School of Health and Social Care Supplementary and Independent Prescribing for Physiotherapists and Chiropodists / Podiatrists

School of Health and Social Care Supplementary and Independent Prescribing for Physiotherapists and Chiropodists / Podiatrists Programme Specification and Unit Specification Version 1.0-0918 January 2017 1

2013 Bournemouth University Circulation: General Bournemouth University undertakes to encourage the recognition, protection and exploitation of intellectual property rights generated by participants in this programme, to the benefit, as appropriate, of students, staff, industrial/other third parties/partners and the university. School of Health & Social Care Bournemouth University Christchurch Rd Bournemouth BH1 3LG 2

CONTENTS 1 BASIC PROGRAMME DATA... 4 2 INTRODUCTION... 5 3 ACADEMIC AND PROFESSIONAL CONTEXT... 5 4 PROGRAMME AIM & OUTCOME... 5 5 PROGRAMME STRUCTURE... 7 6 WORK BASED LEARNING... 7 7 PROGRAMME REGULATIONS... 7 8 POINTS OF REFERENCE FOR PROGRAMME DESIGN... 10 9 PROGRAMME PROFILE... 11 UNIT SPECIFICATION... 12 APPENDIX ONE - COMPETENCY FRAMEWORK... 18 3

BASIC PROGRAMME DATA Originating institution(s) Bournemouth University Award(s) and title(s) Supplementary and Independent Prescribing for Physiotherapists and Chiropodists / Podiatrists External reference points(s) Health and Care Professions Council Professional, Statutory and/or Regulatory Body links Place(s) of delivery Mode(s) of delivery Credit structure Health and Care Professions Council accreditation Bournemouth University and University Centre Yeovil and St Mary s Portsmouth Part-time 40 M level credits Duration Minimum six months maximum not normally longer than 12 months Date of original approval(s) Supplementary Prescribing for Allied Health Professionals originally approved July 2006 (at level H) Reapproved May 2009 and December 2012 (M level) Date of first intake January 2014 Student numbers Optimum 25 x 2 intakes per annum (total figures - joint taught with Independent and Supplementary Prescribing for Nurses and Midwives and Supplementary Prescribing for AHPs) Placements 12 days within students own employment setting Date and version number of this Programme Specification January 2017 version 1.0-0918 4

2 INTRODUCTION This document is presented in order to describe the specification of the programme to prepare appropriately qualified and registered physiotherapists and Chiropodists/ Podiatrists to become Supplementary and Independent Prescribers. 3 ACADEMIC AND PROFESSIONAL CONTEXT This short 40-credit programme meets the Government s agenda to extend the remit on supplementary and independent prescribing (HCPC 2013). It will allow suitably qualified physiotherapists and Chiropodists/ Podiatrists to become supplementary and independent prescribers. The curriculum has been devised by the Department of Health in collaboration with the Health and Care Professions Council. It is set at academic level M as prescribers must be able to draw on relevant research and to use skills of critical appraisal in practice. Assessment of the programme will be via a written examination, an objective structured clinical examination (OSCE), a portfolio, numeracy test and completion of practice hours. 4 PROGRAMME AIM & OUTCOME 4.1 AIM To develop the knowledge and skills required by a physiotherapist or Chiropodists/ Podiatrists to practice as a safe, effective and competent supplementary and independent prescriber. 4.2 OVERALL PROGRAMME OUTCOMES On successful completion of the programme physiotherapists and Chiropodists/ Podiatrists will be able to effectively and safely supplementary and independently prescribe and therefore manage people with a range of medical needs. A Subject Knowledge and Understanding A1. knowledge of drug actions and side effects A2. understanding of safe and appropriate practice A3. knowledge of the pricing of drugs and their cost effectiveness A4. Legislation / legal frameworks relevant to supplementary and independent prescribing A5. understanding of the psychology of prescribing Learning and Teaching Strategies Lectures, discussions, student presentations of case studies, practice experience, observation and discussion with practice supervisor Assessment Written examination, OSCE, Portfolio. 5

