ESR): Draft Standards and Learning Outcomes

PUBLIC C34(18)

COUNCIL

Education Strategic Review (ESR): Draft Standards and Learning Outcomes

Meeting: 12 September 2018 Status: For decision

Project Sponsor: Alistair Bridge (Director of Strategy) Project Board: SMT Paper Author: Alistair Bridge Project team: Ben Pearson, Philippa Mann, Marcus Dye, Roz Platt, Manori Izni- Muneer, Ross Price Council Champions: Clare Minchington, David Parkins and Selina Ullah Project Board: SMT

Purpose 1. The purpose of the paper is to seek Council’s views on proposed new standards for education providers and proposed new learning outcomes, and to seek Council’s approval for us to consult publicly on the proposed standards and learning outcomes.

Recommendations 2. Council are asked to: 2.1. provide views on the: 2.1.1. proposed new standards for education providers (annex one); 2.1.2. proposed new learning outcomes for optometrists (annex two), dispensing opticians (annex three); and contact lens opticians (annex four); 2.1.3. proposal that rather than develop our own learning outcomes for independent prescribers, we should adopt the Royal Pharmaceutical Council’s Competency Framework for all Prescribers (annex five); and 2.1.4. proposed new learning outcomes for fully-qualified practitioners undertaking Continuing Education and Training (CET) (annex six); 2.2. approve a public consultation on the proposed new standards and learning outcomes, subject to taking into account Council’s views and the further views of our Expert Advisory Group provided at the meeting on 10 September 2018; and 2.3. delegate authority to the Chair and Interim Chief Executive and Registrar to sign-off the revised versions of the standards and learning outcomes for consultation, together with an accompanying consultation document and draft impact assessment.

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Strategic objective 3. One of our three strategic objectives is to support the learning and development of optical professionals. Through our Education Strategic Review (ESR), we will ensure that future optical professionals are equipped for the roles they will be expected to perform. In parallel, we are reviewing our CET system to ensure that current optical professionals are fit for the future. Risks 4. The changing needs of patients, changing roles of optical professionals and wider changes in the delivery of healthcare mean that the current system of optical education and training could cease to be fit for purpose. To address this risk, we need to carry out the ESR in a timely way, ensure that changes are based on sound evidence and gain buy-in from stakeholders.

5. To implement the new system of education and training, we will need an effective and efficient approach to the accreditation and quality assurance of education providers. We are currently delivering improvements to our current approach that will pave the way for the implementation of the ESR and ensure consistent standards of education provision.

6. Effective delivery and implementation of the project will require it to be properly resourced. Following the departure of the project director in July, we are recruiting an Interim Director of Education to oversee the ESR, as well as the CET review and the ongoing performance of our functions relating to education and CET. We expect to have someone in post to fulfil this role by the end of September.

Background 7. The proposed new education standards and learning outcomes reflect and build on the evidence and feedback we have obtained so far through the ESR and the CET Review. We commenced the review with a call for evidence and published a report summarising the feedback (June 2017). We commissioned research into patterns and trends in health professional education in the UK and internationally (November 2017) and carried out research exploring the perceptions of newly qualified practitioners and employers in relation to current education and training requirements (June 2018). We consulted on the concepts and principles that should inform the new system of education and training and published an independent report summarising the findings (April 2018).1

1 We have published all the documents referred to in this paragraph on our website: https://www.optical.org/en/Education/education-strategic-review-esr/ 07 September 2018 Page 2 of 33 PUBLIC C34(18)

8. We also carried out extensive engagement with stakeholders, including education providers, and gained input from our ESR Expert Advisory Group, CET Reference Group and from our advisory committees.

Concepts and principles consultation 9. In developing the draft education standards and learning outcomes, we have built on the findings from our consultation on the concepts and principles that should underpin the new system of education and training. During the consultation period, we held a series of bilateral engagement meetings with education providers; met collectively with providers of optometry programmes through the Optometry Schools Council; met ophthalmic dispensing programme leads; and held a series of student discussion groups, with approximately 85 students in total from seven academic institutions. We also held an open invitation event where around 60-70 delegates participated, including professional associations, patient organisations, education providers, employer organisations.

