support, Audit support and project guidance and Patient Safety. Least useful were Moodle refresher and netiquette and critiquing evidence and giving feedback. 11 P a g e
We asked all trainees how likely they would be to recommend HEE KSS Region to a friend or colleague, the scale ranged between not at all likely with a score of 0 to extremely likely with a score of 10: 31/60 (51.6%) scored 10 with the remaining 29 (48.4%) scoring between 5 9. There were no negative scores. Competence assessment using Objective Structured Clinical Examination (OSCEs) 86.7% of the pre-registration trainees stated the baseline OSCEs were either useful or essential as part of their curriculum. 78.3% of trainees stated the final OSCEs in March were useful or essential. This reduction in perceived usefulness was investigated; the pre-registration pharmacists reported that they felt the final OSCEs were harder than the baseline and they had not expected this. One of the aims of the HEE-KSS pre-registration pharmacist OSCEs is to determine if the trainees knowledge and skills are progressing throughout the pre-registration year to ensure they are equipped to be an independent practising pharmacist once qualified; therefore the final OSCEs are intentionally pitched at a harder level than the baseline, focussing on identification and resolution of issues. We have addressed this issue by facilitating a session on OSCE at the Induction study day; where the aims and processes of OSCE are explained and initial feedback from this session has been extremely positive. At the baseline OSCEs 75% of trainees passed 5 or more of the 8 OSCE stations. The strongest station was a patient counselling station on the use of inhalers, with 82% of trainees passing. A station regarding antibiotic stewardship and recommendations proved to be the hardest challenge for the trainees; 33% of trainees passed. At the final OSCEs 67% of trainees passed 6 or more of the 10 OSCE stations. The strongest station was the health promotion counselling station (smoking cessation), 88% of trainees passed. Two stations had the joint lowest pass mark of 40%, one regarding a never event, the supply of intravenous potassium, and the other on the supply of chemotherapy. Triangulation of medication history taking skills was assessed in both baseline and final OSCEs; 71% pass rate was seen at the baseline and 75% pass rate at the final. The OSCE Exam Board noted the OSCE results reflected that the validity of the OSCE assessment. Some trainees reported that written OSCE feedback was not constructive. All OSCE assessors are trained by HEE KSS Pharmacy however an OSCE Assessor Refresher programme has been developed which includes examples of appropriate and inappropriate feedback and any reported issues are investigated. 12 P a g e
At the request of our Education Programme Directors (EPD), mandatory telephone feedback was conducted after the final OSCE if the trainee achieved less than a 40% pass mark. This has been deemed useful by the Educational Programme Directors and is to continue. The OSCEs led to more personal study in areas that were recognised for improvement for 76.7% of the trainees and highlighted areas they and their Educational Supervisors needed to focus on for 76.7% of the cohort. 51.7% of the pre-registration trainees had adjustments made to their training after the OSCEs. 3.1.4 Pre-registration Trainee Pharmacist Intake August 2015-2016 64 pre-registration pharmacist training places were commissioned; 21 in Hampshire & Isle of Wight and 43 in Kent, Surrey & Sussex. Table 4 Pre-registration Trainee Pharmacist commissions 2015-16 No of trainees commissioned to commence training August 2015 HEE KSS HEE Wessex (H&IOW only) 43 21 Number in training 42 21 Number of trainees not commenced training - - Attrition 1 One trainee at Medway NHS Foundation Trust resigned in December 2015 due to personal reasons. 3.1.5 Pre-registration Trainee Pharmacist curriculum development for the 2015-16 cohort As a result of feedback from the 2014-15 cohort of trainees and curriculum planning with trainees and the ES network, a number of changes were made for the 2015-16 regional programme. These changes included: Facilitation of an Introduction to OSCE session at the Induction study day and provision of OSCE templates on Moodle (e-learning platform). An evidence-writing workshop at the Induction study day. Increased exam support including; Explanation of the new style GPhC registration assessments. Calculation sessions at baseline OSCE and exam support day including new-style GPhC questions. Provision of new-style GPhC calculation and clinical questions on Moodle. 13 P a g e
Dementia Friends training and qualification session. Development of The World of Pharmacy Breaking Traditional Boundaries study day to highlight the variety of pharmacy careers available, motivate the trainees and facilitate learning of clinical commissioning. Removal of Introduction to Moodle, Netiquette and Critiquing Evidence e-modules. New Patient Safety e-module. Calculations e-module amended to reflect new exam practice. Learning outcomes for clinical pharmacy updated in the regional handbook. Technical Services Training During 2014 and 2015, HEKSS Pharmacy conducted a review of the Technical Services training programme via a working group which included local technical services (TS) managers, TS technicians and educational programme directors (EPD) to look at improving the quality and consistency of TS training across the region. The result of this effort will be reviewed and analysed in the 2016 exit questionnaire Pre-registration Pharmacist e-portfolio Following a full evaluation of the e-portfolio during 2014-15 a new function has been designed to save the trainees time which maps the practice activities trainees complete (a suggested list is in the HEE KSS pre-registration handbook) to the GPhC performance standards for the 2015-16 cohort. 14 P a g e
3.2 Pre-registration Pharmacist Tutors (Educational Supervisors) 2015-16 3.2.1 Tutors Network In the current 2015/16 cohort, there are 74 pre-registration tutors supporting 64 pre-registration trainee pharmacists. HEE KSS Pharmacy have organised and facilitated four meetings in the last year (June, September, January and March) for educational supervisors/ education programme directors and a representative from each trust is expected to attend. The ES network meetings provide a valuable opportunity for discussing and implementing new changes and developments for the regional pre-registration pharmacist programme and offer an opportunity for sharing good practice between different trusts. ES meetings over the last year have included the following: Discussion of trainees in difficulty and sharing advice. Pre-registration Pharmacist recruitment including national proposals on the reform of recruitment, planning, writing interview questions and review. Pilot of Mult-mini Interviews (MMIs). OSCE review and standard setting. Curriculum development and review of regional pre-reg programme. Technical Services review and standardisation. GPhC updates for network. Exam results and retention. Evaluation of pharmacy showcase event and agreed proposals for future event (full report detailed in section 3.3.1). Summer student recruitment and collaborative working. Undergraduate projects. Medicines Information Learning Portal. In response to trainee feedback on clinical training, HEE KSS Pharmacy delivered a session in November 2015 on planning and co-ordinating of clinical training. The event was attended by 25 pharmacists from across the region who are either responsible for the planning and co-ordination or the delivery content. It was a very practical day and included sessions to provide tools and techniques on the minimum clinical knowledge and skills expected of a newly qualified pharmacist, creating a competency programme for a basic clinical rotation and creating a clinical handover for use within trusts to use across rotations. 15 P a g e