B Intellectual Skills B1. a critical analytical approach to problem solving B2. the ability to undertake a comprehensive literature search B3. use of the internet to access relevant material B4. the ability to critically assess drug research Learning and Teaching Strategies Discussions of case examples, reflection on and in practice, group discussions, literature searching and retrieval of information Assessment Written examination, OSCE, Portfolio. C Subject Specific Skills C1. application of the principles of drug actions to prescribing practice C2. assessment of patients and carers C3. ability to practice within the legal remit of supplementary and independent prescribers C4. accountable and responsible supplementary and independent prescribing practice C5. use of evidence to support prescribing decisions. Learning and Teaching Strategies Lectures, discussions, supervision and observation of practice Assessment Successful completion of practice experience, OSCE, Portfolio and numeracy. D Transferable Skills D1. interpersonal skills during client and carer consultations D2. principles of legal and ethical practice D3. the ability to build therapeutic alliances D4. reflection on personal knowledge and its limitations D6. the ability to formulate an individual learning plan D7. critical appraisal skills D8. clinical decision making as an independent prescriber Learning and Teaching Strategies Mentorship in practice, personal tutorial support, library support, group and personal reflection on practice. Assessment Written examination, OSCE, Successful completion of practice, Portfolio. 6

5 PROGRAMME STRUCTURE Supplementary and Independent Prescribing for Physiotherapists and Chiropodists/ Podiatrists Compulsory Unit Supplementary and Independent Prescribing for Physiotherapists Chiropodists and Podiatrists(40) Requires 40 credits at Level M Outcomes Developed and Assessed: Knowledge as indicated by programme title and skills A 1-5, B 1-4; C 1-5; D 1-8 6 WORK BASED LEARNING Although students will remain in their place of employment throughout the programme they will have the equivalent of 12 days of practice supervised by a designated medical practitioner (DMP). The Department of Health has specified that the DMP must be a registered medical practitioner who: (i) has normally had at least 3 years recent clinical experience for a group of patients/clients in the relevant field of practice; (ii) is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post-graduate Training in General Practice Certificate (JCPTGP); or is a specialist registrar, clinical assistant or a consultant within a NHS Trust or other NHS employer; (iii) has the support of the employing organisation or GP practice to act as the designated medical practitioner who will provide supervision, support and opportunities to develop competence in prescribing practice. (iv) has some experience or training in teaching and / or supervising in practice. 7 PROGRAMME REGULATIONS 7.1 ADMISSION The University standard regulations for the admission to a taught post graduate programme Applicants must confirm their ability to study at this level by presenting evidence of: a UK bachelors degree or overseas equivalent in a relevant subject. 7

Alternatively or in addition, applicants may demonstrate learning through experience, via portfolios or records of achievement, and/or by tasks set at interview, and confirmed by employer reference/s. A combination of academic and experiential qualifications, to be considered on individual merit may also be acceptable. All students whose first language is not English must offer evidence of qualifications in written and spoken English. Acceptable qualifications are IELTS (Academic) 6.5, or TOEFL 90 (internet-based) or 570 (written). In addition, all applicants must meet the following requirements to ensure that they meet the legal, educational and occupational health criteria set out by Department of Health (www.dh.gov.uk) Be registered with the Health Professions Council as a Physiotherapist or Chiropodists/ Podiatrists Have 3 years, post qualifying experience* Have appropriate experience in their area of practice in which they will be prescribing* An ability to study at level M as demonstrated by the criteria set out above. Support from the employing organisation this should include confirmation that the applicant is willing to prescribe and that they will have the opportunity to prescribe on completion of the programme*. In addition the employing organisation are required to confirm the applicant has CRB clearance and will have access to continuing professional development opportunities on completion of the programme Have a designated medical practitioner who will provide the student with supervision, support and opportunities to develop competence in prescribing practice* Have a recent CRB check* *These have been stipulated by the Department of Health It is expected that both students and employers will provide signed documentary evidence that these requirements have been met prior to commencement of the programme. Selection process Students wishing to access the course will apply via their employers who will forward applications to the university. Students requiring entry to level M study will normally have 120 level H credits. Students wishing to access the course without this will be required to show evidence of the ability to study at level M. This may be demonstrated by: Submission of a critical analysis of their current role and how this would be enhanced through their capacity to prescribe. Or evidence of recent academic study, for example completion of a 20 credit level M unit within the past two years, Or Completion of 80 level H credits within the past three years. 8