10. The key findings from the consultation were that: 10.1. the majority of responses to the consultation were supportive of the concepts that we were exploring. In particular, there was a strong endorsement of our intention to take an outcomes-based approach to the regulation of education provision; 10.2. all but one of the stakeholders who responded agreed with the concept of introducing new outcomes-focused standards for education. It was expected that such standards would be less prescriptive and thereby enable greater agility and innovation from providers; 10.3. there was also strong agreement with the concept of ensuring that our education requirements are informed by our standards of practice. Respondents felt that it is important for students to learn what will be expected from them in practice from an early stage in their education; 10.4. most respondents supported the development of new education learning outcomes which all optometry and dispensing optician education providers would be required to deliver, albeit with some caveats. A number of stakeholders could see a case for change because of what they perceived to be deficiencies in the current, competency-based framework. In addition, some stakeholders identified an opportunity for broader learning outcomes to afford education providers more flexibility over how they deliver their programmes. However, the potential for learning outcomes to lead to greater variability in, or a lowering of, standards was identified as a risk that would need to be carefully managed through effective quality assurance; 10.5. the importance and value of including a high quality and varied clinical experience within education programmes was uncontested and a number felt that there is scope to increase this. However, some considerable

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implementation challenges and risks were foreseen with respect to providing a greater number of external clinical placements in particular; 10.6. multi-disciplinary learning was perceived to have significant value in preparing students for multidisciplinary health delivery, and a number of education providers reported that it already forms part of their programmes. However, it was regarded as important that multidisciplinary learning approaches are designed in such a way as to demonstrably enhance learning rather than being treated as a tick box exercise. In addition, a number of implementation challenges were identified, leading some to caution against the GOC taking a prescriptive approach in this area, given the different circumstances of education providers; and 10.7. stakeholders would also like to see the GOC develop a risk-based, evidence-led and proportionate approach to quality assurance in order to ensure compliance with the education standards.

11. Through the consultation we also explored the concept of a national registration exam. This would be an exam set by the GOC and would be in addition to any agreement reached by an education provider with a third party, such as the College of Optometrists (the College) or the Association of British Dispensing Opticians (ABDO), to provide an assessment and/or clinical placements as part of the education programme which they offered to students. However, many respondents viewed the current assessments provided by the College and ABDO as being national registration exams and, therefore, the support for a national registration exam has to be read in this light. While a national registration exam would provide the GOC with extra assurance of consistency, it would involve additional cost for both students and the GOC and would have the potential to undermine our objective of enabling greater flexibility and innovation. At this stage, therefore, we are intending to focus on developing a robust approach to accreditation and quality assurance in order to provide us with assurance of consistent education provision in line with our education standards.

Development of Education Standards and Learning Outcomes 12. At the Council meeting in May 2018 we reported that we had developed draft education standards and learning outcomes, taking into account the findings of the consultation, and we committed to sharing the draft standards and learning outcomes with Council prior to carrying out a public consultation over the summer. Following discussion after the meeting with the Chair and the Council champions, we decided that there would be value in gaining further feedback before consulting publicly. The learning outcomes attached to this paper reflect the significant input we received subsequently from our Expert Advisory Group, CET Reference Group, Education committee, Standards committee and Companies committee.

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13. We are holding another meeting of the ESR Expert Advisory Group on 10 September 2018, when we will be seeking the Group’s views on the attached versions of the education standards and learning outcomes. We will provide Council with a verbal update on the further feedback that they provide and we will revise the education standards following the Council meeting to reflect Council’s feedback and the feedback received from the Expert Advisory Group on 10 September.

Continuing Education and Training Scheme 14. Over the summer we have been consulting on the principles that should inform changes to the CET Scheme, with the consultation ending on 11 September. We are proposing that from January 2020 there should be a stronger focus on promoting continuing professional development. In line with this proposed direction, we have developed draft learning outcomes for CET that are designed to: 14.1. be consistent with the draft learning outcomes that will apply to students; 14.2. ensure that current practitioners have more freedom to carry out CET in relation to areas where they would like to develop; and 14.3. still enable practitioners to maintain their core skills and knowledge.