3.2.2 Training for new Pre-registration Tutors HEE KSS Pharmacy specifically supports new pre-registration tutors by organising a New Tutor Day. This event sees a range of expert speakers from the region covering an introduction to the role and responsibilities specific to a pre-registration tutor including GPhC appraisals and audit. In June 2015, 16 participants attended the new tutor day and the subsequent follow up day held in September to support the 13 week appraisal milestone. In addition to the study days, HEE KSS commissioned The Pharmacy Training Company to deliver on-line modules and assessments for all new tutors, these specifically cover the following understanding the pre-registration scheme; evidence, what it is and how to assess a trainee's written evidence of competence; problem solving, when training isn't straightforward; final steps, preparing a trainee for the registration assessment and registration. 3.2.3 HEE Tutor Training Additional funding from Health Education England was secured to offer a preregistration tutor training and development programme to 50 pharmacists working across London and the South East. The training and development programme was based on the model successfully piloted in Kent Surrey and Sussex for tutors supporting preregistration pharmacist trainees within the CEPN pharmacy project (details above). All 50 places have been filled on the programme, with the introductory study days due to be held at the end of April. This training and development programme has been designed to provide accessible training with a multi-professional element available across sectors, and applications from pharmacists from both acute and community sectors were received. Joining the pharmacists on the study days will be up to 15 candidates from different healthcare professions, including GP, nursing and the allied health professions, for an afternoon workshop bringing together educators from different healthcare professionals to explore what it takes to develop and support learning in a multidisciplinary educational environment. Outcomes from this project will help inform the HEE pharmacy education reform programme which aims to integrate the undergraduate and preregistration programmes. Further trial and evaluation of this tutor training model will help Health Education England to appraise the impact of this training on a wider scale and inform how and what is commissioned in future to ensure that it will be fit for purpose in the new system. 16 P a g e
3.3 Pre-registration Trainee Pharmacist Commissions 2016 2017 Pre-registration Trainee Pharmacists are recruited in September of the preceding commission year. For the 2016-17 cohort 64 pre-registration pharmacist training places were commissioned; 19 in Hampshire & Isle of Wight and 45 in Kent, Surrey & Sussex. Table 5 Pre-registration Trainee Pharmacist commissions 2016 17 No of trainees commissioned to commence training August 2016 HEE KSS HEE Wessex (H&IOW only) 45 19 There will be a total of 20, 19 of which are commissioned by Health Education Wessex Preregistration Trainee Pharmacists commencing their training in H&IOW in August 2016. 3.3.1 Recruitment and Marketing Regional Showcase and Careers Event A regional showcase and careers event for HEE KSS and HEE Wessex (HEW) was held and all were fully supportive of running the event. The event took place on Saturday 11 th April 2015 at St. Thomas Hospital, London. To tie in with this new initiative, we commissioned Larchmont Films to produce a ten minute film promoting pre-registration pharmacist training in Kent, Surrey, Sussex and Hampshire. The film was premiered at the start of the day and then posted on our website and YouTube and advertised on social media after the event. The film has been future proofed so that it remains current and relevant for a number of years. The film is available here: https://www.youtube.com/watch?v=8_kz2cqhxwi 15 of the 16 trusts/organisations within the South East region were represented at the event. There were a total of 50 trust representatives who attended and these ranged from educational programme directors (EPDs), educational supervisors (ESs) and current/past pre-reg pharmacists. Unfortunately Care UK (HMP Isle of Wight) were unable to attend at late notice but were able to provide a promotional leaflet for students interested in prison pharmacy for their pre-reg. Around 132 students from a range of Schools of Pharmacy across the country attended the event. 75 (57%) provided feedback which was overwhelmingly positive about the event with the majority of students enjoying the day whilst finding it extremely informative. The less positive comments were generally around the time allocation of the day (e.g. suggesting equal number of talks in the 17 P a g e
morning and afternoon as the morning block was too long) and the lack of space and time with the trusts. This event has been developed based on the feedback from both students and trusts and will be held on 16 th April 2016. Students will be split into two groups allowing for smaller groups and more dedicated time spent talking to trusts. Table 6 How likely are you to choose a trust within the HEE KSS region for your pre-reg year? Answer Options Before you attended the event After you attended the event Very Unlikely Unlikely Unsure Likely Very Likely 4 6 35 23 7 1 1 1 25 47 Selection of quotes about the day The sessions were professional and well organised. They were excellent public speakers and I was really impressed with the quality of the presentations Having the stands was a great idea the tips and advice from the trusts were valuable and will help strengthen my pre-reg application It was difficult to visit all the stands I wanted to as there were so many people in such a confined space More time allowance at the showcase would be better since I didn t have enough time to go through all the ones I want to go for The whole day was extremely useful, but I think the insight it gave into training in the Kent/Surrey/Sussex region was probably the most useful. I learnt things about the trusts and the training programme at the showcase that cannot be learnt from just searching online Overall it was a really good day, a lot of the talks were very helpful and Mr Dispenser was entertaining, I'm very glad that I came. Thank you for all the effort you put in to it The day was probably the most important and useful careers event I have attended. The advice and help from trusts, HEKSS and other students was invaluable. I hope that it runs next year too I was sure I wanted to apply for at least one trust within HEKSS before attending. After attending and having a better understanding of the great support and opportunities HEKSS provide, I am considering applying here for all 4 trust options 18 P a g e
Recruitment The total number of applications for the South East region in 2015 was 564 (597 in 2014) a decrease of 5.5%. Students can apply to four hospitals. The total number of applicants was 345 (375 in 2014) a decrease of 8%. A total of 235 students were shortlisted and initially invited for interview; of these, 16 were required to attend interviews on both days due to the Trusts they had applied to. The total number of applicants who cancelled their interview place before the 23rd September was 34; a total of 49 applicants (including those for Brighton & Western Sussex) from the reserve list were subsequently invited between 9th 23rd September. A total of 193 students were interviewed in total (169 in 2014) 28 students did not attend over the 2 days of interviews. 