7.2 ASSESSMENT The regulations for this programme conform with the requirements of the Health and Care Professions Council, and are the Standard Postgraduate Assessment Regulations with the following approved exceptions: Period of Registration The maximum period of registration a student may take to complete the programme, from the first registration, is normally 1 year. Pass Mark The pass mark for the short answer examination will be 80%( assessed on a pass/fail basis). The pass mark for the numeracy test will be 100% (assessed on a pass/ fail basis). The pass mark for the OSCE will be 100% (assessed on a pass/fail basis). The record of supervised practice is assessed on a pass/fail basis. For the portfolio a pass will be awarded where the overall element mark is at least 50%. All formal elements of assessment must be awarded a pass for candidates to pass the unit. Provision for failed candidates If a student in any element of assessment fails to answer correctly any question that may result in direct harm to a patient/client or within written submissions within the portfolio recommends treatment which may result in direct harm to a patient/client, the student will fail that element of the programme. If this occurs where a student is being reassessed, the student will be required to re-register and to re-attend the programme. Attendance The Health and Care Professions Council require 100% attendance: the programme team maintain a register. Students who miss one day of the programme are required to undertake work to demonstrate they have met the learning outcomes for the sessions they have missed. Students who miss two days will also have to undertake work to meet the learning outcomes and may be required to attend the sessions they have missed; this may be at a different campus according to when the programme is delivered. Students who miss three days will be required to discuss with the programme leader and their manager their withdrawal or deferment from the programme. 9

8 POINTS OF REFERENCE FOR PROGRAMME DESIGN Health and Care Professions Council Standards for Prescribing (August 2013)prescribing QAA Qualifications Framework Maintaining Competency in Prescribing, National Prescribing Centre, November 2004 Allied Health professionals prescribing and medicines supply mechanisms scoping project report Department of Health 2009 Non medical prescribing by nurses, pharmacists, physiotherapists, Chiropodists/ Podiatristss and radiographers; a quick guide for commissioners. National Prescribing Centre 2010 10

9 PROGRAMME PROFILE School HCS Partner institution None Programme Supplementary and Independent Prescribing for Physiotherapists and Chiropodists / Podiatrists Mode(s) of study Part-time Unit Number Unit Core HESA CC1 % No of Level credits Supplementary and Independent C B7 05 100% 40 M Exam Numeracy OSCE Practice Portfolio Prescribing for Physiotherapists and Chiropodists / Podiatrists P/F P/F P/F P/F 100% 11

UNIT SPECIFICATION SUPPLEMENTARY & INDEPENDENT PRESCRIBING FOR PHYSIOTHERAPISTS AND CHIROPODISTS/PODIATRISTS Version 1 Level M Credit value 40 (20 ECTS) Effective from January 2014 --------------------------------------------------------------------------------------------------------------- PRE AND CO-REQUISITES None AIMS To develop the knowledge and skills required by a physiotherapist or podiatrist to practice as a safe, effective and competent supplementary and independent prescriber INTENDED LEARNING OUTCOMES: Having completed this unit, the student is expected to demonstrate the ability to: 1. Demonstrate how to assess patients needs, across the life span, for medicines through effective consultation 2. Articulate and demonstrate how they will prescribe safely, appropriately and cost effectively 3. Critically appraise and apply the legal frameworks / legislation relevant to the practice of independent and supplementary prescribing 4. Debate and analyse the influences on prescribing behaviour 5. Demonstrate a comprehensive knowledge of drug actions and apply these principles to prescribing practice, including monitoring response to therapy and justify modifications to treatment 6. Evaluate the roles and relationships of others involved in prescribing, supplying and administering medicines with a view to actively building therapeutic alliances 7. Practice autonomously within a framework of professional accountability and responsibility in relation to independent and supplementary prescribing whilst acknowledging their own limitations 8. Proactively develop dynamic clinical management plans 9. Demonstrate numeracy skills appropriate to be able to prescribe safely in own area of practice 10. Understand the process of clinical decision making as an independent practitioner The Department of Health and The Health Professions Council (HCPC) have stipulated these outcomes. 12