15. Through the CET Review, we will be doing further work to determine more precisely how the learning outcomes will relate to CET requirements, looking, for example, at the extent to which registrants will need to carry out CET in relation to all the learning outcomes. We are also developing standards for CET providers, which are consistent with the standards for education providers attached to this paper.

Accreditation and quality assurance 16. In parallel with developing draft standards for education providers and draft learning outcomes for both students and current practitioners, we have been progressing work on our approach to accreditation and quality assurance of education providers. We are implementing our plan to improve our current approach, which involves clarifying and simplifying our policies and processes, with a focus on ensuring a more systematic and risk-based approach. We are also developing our approach to the accreditation and quality assurance of education providers under the new system, i.e. to ensure that the proposed new standards for education providers are enforced effectively.

17. A more outcomes-based approach will provide education providers with flexibility about how to meet our standards, but the onus will be on them to demonstrate how they have chosen to do so. For example, education providers will need to show that they have robust processes in place to ensure that students have the requisite skills and knowledge prior to students engaging with (as opposed to observing) patients. We will be seeking the views of our Education Committee on our approach to accreditation and quality assurance at 07 September 2018 Page 5 of 33 PUBLIC C34(18)

its next meeting on 15 October. We will then provide Council with an update on this area of work and our plans for implementation of the ESR at the November meeting.

Analysis 18. The draft standards for education providers cover the following five areas: 18.1. Standard 1: Patient safety and professionalism; 18.2. Standard 2: Safe and accessible learning; 18.3. Standard 3: Access to early, frequent and varied clinical experience; 18.4. Standard 4: Developing and delivering curricula; and 18.5. Standard 5: Delivering value for students, patients and employers.

19. Education providers will need to enable students to achieve the required learning outcomes. There are different draft learning outcomes for optometrists, dispensing opticians, contact lens opticians and independent prescribers. The draft learning outcomes are divided into four domains (with the exception of the learning outcomes for independent prescribers, which are discussed below): 19.1. Domain 1: a knowledgeable and skilful clinician and scientist; 19.2. Domain 2: a trusted eye health and vision professional; 19.3. Domain 3: a safe and confident practitioner; and 19.4. Domain 4: a collaborative and effective colleague and manager.

20. Domains 2, 3 and 4 are the same for the draft learning outcomes for optometrists, dispensing opticians and contact lens opticians. We have been careful to ensure that these domains are informed by and consistent with the standards of practice which students will be required to meet once they join our register as fully-qualified practitioners. For each of the learning outcomes, we have shown in brackets the relevant standards in our Standards of Practice.

21. The differences between the draft learning outcomes relate to Domain 1, which is the section where the required clinical knowledge and skills are described. In developing the different versions of Domain 1, we have taken a forward-looking approach, seeking to ensure that students will be equipped for the roles that they will be expected to perform in the future.

22. We have also developed draft learning outcomes to guide the continuing education and training (CET) of fully-qualified practitioners. We are proposing to have a single set of learning outcomes for CET that will enable registrants to choose CET that helps them to maintain their core skills and knowledge and also engage in continuing professional development. These have the same four domains as the learning outcomes that will apply to students. The content of Domains 2, 3 and 4 will also be the same, with the differences relating to Domain 1. Domain 1 in the attached version of the CET learning outcomes show some different learning outcomes for optometrists, dispensing opticians

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and contact lens opticians. However, in the light of Council’s feedback and the further feedback from the Expert Advisory Group, we will consolidate these learning outcomes further with a view to consulting on a single set of CET learning outcomes for all registrants.

23. We have taken a different approach to the development of the learning outcomes for independent prescribers, taking into account the views of the Expert Advisory Group and the CET Reference Group. We are proposing to adopt the Royal Pharmaceutical Council’s Competency Framework for all Prescribers. This applies to all healthcare professionals who prescribe, including optometrists who have qualified as independent prescribers, while recognising that different groups of healthcare professionals treat different conditions using different medicines.

24. This Framework covers the following ten areas: • assess the patient; • consider the options; • reach a shared decision; • prescribe; • provide information; • monitor and review; • prescribe safely; • prescribe professionally; • improve prescribing practice; and • prescribe as part of a team.

25. Using this Framework would mean that independent prescribers in the optical sector are required to meet the same standards as other healthcare professionals and are recognised as being capable of participating within the wider healthcare system. We will test this approach through the forthcoming consultation and will also engage directly with independent prescribers to gain their views.