2 students were interviewed before the dates due to overseas placements using the interview assessment paperwork. The 5.5% decrease in applications to the South East region compares to a national 8.0% decrease in applications to hospital across England and Wales compared to 2014. The number of applications was the lowest number since the 2012 intake. The numbers were surprising as they were expected to rise due to increasing student numbers and the end of the Royal Pharmaceutical Society Pharmacy Professional Sponsorship Scheme. One argument for the decrease in numbers is that students are so concerned at how difficult it may be to get a place that they willingly accept the first thing they are offered, which in a lot of cases is a community placement as the large multiples tend to offer these many months before hospital applications open. Interview Assessment process and scoring As part of the interview assessment process; students complete a written prioritisation test which consists of 6 scenarios which require prioritising, 5 multiple choice calculations. Both of these assessments are completed in a classroom style environment with a maximum of 20 students at a time. Each assessment is 20 minutes. Students also complete a 6 minute role play scenario with a simulated patient and assessor to test communication and consultation skills and compassion with an added criteria regarding patient harm. Students have a 20 minute panel interview with representation from the trusts which shortlisted them, this panel interview consists of 8 standardised questions with model answers supplied by all trusts to support consistency of marking. A double marker attended both days of the interviews and rotated around the different interview rooms to ensure consistency and support less experienced interviewers. On the whole, marking was consistent and fair across both days. 19 P a g e
3.4 Pharmacy Undergraduates 2015 We introduced a new application process for the 2015 summer placements for undergraduates. 3 rd year pharmacy students applied on-line via our website. All applications were then circulated electronically to all participating trusts within KSS and H&IOW. There were 18 participating organisations for the summer of 2015 including the first joint community/hee KSS placement. Students could apply for as many organisations as they wanted; this resulted in an overall number of applications of 1680. Total number of applicants was 289. This new process reduced the burden of applications being received directly to trusts from students. Summer placements for pharmacy undergraduates are funded within Hampshire & Isle of Wight by Health Education England Wessex. The numbers of commissioned places are shown in the table below. Table 7 Funded Undergraduate summer placements Health Education Wessex (H&IOW only) Trusts hosting placements in 2015 4 Number of placements 2015 16 Number of students participating 15 Number of total weeks funded 60 Placements for 2015 15 placements totalling 60 weeks were funded across four acute trusts in Hampshire & Isle of Wight. Portsmouth Hospitals NHS Trust had one student decline their placement. The handbook was revised and updated, with input from the pre-registration pharmacist tutors and previous summer students, to ensure that the contents continue to guide the students through a successful placement. The summer student scheme study day was delivered in the Hampshire and Isle of Wight region at the end of June 2015 at the start of the university summer vacation. Topics covered included an introduction to the pharmacy team structure, hospital pre-registration training delivered by two current pre-registration pharmacists from Hampshire who were coming towards the end of their training, a session on NHS pharmacy career structure presented by a Consultant Pharmacist and a session covering the HEE-KSS Pharmacy pre-registration training programme including details of the interview process. The day was well received by the undergraduates and they found the presentations by the current pre-registration pharmacist and the career pathway information particularly useful. 20 P a g e
Retention of Pharmacy Undergraduates into Pre-registration Trainee Pharmacist placements Three of the 15 pharmacy undergraduates completing placements within Hampshire & Isle of Wight in the summer of 2015 have successfully secured a pre-registration pharmacist training post commencing in August 2016; a further three have secured a pre-registration pharmacist training post within Kent, Surrey and Sussex. 21 P a g e
3.5 Pre-registration Trainee Pharmacy Technicians Health Education England, working across Kent Surrey and Sussex (HEE KSS) Pharmacy team supports trainees for both registered and unregistered pharmacy support staff in the KSS and Hampshire and IOW through:- Advice to HEE s Kent, Surrey & Sussex and Wessex local teams contracts and commissioning managers on the capacity and capability of organisations to train preregistration trainee pharmacy technicians. Seeking to commission value for money NVQ training through economies of scale. Maintaining a database of preregistration trainee pharmacy technicians in post. Setting up, reviewing and monitoring Service Level Agreements with NVQ centres to provide NVQ registration and support across the region. Troubleshooting training problems and supporting trainees in difficulty. Providing educational support events for Educational Programme Directors. Quality management. 3.5.1 Review of Pre-registration Trainee Pharmacy Technician Education It had been identified that Pre-registration Trainee Pharmacy Technician (PTPT) education provision is variable in terms of quality, sustainability and value for money across the 4 Local offices. Therefore based on this rationale and due to the economies scale working across the geography will support, agreement from the Health Education London & South East Executive Group was obtained to tender for provision of both Pre-registration Trainee Pharmacy Technician qualifications across the 4 Local Offices The rationale for this decision is based on several factors and to support: Sustainability. Value for money. Implementation of contract monitoring based on specifications developed by stakeholders. Inclusion of Quality Management processes for both qualifications. Pharmacy technician workforce modelling. A procurement project led by the Interim Head of Pharmacy for KSS on behalf of the four local offices ran from June 2015 - May 2016. 22 P a g e
3.5.2 Pre-registration Trainee Pharmacy Technicians 2013 2015 Table 8 shows the number of pre-registration trainee pharmacy technicians who were commissioned to commence training in 2013. Commissions are being held at 16 by Wessex to meet workforce demand. Brighton and Sussex University Hospitals NHS Trust recruited 4/6 requested commissions. Kent Community Health NHS Trust had their first trainee who completed their training by December 2015. One trainee resigned from Brighton and Sussex University Hospitals NHS Trust in February 2014. Table 8 Pre-registration Trainee Pharmacy Technician commissions 2013-2015 HEE KSS HEE Wessex (H&IOW only) No. of 1st year commissions 2013 34 16 No of places filled 32 14 Attrition (%) in first year 1 (3%) - Attrition (%) in second year - - Total 31 14 Number qualifying 31 14 23 P a g e
3.5.3 Retention / First Destination Employment for Qualified Pharmacy Technicians First destination for the 45 pre-registration trainee pharmacy technicians that are now registered is shown below in table 9 with a comparison included for NHS retention figures. Table 9 Retention of trainees into NHS posts Year of qualification Retention into NHS posts upon qualification (% of total students qualifying) 2015 80% 2014 74% 2013 83% 2012 84% 2011 77% NHS Destinations 2015 % placement hospital 57.7% other NHS hospital in region 11.1% other NHS hospital elsewhere 11.1% 24 P a g e