Competencies for Prescribing The competencies for prescribing are laid out in the appendix. Relationship between course outcomes and Prescribing Competencies The learning outcomes of the programme relate to the prescribing competencies as follows: Learning outcome 1 Practice Learning outcome 2 and 9 Practice Learning outcome 3 Principles Learning outcome 4 Principles Learning outcome 5 Practice Learning outcome 6 Responsibility Learning outcome 7 Subsumes all the competencies Learning outcome 8 Principles and practice Learning Outcome 9 Practice Learning Outcome 10 - Subsumes all the competencies LEARNING & TEACHING METHODS The taught indicative content will normally be delivered over 26 days plus 12 days of supervised clinical practice, or via a blended learning route of 8 days taught content, 10 days open learning and 12 days supervised clinical practice. Attendance for the taught days is mandatory. Learning and teaching will take place in both the classroom and in practice. Lectures of factual material will be followed by question and answer sessions including group discussion and analysis of case examples. Lectures will be shared with students undertaking the Independent and Supplementary Prescribing Programme for Nurses and Midwives. A medical practitioner (DMP) will assess prescribing competence by practice supervision. Students will be expected to shadow their DMP and critically reflect upon patient care scenarios, demonstrating in-depth analysis of prescribing behaviour. To facilitate learning the student will be required to maintain a portfolio that will be structured around practice based competencies. Successful completion of the portfolio will include evidence of supervised practice and will be summatively assessed. All students will have a personal tutor from the University and the support of a DMP as a supervisor in practice. In addition action learning groups will provide the opportunity for student to discuss issues arising from their burgeoning role. Supervisor workshops are planned to appraise DMPs of the learning outcomes expected from the programme and their responsibilities. Telephone consultation and support for the student and DMP will be used when necessary. Students understanding of the content and application of knowledge for prescribing behaviour along with the associated decision-making skills will be tested by means of a written examination and a portfolio. Competency in the strategies for undertaking a prescribing consultation, notably those related to communicating with patients and generating treatment options, will be assured through a final OSCE. 13

ASSESSMENT Summative Assessment Total assessment workload will not exceed the equivalent of 10,000 words The learning outcomes of the programme will be assessed as follows: 1. Learning outcomes 2, 3, 4, 5 & 6 examination (two hours equivalent to 2,000 words)(pass mark 80% - assessed on a pass/fail basis) 2. Learning outcome 9 in course numeracy test (30 minutes equivalent to 500 words) (pass mark 100% - assessed on a pass/fail basis) 3. Learning outcomes 1, 2 - OSCE (equivalent to 2,000 words)(pass mark 100% - assessed on pass/fail basis) 4. Learning outcomes 1-10 successful completion of practice experience and attainment of practice outcomes (assessed on a pass/fail basis) 5. Learning outcomes 1-8 - Practice portfolio (5,500 word equivalency) (pass mark 50%) (100% weighting for unit) Indicative Assessment 1. A written examination consisting of 20 short answer/ multi-choice questions. The examination tests pharmacological knowledge and its application to practice. The pass mark for the examination is 80% 2. A numerical assessment within the context of prescribing practice. Linked to learning outcome 12. The pass mark for the numeracy assessment is 100% 3. An Objective Structured Clinical Examination (OSCE) which takes place in a setting relevant to the students area/field of practice. The OSCE will consist of two parts to test students initial and follow-up prescribing behavior. Students will be required to respond to a patient presenting with a problem relating to their field of practice. Students will be expected to articulate their potential prescribing practice in relation to this patient, following taking a patient history, a physical examination and reaching a diagnosis. Students are also expected to discuss any required follow up. This examination is assessed on a pass fail basis. It is expected that the DMP will be present during the OSCE examination together with a member of the teaching staff. However if this is not possible then the examination will be audio recorded with written consent gained by the patient. 4. Satisfactory completion of the period of practice experience and the sign off by the designated medical practitioner and the employer that the student is competent to prescribe medicines in their area of practice. This is recorded in the practice profile and is assessed on a pass/fail basis. 5. A portfolio that demonstrates application of theory to practice, and provides rationale for prescribing decisions and reflective practice. The portfolio provides the evidence of attainment of the practice based standards. It will also include evidence of numeracy skills, writing prescriptions and a range of scenarios. Linked to learning outcomes 1-12. The pass mark for the portfolio is 50% 14