Impacts 26. The following impacts have been identified: 26.1. Reserves – the project is being funded from reserves; 26.2. Budget – a dedicated project budget of £331,388 has been allocated and approved for 2018/19; 26.3. Legislation – We do not currently anticipate any need for legislative change; 26.4. Resources – we are in the process of recruiting an Interim Director of Education who will lead the project and review the resource needs of the project; 26.5. Equality, diversity and inclusion (EDI) – potential impacts will be explored in consulting on proposals;

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26.6. Human Rights Act – potential impacts will be explored in consulting on proposals; and 26.7. Sustainability – potential impacts will be explored in consulting on proposals.

Devolved nations 27. In developing the draft education standards and learning outcomes, we have taken account of the fact that the arrangements for funding and delivery of community and hospital eye services differ across the UK and this may have a bearing on future expectations of eye health professionals. One of the learning outcomes in Domain 4 of the learning outcomes for optometrists, dispensing opticians and contact lens opticians requires sets out the need to understand the differences in healthcare systems in each of the four countries of the UK (domain 4.1). Through the consultation and our ongoing stakeholder engagement we will explore these differences further and take the feedback into account.

Timeline for future work 28. We are continuing to progress the ESR in line with the project plan agreed by Council in July 2017. We are progressing the CET Review in line with the timetable agreed with Council in May 2018.

29. We are proposing to consult on the draft standards for education providers and draft learning outcomes from October 2018 to December 2018. We will then analyse the feedback with a view to presenting final versions to Council in February 2019 for approval. This is subject to the amount and nature of feedback that we receive, which will determine how much further work is needed to finalise them.

30. We will provide an update to Council in November 2018 once the Interim Director of Education is in post. This will cover our approach to accreditation and quality assurance and plans for implementation of the ESR.

Attachments Annex 1: draft standards for education providers Annex 2: draft learning outcomes for optometrists Annex 3: draft learning outcomes for dispensing opticians Annex 4: draft learning outcomes for contact lens opticians Annex 5: Royal Pharmaceutical Council’s Competency Framework for all Prescribers Annex 6: draft learning outcomes for CET

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DRAFT STANDARDS FOR EDUCATION PROVIDERS

Education Standards

Introduction The General Optical Council is the UK statutory professional regulator of Optometrists, Dispensing Opticians, Contact Lens Opticians and Optical Businesses. Our purpose is to protect the public by promoting high standards of education, performance and conduct amongst those we regulate. These Education Standards set out what we require from UK training establishments providing qualifications that lead to registration with us as an Optometrist or Dispensing Optician and for specialist registration as a Contact Lens Optician or Optometrist Independent Prescriber. Our requirements for education and training are the start of a career-long journey of education, training and continuing professional development that all those registered with the GOC will participate in. This is an important part of what it means to be an optical professional, to maintain public protection and to uphold the standards we set out in our Standards of Practice for Optometrists and Dispensing Opticians. We require all providers who are engaged in the education, training or assessment of student optometrists, dispensing opticians, contact lens opticians and optometrist Independent Prescribers to meet these standards. This is part of our regulatory framework to maintain public protection and safety. These standards apply to all academic, clinical and practical components of approved or provisionally approved UK-based education and training leading to registration with us, wherever or whoever delivers or contributes to the delivery of them. This could include employer organisations and professional bodies, together with universities and colleges. Most of these standards are outcomes-based and describe what the education and training activity will achieve and the supporting processes that will be in place to meet our standards and maintain public protection. They are directly related to the competencies we require, which a person must be able to demonstrate in order to be granted a qualification as an Optometrist or a Dispensing Optician. We express these as Learning Outcomes. We recognise that there may be a variety of ways to meet these standards and we welcome variety and innovation. Some of our standards are developmental and encourage education and training providers to continue to develop their activity. We expect all providers to demonstrate ongoing continuous improvement and development of their education and training. We will periodically quality assure providers’ activity by various means, to ensure they continue to meet these standards. Through our 07 September 2018 Page 9 of 33 PUBLIC C34(18) – ANNEX ONE quality assurance and decision-making processes we will ensure that all the education and training providers we approve have met our requirements to an equivalent standard. We commit to taking a proportionate approach to our requirements and our approval and quality assurance processes, which we will continue to develop. Where an education or training provider ceases to meet our standards we will take prompt action. In some circumstances this may include removal of approval. Where our approval is removed, such qualifications would no longer provide a route to registration with us.