3.5.4 Pre-registration Trainee Pharmacy Technicians 2014 2016 Table 10 shows the number of pre-registration trainee pharmacy technicians who started training in the financial years 2014/15. All trainees start in September 2014 and are due to complete by July 2016. Table 10 Pre-registration Trainee Pharmacy Technicians commissions 2014 2016 HEE KSS HEE Wessex (H&IOW only) No. of 1st year commissions 2014 28 14 No of places filled 25 14 Attrition (%) in first year 1 1* Attrition (%) in second year 0 0 Total number of trainees March 2016 24 13 One trainee at Western Sussex Hospitals NHS Foundation Trust declined the offer of a post; it was too late to re-recruit. One trainee at Dartford and Gravesham NHS Trust resigned in November 2014 for personal reasons. One trainee at Portsmouth Hospital NHS Trust is on maternity leave. 3.5.5 Review of training at the end of year 1 (KSS only) A review of year 1 was carried out in June 2015. Responses were received by all 37 trainees (100%) Trainees were asked how well their induction at their trust prepared them for work, the majority (72.9% n = 27) reported either very well or well. Trainees were also asked how well their department induction familiarised them with patients, other staff, duties and health and safety. 97.3% (n=36) trainees were provided with and had access to their educational plan within their first 4 weeks of the year along with having an Educational Supervisor (lead assessor) responsible for overseeing their two year programme. 86.5% n=32 met with their ES to discuss their duties in the post. Trainees were asked how often on average they met with their Educational Supervisor (lead assessor) to discuss progress. 54% n=20 met monthly during the months Sept Nov. This increased to (59.4%, n=22) during the last 3 months May Jul. Meetings with Educational 25 P a g e
Supervisors were mostly always documented (62.2% n=23) with the remaining 35.1% n=13 sometimes documented. One trainee reported meetings were not documented. Underpinning Knowledge Provision and NVQ Assessment for Pharmacy Services Trainees receive their underpinning knowledge provision and NVQ Assessment in a variety of ways within HEE KSS. 43.2% n=16 attend college; 21.6% n=8 complete distance learning packages and 35.1% n = 13 completed a blended learning approach. 3.5.6 Pre-registration Trainee Pharmacy Technicians 2015 2017 Table 11 shows the number of pre-registration trainee pharmacy technicians who started in the financial years 2015/16. All trainees start in September 2015 and are due to complete by July 2017 with the exception of two trainees at East Sussex Healthcare NHS Trust who started in February and March 2016. Table 11 Pre-registration Trainee Pharmacy Technicians commissions 2015 2017 HEE KSS HEE Wessex (H&IOW only) No. of 1st year commissions 2015 34 15 No of places filled 33 15 Attrition (%) in first year 1 (3%) - Number in training 32 15 One trainee at Surrey and Sussex Healthcare NHS Trust withdrew before commencing training. One trainee at Royal Surrey County Hospital resigned in November 2015 due to personal reasons. 26 P a g e
3.6 Pre-registration Trainee Pharmacy Technicians Educational Programme Director Support HEE KSS Pharmacy has facilitated three Educational Programme Director (EPD) network days. The network days are led by the EPDs and provide a forum for sharing good and best practice and promoting the spread of innovation in pharmacy technician training and development. network meetings over the last year have focussed on: Value based recruitment. Implementation of the professional appraisal tool. Support for Trainees requiring additional support. Retention and exit survey summaries. Workforce planning and procurement of education provision across London and South East. EPD Orientation guide. Cross sector placements. PTPT s undertaking the Medicines Management Accreditation. Careers session workshop. National updates. EPD 3.7 NVQ/QCF Infrastructure (KSS Only) During 2015-16 HEE KSS has funded six (eight in 2014-15) a decrease of 25%, new assessors; there was no funding for new verifiers across KSS. 3.8 Trainee Pharmacy Assistants (KSS Only) Pharmacy assistants are required to undertake the Level 2 NVQ Certificate in Pharmacy Service Skills (QCF) either completing the full award or units appropriate to their area of work. This knowledge is gained in the workplace using a training manual to guide their study. Provision is currently purchased via a spot purchase system and trusts can choose between two current providers, Buttercups Ltd and Bradford College, with varying costs. The number of L2 s to be trained is scoped each year; there was a significant increase in the number of L2 s which required training in 2015-16; the predicted number of staff requiring training was greater than the budget available resulting in each trust receiving a proportion of funds for training. This varied depending on the provider and the number to be trained. Overall the initial number of funded L2 s across Kent, Surrey and Sussex was 45 an increase of 25 (55%) from last year. 32/45 (71%) were enrolled with Buttercups and 13 (29%) with Bradford. 27 P a g e
3.9 Apprenticeships Band 1-4 pathways Apprenticeships are a key governmental priority. Health Education England (HEE) has a Department of Health target to double the number of healthcare apprenticeships from 2015/16 and beyond. The use of Level 2 Pharmacy Apprenticeships have historically had a low uptake; the rationale for this has been linked to several external factors: Lack of strategy to support pharmacy departments with understanding the benefits of employing an apprentice or apprenticeship framework requirements. Lack of recruitment strategy for employing apprentices to work as pharmacy assistants. Disparity between regulatory requirements to work as a Pharmacy Assistant and what the apprenticeship framework requires. Link to current development of level 2 pharmacy trailblazer and impact on apprenticeship model. Health Education England working across Kent, Surrey & Sussex (HEE KSS) Pharmacy has recognised the potential to work with pharmacy employers to develop a strategy that will enable an increase in the use of pharmacy apprenticeships for pharmacy assistants. Funding was agreed for a Pharmacy Support Staff Apprenticeship Project Lead to work collaboratively with the HEE KSS Apprenticeship Lead and stakeholders to lead the development of an education strategy. The aim is to implement the use of apprenticeships for pharmacy assistants. The post will also lead on the development of a career pathway for pharmacy support staff in primary and secondary care. This work will contribute to HEE Band 1-4 and Talent for Care agendas. In addition, HEE KSS has developed a proposal for a pilot project to employ 15 Level 2 Pharmacy Apprentices training in both primary and secondary care. The pilot currently has approval from the National Skills Academy and will be funded through HEE KSS project money. Learning from this pilot will be shared with colleagues across the geography to support a cohesive pharmacy apprenticeship strategy. Outcomes of the strategy and pilot will be reported on in 2016 Annual report. 28 P a g e
4 Developing the existing workforce supporting qualified staff 4.1 Pharmacy Accreditations 4.1.1 Training for pharmacists and pharmacy technicians leading to accreditation HEE KSS Pharmacy manages a range of accreditations, which contribute to service development and enhanced roles performed by pharmacy staff. These programmes are:- Final Check of Dispensed Items - Accredited Checking Pharmacy Technicians (ACPT) Pre and In Process Checking in Technical Services (PIPC) National Medicines Management Scheme (NMMS) Practice Supervisor (PS) All programmes meet the requirements stipulated in their respective National frameworks. 4.1.1.1 Core Checking Skills Course for ACPT and PIPC The Core Checking skills course has been developed to deliver the theory elements for both the ACPT and PIPC Accreditation as follows: National Frameworks. Developing a checking a procedure. Attitudes and Attributes of Good Checkers. Pharmacy Law. Feedback Skills. The implementation of the Core Checking Skills course is designed to offer more flexibility as an ACPT or PIPC trainee as they will not need to repeat the same study elements twice if they go on to accredit in the other checking practice area. Number of Pharmacy Technicians completing the Core Checking Skills Course during April 15 - March 16 Kent, Surrey & Sussex H&IOW Other Total ACPT 39 20 4 63 PIPC 8 10 0 18 Thus far there have not been any Pharmacy Technicians go on to accredit in the other checking practice area. 29 P a g e