INDICATIVE CONTENT Consultation, decision-making and therapy including referral Models of consultation Accurate assessment, communication and consultation with patients and their carers Concepts of working diagnosis or best formulation Development of a management plan Confirmation of diagnosis further examination, investigation, referral for diagnosis Prescribe, not to prescribe, non-drug treatment or referral for treatment Able to work with patients and clients as partners in treatment Influences on and psychology of prescribing Patient demand versus patient need External influences, for example companies/colleagues Patient partnership in medicine-taking including awareness of cultural and ethnic needs Conformance normalisation of professional prescribing behaviour Achieving shared understanding and negotiating a plan of action Prescribing in a team context National and local guidelines, protocols, policies, decision-support systems and formulae Rationale, adherence to and deviation from Understand the role and functions of other team members Documentation, with particular reference to communication between team members Auditing, monitoring and evaluating prescribing practice Interface between multiple prescribers and the management of potential conflict Budget/cost effectiveness Issues relating to dispensing practices Reviews diagnosis and generates treatment options within the clinical management plan Able to refer back to medical practitioner when appropriate Proactively develops dynamic clinical management plans Clinical pharmacology including the effects of co-morbidity Pharmacology, including pharmacodynamics and pharmacokinetics Anatomy and physiology as applied to prescribing practice Basic principles of drugs to be prescribed absorption, distribution, metabolism and excretion including adverse drug reactions, interactions and reactions Patient compliance and drug response Impact of physiological state in, for example the elderly, the young, pregnant or breast-feeding women, on drug responses and safety Evidence-based practice and Clinical Governance in relation to prescribing 15

National and local guidelines, protocols, policies, decision support systems and formulae rationale, adherence to and deviation from Continuing professional development role of self and organisation Management of change Risk assessment and risk management, including safe storage, handling and disposal Clinical supervision Auditing and systems monitoring Identifying and reporting ADRs and near misses Drug calculations Legal, policy and ethical aspects Legal basis, liability and indemnity Legal implications of advice to self-medicate including the use of complementary therapy and over the counter medicines Safe keeping of prescription pads, action if lost, writing prescriptions and record keeping Awareness and reporting of fraud Drug licensing and monitoring Yellow card reporting to the Committee of Safety on Medicines Prescribing in the policy context Manufacturers guidance related to literature, licensing and off label Ethical basis of intervention Informed consent, with particular reference to client groups in learning disability, mental health, children, the critically ill and emergency situations Principles of supplementary and independent prescribing and application to practice Professional accountability Accountability and responsibility for assessment and prescribing Maintaining professional knowledge and competence in relation to prescribing Accountability and responsibility to the employer Prescribing in the public health context Duty to patients and society Policies regarding the use of antibiotics and vaccines Inappropriate use of medication including misuse, under- and over-use Access to health care provisions and medicines Numeracy for prescribing practice INDICATIVE KEY LEARNING RESOURCES Books Brookes D & Smith A 2007 Non medical prescribing in Health Care Practice. Basingstoke. Palgrave Macmillan Courtney,M & Griffiths,M eds 2010 Independent and Supplementary Prescribing 2 nd edition. Cambridge. Cambridge University Press Dawson J. 2002 Crash Course in Pharmacology 2 nd ed. Edinburgh. Elsevier Science 16