Standard 1: Patient Safety and Professionalism

Patient safety and professionalism are at the heart of our requirements to ensure students are equipped and supported to practise safely and competently in accordance with our Standards of Practice for Optometrists Introduction and Dispensing Opticians throughout their professional lives. We expect this wherever, and in whatever, practice setting students go on to work as fully qualified optometrists and dispensing opticians, as Contact Lens Opticians or as Optometrist Independent Prescribers in the UK. The development and delivery of education and training is directly informed by and reflects the GOC’s Professional S1.1 Standards for Optometrists and Dispensing Opticians in order to equip students to practise in accordance with our professional standards from day one of their professional registration with the GOC.

Providers reflect annually on the emphases they place on our professional standards in the context of evolving and S1.2 new professional practice, available data and knowledge about professional risk, and of patient need and expectations and make appropriate modifications to ensure their provision remains relevant, up to date and safe.

Providers embed up to date UK evidence-based practice in their activity that reflects good practice in clinical, S1.3 professional and educational practice.

Providers embed the knowledge, understanding and application of all relevant legislative and regulatory S1.4 requirements and clinical and professional standards within their provision.

Opportunities for students to learn and engage regularly in reflective practice activity, including self-reflection, case- S1.5 based discussion, peer review and clinical audit, are integrated from the start provision and as appropriate to the level of study.

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Providers cultivate and maintain a culture of openness and candour, compassion and mutual respect with and S1.6 between staff and students, and others in the design and delivery of their programmes.

S1.7 Education and training activity is free from unfair bias, conflicts of interest and unwarranted influence of 3rd parties.

A culture that enables all prospective and new students to understand and act on their professional obligations to be S1.8 registered as students with the GOC throughout their education and training and uphold the GOC’s Standards for Optical Students is cultivated and maintained by providers.

A culture of lifelong learning in practice, individually and together with others is cultivated within students and S1.9 maintained by providers.

Standard 2: Safe and Accessible Learning

The learning and practice environments that students, staff and patients occupy in the delivery of education and training must be safe and accessible. This is important to protect all those who study, work and visit these environments and to model the safe and accessible working environments students, as new Introduction professionals, will go on to work in in accordance with our Standards of Practice for Optometrists and Dispensing Opticians, and where relevant our Standards for Optical Businesses, once they join our register as fully qualified or specialist practitioners. All student learning environments are safe and accessible to students, educators, training supervisors and patients S2.1 and carers, and free from discrimination, harassment and victimisation.

Safe, accessible and prompt channels are in place for raising concerns and an environment in which it is safe to S2.2 speak up and the public is cultivated and maintained, for students, educators and patients.

Clear and accessible internal mechanisms for appropriately supporting students and staff who are struggling or need S2.3 additional support are maintained, and providers respond promptly and fairly to signs of impairment by students or staff, and promptly refer allegations of impaired student and professional registrant fitness to practise to the GOC.

All technology, devices and equipment is safe to use and remains in good working order, is reflective of the variety S2.4 of technology used in professional practice settings, and is accessible to students.

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The safety, feasibility and adequacy of the staff-student ratio is demonstrated by providers in the context of their S2.5 overall provision.

All relevant staff and supervisors provide regular opportunities to be accessible to students on an individual and S2.6 group basis and promote a culture of openness and accessibility to students.

Student, patient and public involvement is embedded in the design and development of provision and student, S2.7 patient and public feedback is taken into account regularly.

S2.8 Mechanisms are in place to ensure there is a reasonable workload for staff and students at all times.

All staff involved in the design and delivery of programmes (including clinical experience) are professionally S2.9 competent to fulfil their roles, and programmes should be led by GOC registrants, as appropriate to the programme.

Providers have the resources to deliver programmes in accordance with these standards including, but not limited S2.10 to, teaching and support staff, equipment and facilities, access to all relevant forms of clinical experience for students.