4.1.1.2 Final Check of Dispensed Items - Accredited Checking Pharmacy Technicians (ACPT) Training for the ACPT Scheme is delivered locally using regional Clusters to minimise disruption to service delivery and to support the NHS move to work-based learning. The Cluster arrangements with Kent, Surrey, Sussex and Hampshire, IoW and Guys and St Thomas NHS Foundation Trust (GSTFT) continue to work effectively and support timely training and assessment. The assessments are rotated around the region with Clusters hosting it on a rotational basis. The organisation, quality management and management of the assessment remain a HEE KSS Pharmacy responsibility. Annual course review meetings are held each July to ensure that e-learning platform activities and face to face study sessions are updated to reflect current practice. The review meeting is attended by all Cluster Leads. Table 14 Numbers of ACPT Trainees Trained during April 15/March 16 Kent and Medway 14 East Sussex 4 West Sussex 11 Surrey 10 Hampshire & Isle of Wight 20 London 4 Total 63 4.1.1.3 Pre & In Process Checking Technical Services (PIPC) This programme has been tailored to meet local needs by the PIPC Accreditation Working Group. The HEE KSS PIPC scheme meets the requirements outlined in the 3rd version of the National Framework. The scheme does not accredit staff to undertake the final release check as this remains the responsibility of the Authorised Pharmacist, however it does provide a valuable mechanism for assuring standards across the region and enabling the transfer of accreditations across organisations in the South of England. 30 P a g e
During 2015 an additional cohort was organised and delivered with the support of University Hospitals Southampton NHS Foundation Trust* see table below. Part of the entry criteria for the PIPC programme is that staff have undertaken Fundamentals of Aseptics training or equivalent. This is funded jointly with London Pharmacy Education & Training (LPET) to improve economies of scale and reduce cost. This day is generally attended by 2 nd year pre-registration trainee pharmacy technicians. Three days have been held during April 2015 March 2016; 33 participants attended from KSS and 21 from H&IOW. Alternative underpinning knowledge is available through other resources including University of Leeds Aseptic Processing DVD. HEE KSS work closely with the Specialist Pharmacy Quality Assurance Teams sharing information on training sites to ensure that if the units have any critical/major sanctions trainees are not impacted upon. Table 15 Number of participants on Pre & In-Process Checking Accreditation Scheme April 15 March 16 Training for Accreditation Schemes Kent, Surrey & Sussex H&IOW Other Total Pre & In Process Checking (PIPC) Sept 15 *additional cohort Pre & In Process Checking (PIPC) March 16 2 4 0 6 6 6 0 12 31 P a g e
4.1.2 National Medicines Management Accreditation Programme (NMM) Medicines management is a method of working that aims to prevent, detect and address medicines related problems, to achieve the optimum use of medicines and ensure patient focused care. Delivery of the National medicines management accreditation programme was re-designed and developed in 2015, based on the needs of stakeholder and in line with National policies and guidance. The following changes were implemented from September 2015 and the main benefits to Trusts from the introduction of these changes are: Ability to complete individual modules and deliver training in-house if preferred, means greater flexibility and accessibility to support effective planning and targeting of resources at Trust level, particularly for 7-day services. Candidates can complete the accreditation over 3, 6 or 12 months, flexible dependant on Trust/organisation support infrastructure and individual candidates. Removal of the requirement for 6 months clinical experience prior to entry will reduce the need for duplicated training and/or in-house assessment models which are currently being used by Trusts to fill the gap. Now, prior to enrolling on the course, pharmacy technicians must undergo a full induction to the clinical ward environment. We recommend Trusts use the APTUK Foundation Pharmacy Framework to identify and address any skill gaps during the induction period so that candidates are best prepared to undertake the accreditation module/s. This framework can be accessed here: http://www.aptuk.org/media/dynamic/files/2014/06/13/aptuk_foundation_pharmacy_fra mework_june_14.pdf Introduction of e-portfolio to facilitate effective submission and assessment of evidence and to keep track of progress. Module 3, Medicines and Device Counselling was removed from the programme and essential communication skills are imbedded into modules 1 and 2. Pharmacy Technicians have access to the CPPE Consultation Skills programme commissioned by HEE. 32 P a g e
Table 16 Number of participants on National Medicines Management Accreditation Scheme April 2015 to February 2016 Kent, Surrey & Sussex H&IOW Other Total NMM (cohort 6) 27 10 2 39 NMM (cohort 7) NMM (cohort 8) 13 plus 21 in-house trainees 13 plus 5 in-house trainees 2 plus 2 in-house trainees 2 plus 5 in-house trainees 0 38 0 25 Total 79 21 2 102 4.1.3 Practice Supervisor Accreditation The Practice Supervisors accreditation is a foundation course which is grounded in the Educational and Practice Supervisors competency framework and will provide an accreditation in being a Practice Supervisor. To achieve the full accreditation, applicants need to complete all three modules which are delivered over a 12 week period as an online course. The following Cohorts were delivered: Cohort 13 March 2015 Cohort 14 September 2015 Cohort 15 February 2016 No significant changes to the curriculum have been made during 2015-16. Table 17 Number of participants on Practice Supervisors Accreditation April 2015 to March 2016 Kent, Surrey & Sussex H&IOW Total Cohort 13 14 5 19 Course not completed 1 withdrawn 3 deferred* Cohort 14 19 9 28 4 deferred Cohort 15 17 4 21 - Overall 50 18 68 * one of the deferred candidate from cohort 13 completed in cohort 14. 33 P a g e
4.1.4 Assessment of Competence & Accreditation The numbers of candidates undertaking the assessment and their success rates are shown in table 18. The figures are shown for the Period April 2015 to March 2016. The number of candidates coming forward for assessment is not in line with the numbers enrolling on courses as candidates complete practice activities at their own speed and may come forward for assessment at any time in the 18 months following enrolment. Table 18 Number of candidates taking assessment and pass rates Accreditation Assessments Kent, Surrey & Sussex H&IOW Other Pass rate ACPT (4 exams) 24 14 6 92% PIPC 9 10 0 95% National Medicines Management (2 exams) Practice Supervisor cohort 13 Practice Supervisor cohort 14 27 15 0 84% 10 3 0 87% 11 9 0 83% Table 19 Number of practising accredited staff within the HEE KSS Pharmacy region from April 2015 to March 2016 Accredited Scheme Reaccreditations Accrediting for first time Total practising accredited staff Accredited Checking Technicians 211 42 465 Pre & In-Process Checking Accreditation 17 10 52 National Medicines Management 95 47 258 Practice Supervisor Accreditation N/A 34 156 34 P a g e