McGavock, H. 2003 How drugs Work. Oxford. Radcliffe Medical Press Neal,J. 2009 Medical Pharmacology at a Glance 6 th edition. Oxford. Blackwell Science Rushforth H.2009 Clinical Assessment Made Easy (UK edition) Lippincott Williams and Wilkins. The British National Formulary (all students are supplied with a copy) Web-based sources Useful websites www.npc.co.uk National Prescribing Centre web site, provides a range of information to support non medical prescribers, including a competency framework and access to Merck updates, patient group directions www.dh.gov.uk The Department of Health website provides information on non medical prescribing www.mhra.gov.uk The Medicines and Healthcare Products Regulatory Agency website contains information about the legal framework governing prescribing, supply and administration of medicines www.nelh.org National Electronic Library for Health, latest information on medicines and clinical conditions, as well as useful resource on complementary therapies www.the-shipman-inquiry.org.uk Information on the recommendations from the Shipman Inquiry www.nelm.nhs.uk National electronic library for medicines good links to research, NICE guidance, and latest news page www.palgarve.com/skills-4study/index 17

Appendix One Competency Framework THE CONSULTATION (competency) ESTABLISHING OPTIONS (competency) (involving carers, parents and / or advocates where appropriate) Reviews diagnosis, generates treatment options for the patient and follows up treatment within the scope of the clinical management plan (overarching statement). Behavioural indicator Takes and / or reviews the medical and medication history and undertakes a physical examination where appropriate Notes Views and assesses the patient s needs holistically (psychosocial, physical) Accesses and interprets all relevant patient records to ensure knowledge of the patient s management Reviews the nature, severity and significance of the diagnosis / clinical problem Requests and interprets relevant diagnostic tests Considers no treatment, non-drug and drug treatment options (including referral and preventative measures) Assesses the effect of multiple pathologies, existing medication and contraindications to treatment options 18

Assesses the risks and benefits to the patient of taking / not taking a medicine (or using / not using a treatment) Selects the most appropriate medicine, from the CMP; dose and formulation for the individual patient; prescribes appropriate quantities Monitors effectiveness of treatment and potential side-effects Establishes, monitors and makes changes within the scope of the clinical management plan in light of the therapeutic objective and treatment outcome Ensures that patients can access ongoing supplies of their medication COMMUNICATING WITH PATIENTS (competency) (carers, parents and / or advocates where appropriate) Establishes a relationship based on trust and mutual respect. Sees patients as partners in the consultation. Applies the principles of concordance (overarching statement). Behavioural indicator Ensures that the patient understands and consents to be managed by a prescribing partnership in accordance with local arrangements Notes Listens to and understands patients beliefs and expectations Understands the cultural, language and religious implications of prescribing 19

Adapts consultation style to meet the needs of different patients (e.g. for age, level of understanding, physical impairments) Deals sensitively with patients emotions and concerns Creates a relationship which does not encourage the expectation that a prescription will be written Explains the nature of the patient s condition and the rationale behind, and potential risks and benefits of, management options Enables patients to make informed choices about their management Negotiates an outcome to the consultation that both patient and prescriber are satisfied with Encourages patients to take responsibility for their own health and self-manage their conditions Gives clear instructions to the patient about their medication (e.g. how to take / administer it, where to get it from, possible side-effects) Checks the patients understanding of, and commitment to, their treatment 20