Effective systems are in place to identify, record and respond to issues that may affect safety, and to learn promptly S2.11 from things that go wrong.

Regular and robust internal quality assurance systems are in place to ensure the safety of students and patients in S2.12 any clinical environments attended by students.

All supervisors of student clinical experience, in all relevant forms, are supportive, accessible and competent to fulfil S2.13 the supervisory role.

Standard 3: Developing and delivering curricula

It is the responsibility of education and training providers to make decisions about how they will design and Introduction deliver their provision to meet these Standards. We seek to enable providers to design, develop and deliver their provision in ways that are innovative, can continue to evolve and reflect continuous improvement, as well as reflecting the needs of patients, the optical sector and wider health systems in the UK while meeting

07 September 2018 Page 12 of 33 PUBLIC C34(18) – ANNEX ONE student and employer needs. We expect a diversity of approaches to education and training to develop, that is fair and accessible and continues to meet these standards. Providers develop and deliver curricula that delivers all learning outcomes in accordance with the relevant route to S3.1 registration as set out in Annex 1, 2 or 3 of the standards.

Curricular is delivered holistically and makes clear throughout to students the interconnections between the content S3.2 delivered and the skills, knowledge and behaviours being developed.

An active process of continuous improvement is maintained by providers to remain in step with educational, clinical S3.3 and technological good practice, reflective of practice in the UK optical sector and of changing patient demographics and clinical need.

Active mechanisms are in place to keep up to date with clinical, professional, demographic, policy and legislative, S3.4 employer and patient needs and expectations and embed this knowledge and understanding into education and training.

Use of new technologies, technological simulation and role-play, and experience with real patients under supervision S3.5 is embedded in the education and training.

New and innovative approaches are developed by providers to their design and delivery of education and training S3.6 while maintaining safety, quality, accessibility and relevance to the achievement of the learning outcomes in Annex 1, 2 or 3.

Opportunities are created by providers to deliver relevant aspects of their education and training with students of S3.7 other healthcare professions, reflective of the multi-professional teams and professional engagement typical in eye health and vision services in the UK.

Providers develop their curricula and determine their delivery modes in the context of the place of eye health and S3.8 vision services in the wider health systems within the UK, and curricula that reflects the interrelationships between the various services, decision-making and provision and health professional groups.

Providers are assured, and have evidence to support, that students have demonstrated safe and sufficient S3.9 attainment of the learning outcomes set out in Annex 1, 2 or 3 as relevant to the programme.

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S3.10 Effective management systems in place to plan, monitor and centrally record student assessment.

Regular use is made of formative student assessment, and periodic use of summative student assessment at all S3.11 relevant stages. The pass mark of individual assessments, leading to satisfactory progression and completion, is at a level that commands confidence and assures safety.

No student is permitted to progress to subsequent stages of education and training until they have demonstrated S3.12 through formative or summative assessment that they are safe and competent to do so.

S3.13 Providers demonstrate their assessments are fit for purpose and deliver valid and reliable results.

Standard 4: Access to Early, Frequent and Varied Clinical Experience

We recognise that academic theory and clinical practice are each vital components and also indivisible aspects of equipping students to become confident, competent and safe practitioners, either as Optometrists or Dispensing Opticians, Contact Lens Opticians or Optometrist Independent Prescribers in Introduction predominantly patient-facing clinical professions. This means the integrated mix of academic theory and clinical practice must be a clear feature of the education and training that leads to professional and specialist registration with us. Providers integrate academic theory with clinical experience reflective of the stage of study at all stages ensuring S4.1 relevant theory and evidence based practice underpins in all relevant practical elements.

Students have a mix of observational and practical exposure to a range of clinical environments, within practice S4.2 settings reflective of the UK optical sector, from the start of the education and training activity onwards and as appropriate to their level of study.

There is adequate, active, safe and competent clinical supervision to maintain patient, student and staff safety which S4.3 is quality assured periodically by the approved provider, and students receive adequate induction to all new clinical settings.

Students do not engage in any clinical experience that is beyond their level of study or individual competence and S4.4 that which is permitted in law.