4.2 Pharmacy Foundation Training (band 6 and 7 pharmacists) KSS only The Foundation Pharmacist programme comprises a Postgraduate Certificate (stage 1) and Diploma (stage 2) in General Pharmacy Practice (delivered jointly by the University of Brighton and Medway School of Pharmacy) accompanied by a workplace programme of guided learning and formative assessment. The course is commissioned for Foundation Pharmacists who are employed by NHS trusts within the region. 4.2.1 Foundation Pharmacist Programme Updates Every year changes are made to assist the facilitation of the workplace place element of the programme. Over the last year the following new initiatives were implemented: An electronic portfolio was created for the foundation programme and has been implemented for the 2016 cohort of Foundation Stage One trainees. The implementation of the e-portfolio will be a phased approach with an aim to implement for stage 2 trainees in 2017. A training module for the Record of In-service Training Assessment (RITA) was launched on the e-training for Trainers website (http://www.etft.co.uk/). This module is primarily aimed at educational supervisors but is also applicable to foundation pharmacists, and those involved in the foundation pharmacist programme. A training module for Medication Related Consultation Framework (MRCF) was also created and implemented on the e-training for Trainers website (http://www.etft.co.uk/). This module is also applicable and accessible by other trainee groups to other programmes such as pre-registration pharmacists and medicines management pharmacy technicians. This module is primarily aimed at practice supervisors carrying out the MRCF assessment but is also of use from trainees and those involved in the relevant programme. Two open evening events were held for prospective foundation pharmacist trainees. These were held in September and October and received excellent feedback. Our website has been expanded to host all workplace programme information, to assist trusts in accessing the most relevant and up to date information in a convenient way. 35 P a g e
4.2.2 Foundation Pharmacist Intake January 2016 There were 42 applications from the 11 trusts in Kent, Surrey and Sussex for the 2016 intake. All applicants successfully started the programme on the 1 st January 2016, however two applicants withdrew from the programme by 12 th January, both had accepted job offers in hospitals outside the region. 4.2.3 Foundation Pharmacist Retention Information Foundation pharmacists are employed by acute and community health trusts within the region and they often move when opportunities arise. The retention information of the foundation pharmacists in current cohorts is below. The attrition rates include those trainees who have left the region but are still on the programme. Table 20 Retention information for Foundation Pharmacists entering programme at Stage 1 of the programme. Commissions Attrition/On break Stage One March 2013 37 20* Stage One March 2014 36 10 Stage One March 2015 49 11 Stage One March 2016 42 4 *4 graduated and exited with Certificate end of stage 1. Table 21 Retention information for Foundation Pharmacists who APEL onto Stage 2 of the programme. Commissions Attrition/On break Stage Two 2013 8 0 Stage Two 2014 6 2 Stage Two 2015 3 0 36 P a g e
4.3 Foundation Pharmacist Educational Supervisors and Programme Directors The foundation pharmacist programme course can take a trainee a maximum of six years to complete. The current trainee numbers indicate there are 112 active foundation pharmacists who are supported by practice and educational supervisors. Each trust has a foundation pharmacist Educational Programme Director that oversees the implementation and development of the programme locally. HEE KSS Pharmacy has led on the workplace element of the programme ensuring that induction training is available for educational supervisors and including the quality management of the workplace component of the programme in the annual Contract Review process. In addition we manage a network for Foundation Education Programme Directors. 4.3.1 Foundation Pharmacist Educational Programme Directors Network KSS Foundation Pharmacist Programme Educational Programme Directors Network met 3 times in 2015/16. From these meetings a variety of initiatives were implemented: Incorporation of the Stage 1 Pre-requisite learning outcome into local induction. Creation of a who to contact document for Foundation Pharmacist and relevant supervisors. Assist in coordinating and arranging case guardians to assist the academic team ensure learning materials for sets are up to date and relevant. Approval of application processes, such as the workplace checklist and declaration for trainees wishing to enter the programme. The group decided that evidence for the e-portfolio would be mapped to the 90 behavioural statements of the Foundation Pharmacist Framework, rather than at the 26 competency level. 4.3.2 Training for Foundation Pharmacist Educational Supervisors We organised one induction day for educational supervisors in October 2015, with a total of 20 participants attending. The induction day covers orientation to the foundation pharmacist programme, giving practical advice to educational supervisors. The induction day is supported by the Educational Supervisors Orientation Guide, which the participants undertake as pre-course work. A half-day session was held in January for e-portfolio super user training. A total of 22 participants from 12 Trusts attended and included a mixture of EPDs, ES and FPs. 37 P a g e
4.4 Management Skills for Senior Pharmacy Staff The ninth cohort of this programme started in September 2015. There are 8 participants from KSS, 2 from HIOW and 2 from London. The course participants include senior pharmacists from the acute and primary care pharmacy services and senior pharmacy technicians from acute, primary care pharmacy services and pharmacy education. The programme is led and taught by Chief Pharmacists across KSS & H&IOW. Participants are supported to develop a portfolio of their management competences - this is linked to the Royal Pharmaceutical Society Advanced Pharmacy Framework and the NHS Leadership Framework. Participants are required to undertake a project in the workplace to apply their management skills 4.5 Safe Prescribing The safe prescribing project aims to improve the prescribing practices of medical and non-medical prescribers within Kent, Surrey and Sussex, through a variety of methods. In 2015/16 many of the previous work streams were completed and embedded into business as usual within HEE KSS Pharmacy, such as non-medical prescribing training commissioning and contract monitoring and the maintenance of the diagnostic prescribing assessment for South Thames Foundation School (STFS) trainees. 4.5.1 Commissioning of Non-Medical Prescribing Training within Kent Surrey and Sussex Three universities won the contracts for provision of Non-Medical Prescribing Training within Kent, Surrey and Sussex in September 2015: University of Brighton Medway School of Pharmacy University of Nottingham A total of 160 places were commissioned in the first year (October 2015 August 2016) with the first cohort of 20 enrolled in October 2015. In winter 2015 it was decided to increase the number of commissioned places to 230 (October 2015 January 2017) as demand for places exceeded expectations. Contract monitoring process for these programmes has been initiated. 38 P a g e