PRESCRIBING EFFECTIVELY (competency area) PRESCRIBING SAFELY (competency) Is aware of own limitations. Does not compromise patient safety. Justifies prescribing decisions (overarching statement). Behavioural indicator Knows the limits of own knowledge and skill, works within them Notes Knows how and when to refer back to, or seek guidance from, the independent prescriber, another member of the team or a specialist Only prescribes a medicine with adequate, upto-date knowledge of its actions, indications, contra-indications, interactions, cautions, dose and side-effects Knows about common types of medication errors and how to prevent them Makes prescribing decisions often enough to maintain confidence and competence Keeps up-to-date with advances in practice and emerging safety concerns relating to prescribing Understands the need for, and makes, accurate and timely records and clinical notes Writes legible, clear and complete prescriptions which meet legal requirements Checks doses and calculations to ensure accuracy and safety 21

PRESCRIBING PROFESSIONALLY (competency) Works within professional, regulatory and organisational standards (overarching statement). Behavioural indicator Accepts personal responsibility for own prescribing in the context of a shared clinical management plan, and understands the legal and ethical implications of doing so Notes Uses professional judgement to make prescribing decisions based on the needs of patients and not the prescribers personal considerations Understands how current legislation affects prescribing practice Prescribes within current professional and organisational codes of practice / standards Keeps prescription pads safely and knows what to do if they are stolen / lost IMPROVING PRESCRIBING PRACTICE (competency) Actively participates in the review and development of prescribing practice to improve patient care (overarching statement). Behavioural indicator Reflects on own performance, can learn and change prescribing practice Notes Shares and debates own, and others, prescribing practice (e.g. audit, peer group review) 22

Challenges colleagues inappropriate practice constructively Understands and uses tools to improve prescribing (e.g. review of PACT / prescribing data / feedback from patients) Reports prescribing errors and near misses, reviews practice to prevent recurrence Develops own networks for support, reflection and learning Establishes multi-professional links with practitioners working in the same specialist area Takes responsibility for own continuing professional development PRESCRIBING IN CONTEXT (competency area) INFORMATION IN CONTEXT(competency) Knows how to access relevant information. Can critically appraise and apply information in practice (overarching statement). Behavioural indicator Understands the advantages and limitations of different information sources Notes 23

Uses relevant, up-to-date information, both written (paper /electronic) and verbal Critically appraises the validity of information (e.g. promotional literature, research reports) when necessary Applies information to the clinical context (linking theory to practice) Uses relevant patient record systems, prescribing and information systems, and decision support tools Regularly reviews the evidence behind therapeutic strategies THE NHS IN CONTEXT* (competency) * This competency has an NHS focus. However, the principles underpinning several of the statements still apply to health care professionals working in non-nhs organisations Understands, and works with, local and national policies that impact on prescribing practice. Sees how own practice impacts on wider NHS (overarching statement). Behavioural indicator Understands the framework of supplementary prescribing and how it is applied in practice Notes Understands and works with local NHS organisations and relevant agencies contributing to heath improvement (e.g. social services) Works within local frameworks for medicines use as appropriate (e.g. PGDs, formularies, protocols and guidelines) 24

Works within the NHS / organisational code of conduct when dealing with the pharmaceutical industry Understands drug budgetary constraints at local and national levels; can discuss them with colleagues and patients Understands national NHS frameworks for medicines use (e.g. NICE, NSFs, medicines management, clinical governance, IT strategy) THE TEAM AND INDIVIDUAL CONTEXT (competency) Works in partnership with colleagues for the benefit of patients. Is self-aware and confident in own ability as a prescriber (overarching statement). Behavioural indicator Relates to the independent prescriber as an equal partner Notes Negotiates with the independent prescriber to develop and agree clinical management plans Thinks and acts as part of a multidisciplinary team to ensure that continuity of care is not compromised Establishes relationships with colleagues based on understanding, trust and respect for each others roles Recognises and deals with pressures that may result in inappropriate prescribing Is adaptable, flexible, proactive and responsive to change 25

Seeks and / or provides support and advice to other prescribers, team members and support staff where appropriate Negotiates the appropriate level of support for role as a prescriber 26