4.5.2 Diagnostic Prescribing Assessment There is evidence that significant numbers of errors occur in prescribing in both hospitals and general practice. Within KSS work has commenced to reduce this focussing on the use of a diagnostic prescribing assessment (DPA) for Foundation doctors to target where additional training and support is most needed. The assessment has been in place since 2012 focusing on the foundation doctor workforce. The multidisciplinary Prescribing Assessment Group (PAG) refined the Foundation Doctors diagnostic prescribing assessment, which consists of 5 scenario based written prescribing questions and 12 electronic multi-choice questions. The written assessment was carried out in all 11 Trusts in KSS and 5 Trusts from London and was undertaken by 753 foundation doctors. All trusts in South London undertook the assessment on paper charts even when electronic prescribing systems were in place to ensure that the foundation trainees were competent in the practical principles of prescribing. The MCQ was available to all STFS trainees and 851 completed it. The high uptake was due to the early access was granted to trainees to the online platform that was used to host the questions. All 11 trusts in KSS carried out the assessment during Trust induction and trainees who were identified as requiring additional time for assessment, such as those who are dyslexic, were identified prior to induction and given additional time. To ensure consistency with marks and grading of serious errors (a mark given to an error made within the assessment that could have caused serious harm or death) a marking guide is used. For each marking point clear direction was given, and where a doctor failed to obtain a mark, learning points and suggested SCRIPT modules were outlined. As in previous years, the assessment is for formative purposes; therefore a pass mark was not set. Overall 410 doctors (54.4%) made at least one serious error, over a quarter of these occurring in relation to opioid prescribing. This is a significant decrease from 70.2% in 2014, but higher than 46.4% in 2013. The initial increase in 2014 was thought to be caused by the implementation of the marking criteria document. Feedback obtained from candidates after the assessment highlighted the lack of confidence in prescribing medication in infusions. The majority felt that the assessment was appropriately challenging. There were a high volume of comments made in regards to requesting additional teaching on the practicalities of prescribing on the drug chart, or their lack of familiarisation with the drug chart. Those doctors that required further assistance and training were highlighted from the assessment and support given. It was identified that there was a variation in the feedback mechanisms carried out by different trusts, most offering feedback within two weeks of the assessment. Directors of 39 P a g e
medical education, foundation training programme directors and medical education staff are informed and involved in the development and implementation of the assessment, through email communications, South Thames Foundation School Advisory and Development Meetings, Local Faculty Groups and Local Academic Boards. The assessment for 2015 was widely advertised through the STFS website, induction letters from trusts and also via email. This year all foundation doctors were given Athens accounts prior to induction, to ensure they could access the online BNF. The implementation of the prescribing assessment has helped to provide a consistent approach to identify F1 doctors who may require additional prescribing support and therefore reduce risks to patients. Every Foundation Doctor starting August 2016 will be required to have passed the Prescribing Safety Assessment (PSA). Despite this the HEE KSS DPA will continue to be facilitated for newly qualified doctors to ensure they are able to demonstrate they can competently prescribe in practice using local drug charts / prescribing systems. Those trainees who fail the PSA will have remediation in a similar process to what is offered to those who fail the DPA, with greater emphasis on utilising SCRIPT. More information can be found on the STFS website http://www.stfs.org.uk/safe-prescribinginformation-medical-students Future work for the prescribing assessment includes piloting an adapted assessment on an electronic prescribing system for use on foundation and other prescribers on induction, with the aim to introduce the first e-dpa in August 2016. 4.5.3 Medical Schools report Since the implementation the DPA has been carried out by over 2000 trainees. Information on these results has been statistically analysed by medical school, with reports generated for those schools who have had more than 50 candidates undertake the assessment. The reports are sent to the medical schools to assist in forming the training provided in the undergraduate degree, with the aim of improving prescribing competence. We will monitor this to see if there is a reduction in the number of serious errors that occur by their students within the assessment in future sittings. In addition a report was created for Non-UK medical schools graduates, to inform support required for this group of trainees on induction. 4.5.4 Implementation of Safe Prescribing initiatives within South London trusts hosting South Thames Foundation School (STFS) trainees. To ensure equality to all STFS trainee doctors a discreet piece of work was carried out by HEE KSS on behalf of HEE South London, to investigate the implementation of safe prescribing initiatives within South London Trusts. The report created was shared with HEE South London and 40 P a g e
STFS. From this STFS is developing a work stream to ensure the recommendations within the report are put into practice throughout KSS and South London. 4.5.5 SCRIPT: Electronic Prescribing Training Platform 4.5.5.1 Foundation Doctors SCRIPT (Standard Computerised Revalidation Instrument for Prescribing and Therapeutics) is an electronic prescribing training tool, which was designed to enable foundation doctors to undertake basic revision and reach minimum standards in prescribing and enable them to build upon their existing skills in safe and rational prescribing. SCRIPT has been purchased for use by all South Thames Foundation School doctors, and was implemented throughout acute trusts in Kent, Surrey, Sussex and South London in July 2014. South Thames Foundation Schools mandate a minimum of 6 modules per year; however trusts are able to select which modules and can mandate more modules, dependant on local priorities and risks. In addition individual trainees may be required to undertake modules as remediation dependant on their assessment results. In August 2015 the SCRIPT system was upgraded to a new version which allowed for greater reporting capability for Trust administrators. The new system was restricted to use for foundation doctors only and relevant communications were sent. Existing foundation doctors were unable to access the old version of SCRIPT and information was cascaded to ensure this was managed at a local level. 4.5.5.2 Continual Professional Development The safe prescribing project is undertaking a pilot to investigate if SCRIPT is a suitable platform for providing Continuing Professional Development in the areas of Prescribing and Therapeutics for prescribers (both Medical and Non-medical Prescribers) and those supporting prescribers, such as pharmacists. Two SCRIPT clones have been created: NMP Clone: for Non-Medical Prescribers (Midwife, Nurse, Optometrist, Pharmacist, Physiotherapist, Podiatrist, Radiographers) across primary and secondary care. CPD Clone: for medical prescribers (Consultant, Core Trainee, Registrar, Staff Grade and Specialist Trainees), pharmacists and pre-registration pharmacists in Acute and Community Care Trusts. The pilot is from the 18 th January 2016 to the 9 th May 2016. Participants are required to undertake a short survey after each module. A task and finish group will comment on their 41 P a g e
experiences, which will feed into the evaluation that will be reported to the safe prescribing board for consideration for commission for CPD for prescribing training. 4.5.6 Report on electronic prescribing systems and support to newly employed prescribers. The safe prescribing project commissioned Dr Sarah Slight, University of Durham to investigate the types of support offered to newly employed prescribers to orientate them to the electronic prescribing systems available, including lessons learnt from trusts who have implemented electronic prescribing in regards to error rates and prescriber training. The information collated would be a useful reference for Trusts implementing eprescribing systems throughout Kent, Surrey and Sussex. The report was completed in October 2015 and was cascaded to all trusts. It is available on the website http://www.ksspharmacy.nhs.uk/prescribing/ 42 P a g e
5 Quality Management The quality management of commissioned training places is managed as part of the wider Health Education England s quality processes. For KSS this includes preregistration pharmacists, preregistration trainee pharmacy technicians and Foundation Pharmacists, In Hampshire and the Isle of Wight the quality management system covers preregistration pharmacists and preregistration trainee pharmacy technicians. Quality Management processes for 2016 were reviewed and agreed at the Reviewing Quality in Practice Day on the 2nd December 2015. A notable change was the removal of a requirement for a Quality Manual to be submitted to and verified by HEE KSS. The core elements of workplace education (such as Induction, Equality & Diversity etc.) should be monitored through the Trust Quality Improvement Tool (QIT) (KSS) or Local Development meetings (Wessex). This will support multi-professional working and reduce duplication of requests for evidence. KSS EPDs are required to attend one meeting a year to present the Quality Manual as evidence into the Quality Improvement Tool and One LDA meeting per year for Wessex EPDs. 5.1 Visits and Reporting 5.1.1 Routine Quality Visits Based on feedback and our experience we believe that Routine Quality Visits are an essential component of Quality Management processes for all parties. Therefore we will be continuing with our Routine Quality Visits. They will be conducted on a 6 year cycle. 4 routine quality visits were conducted in 2015: Frimley Health Maidstone and Tunbridge Wells Isle of Wight East Sussex 43 P a g e
5.1.2 Exception and Developmental Visits The criteria for Exception and Developmental Visits remain unchanged for 2015-16. There were no exception visits. Following our procedures, one Trust was identified in 2015-16 requiring a Follow up Visit post a routine quality visit 5.1.3 Quality Manual In light the of the General Pharmaceutical Council s plans to revise their Initial Education and Training standards, HEE KSS Pharmacy have made no proposed changes to the Quality Manual specification for 2015. Although, the Quality Manual will not be verified by HEE KSS Pharmacy it is still seen as an important element of Trust education quality control systems and should be used as an evidence tool for the QIT meetings outlined above. 5.1.4 Pharmacy Local Faculty Group (LFG) Report (previously Annual Audit and Review) To support Pharmacy LFGs the Annual Audit and Review has been modified and has become a Pharmacy LFG report or Education Strategy Group (ESG) report for Wessex. The purpose of the report is to capture the outputs of the LFG/ESG and capture future plans to support robust action planning. The report will need to be signed off by the Pharmacy LFG/ESG Chair and Chief Pharmacist. All trusts submitted their Pharmacy LFG/ESG report by March 31st 2016. This forms part of an annual cycle and enables us to identify notable practice across all trusts at one fixed point each year. 44 P a g e
5.2 Trainee Voice and Educational Support 5.2.1 Trainee Feedback As part of our quality management processes; all commissioned preregistration trainees are invited to take part in the end of year survey. The total number of responses received for both trainee groups is 142 (100%) broken down as follows: Pre-registration Trainee Pharmacists 60; 1st year Pre-registration Trainee Pharmacy Technicians 37; 2 nd year Pre-registration Trainee Pharmacy Technicians 45. The majority of the questions for each trainee group are the same and include questions about specific rotations during their training year. Feedback on the rotations is shared with the placement organisation where there are three or more trainees. In addition we produce an anonymous spread sheet with 20 metrics reflecting key areas of training that organisations can use for benchmarking themselves against others. The surveys indicated that the vast majority of trainees 94.3% (n=134) would recommend training in their base hospital to future preregistration trainees. Regarding the trainee educational supervisor, 93.8% (n=92; 1 st year question only) met with their ES to discuss duties in the post and expectations of progress within the first two weeks of starting. There were a range of comments on educational supervision and support to trainees. The majority of these were extremely positive. For example, My ES has been an unbelievable sense of structure and involvement. We have had fortnightly meetings, all of which documented, to discuss what has happened and what is planned. This has enabled me to become very self directed in my learning knowing I had the meetings to show what I had achieved No concerns with my ES. She has been supportive and professional throughout my pre-reg. My ES has been receptive to what I say, especially in my one-to-one meetings where we also discuss what she could start/stop/continue doing. I cannot praise my ES enough, she has always been ready to help support me through this year from pharmacy related stuff and personal affairs. She had really made the year from me and taught me invaluable skills for the future. My ES is very supportive and always makes time to meet if I have any questions and issues which are not raised during 2-weekly meetings. My ES is also encouraging and often suggests or organises opportunities for developing training which includes attending courses and ward rounds (eg.with the specialist pain nurse). I find all this very useful to my special training needs and development. My Educational Supervisor has been a key part of my development and success as a PTPT. I have been supported and challenged by my ES - everything she has done has helped me develop as a person as well as a Pharmacy Technician. 45 P a g e
5.2.3 Trainees requiring additional support (TRAS) The term Trainees in Difficulty was reviewed by the Trainee Support Group and amended to Trainees Requiring Additional Support in the autumn of 2015. HEE KSS continues to provide a referral and support process using a RAG matrix to help trusts assess when they need to refer a trainee for extra support. Trainees are also able to self-refer. During the 2015/16 period 11 Foundation Pharmacists, 7 pre-registration pharmacists, 9 first year and 6 second year pre-registration pharmacy technicians were supported through the process. Of these, 2 pre-registration pharmacists were able to access externally funded support services via the Trainee Support Group as a result of the HEE KSS Pharmacy TRAS referral and support process. 46 P a g e
6 Delivering the service 6.1 Ways of Working To improve organisational efficiency and effectiveness, Health Education England reviewed its way of working in April 2015. This resulted in Health Education Kent, Surrey, and Sussex, the 3 London LETBs, Health Education South London (HESL), Health Education Central & East London (HECEL), and Health Education North & West London (HENWL) forming the London & South East geography. As part of this work an integration project began for Pharmacy to review and develop a model that can deliver HEEs mandate, provide expertise and support multi-professional opportunities across a London and South East (L&SE) geography. Reviews of the current provision from HEE KSS and London have been underway in 2015. As a result of this review from 1st July 2016 there will be a new London and South East (LaSE) pharmacy structure that will replace KSS. 6.2 Staff The Pharmacy Team were relocated from their base at University Hospitals Brighton NHS Trust, Princess Royal Hospital to Crawley Hospital in December 2015 to join the rest of the Kent, Surrey and Sussex local team office. 47 P a g e
6.3 Staff Achievements We were awarded the following achievements Health Education England, Chairs Recognition Award for Research 2015: Are doctors competent to prescribe at the start of the UK Foundation Training Programme? Katie Reygate, Gail Fleming, Jan Welch and Marc Terry. Health Education England, working across Kent, Surrey and Sussex Team of the year award 2015: The Pharmacy Team Gail Fleming was awarded a Fellowship by the Royal Pharmaceutical Society 48 P a g e