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Providers develop working relationships, and where appropriate formal partnerships, with other academic schools or S4.5 institutions, employer bodies, professional associations and any relevant others, to cultivate, optimise and deliver access to early, frequent and varied observational and practical clinical experience for students.

Providers remain responsible at all times for the quality and safety of clinical experience delivered within their S4.6 education and training, in accordance with these standards.

Providers actively encourage and where appropriate support the development of teaching and supervisory S4.7 opportunities for appropriately qualified and competent clinical practitioners from a range of practice settings and employer types.

All students are referred to as, and clearly identifiable as, ‘students’ and ‘students under supervision’ at all stages of their education and training until entered on the GOC’s register as a fully qualified practitioner. Where already S4.8 registered as an optometrist or dispensing optician and while a participant in training for specialist registration, they are clearly identifiable as being ‘in training’.

Standard 5: Delivering Value for Students, Patients and Employers

It is crucial that the UK education and training we accredit and quality assure demonstrates good value for students and equips them to practise confidently, competently and safely as autonomous professionals in the UK optical sector. We know the optical sector is continuing to evolve, the needs of patients are Introduction changing and the range of eye health and vision services being made available are also continuing to develop. This means providers must also take these factors into account in the design, development and delivery of their education and training provision. Students are equipped to practise competently and safely in any geographic location in the UK as an optometrist, S5.1 dispensing optician, Contact Lens Optician, or Independent Prescriber.

The regulatory requirements placed upon students and professionals are made clear at all times, including in the S5.2 marketing, admissions and registration process relating to education and training provision. This includes that the student must be registered with the GOC.

S5.3 All course marketing and information material remains up to date, relevant and correct.

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Providers may integrate relevant employer or contractor requirements in their programmes, where they are not S5.4 contrary to these standards and where it meets an evidence-based geographic or sectoral workforce need.

Prospective students and current students and staff have clear, timely and accessible information about the S5.5 programmes they are or will participate in and how they relate to the learning outcomes set out in Annex 1, 2 or 3 of these standards.

Providers regularly evaluate information about their student performance, progression and outcomes by collecting, S5.6 analysing and using various data. This includes to determine the quality of formative and summative assessment, to and within education and training accessibility and to uphold equality and diversity.

Students have access to support for their academic and general welfare needs. Support is readily available to S5.7 students and they have access to careers advice.

Providers develop education and training, where it is feasible for them, that facilitates professional mobility between non-regulated optical sector roles to roles regulated by the GOC where there is evidence this would be beneficial to S5.8 the delivery of eye health and vision services in the UK. In doing so they take account of the GOC’s policies relating to approval of prior learning.

07 September 2018 Page 16 of 33 PUBLIC C34(18) – ANNEX TWO LEARNING OUTCOMES FOR OPTOMETRY STUDENTS

NB The referenced standards in brackets following each learning outcome refer to the GOC’s Standards of Practice for Optometrists and Dispensing Opticians.

Domain 1. A knowledgeable and skilful clinician and scientist. 1.1 Has a knowledge of relevant systemic and ocular development, anatomy, biology, physiology, pathophysiology and epidemiology to ocular conditions. [Standard 7] 1.2 Ability to conduct an adequate assessment for the purposes of the optical consultation, including where necessary any relevant medical, family and social history of the patient. This may include current symptoms, personal beliefs or cultural factors. [Standard 7] 1.3 Understands and able to apply a wide range of ocular examination techniques, diagnostic procedures and diagnostic drugs to examine the eye health of the patient. [Standard 7] 1.4 Understands and applies knowledge of visual processing to the measurement and management of normal and abnormal visual function. [Standard 7] 1.5 Understands and applies knowledge of geometric and visual optics, and accommodation, to evaluate refractive error and to prescribe spectacles, contact lenses or low vision devices. [Standard 7] 1.6 Ability to analyse and process the information obtained during assessment and examination of the patient to form a differential diagnosis. Able to make a reasoned final diagnosis using professional judgement. [Standard 7] 1.7 Diagnoses and manages a common range of normal and abnormal ocular conditions and disease. [Standard 7] 1.8 Understands and applies knowledge of pharmaceuticals, pharmacology and microbiology to patient care. Understands the principles of independent prescribing and the legislation relating to the use and supply of exempt and controlled drugs. [Standard 7] 1.9 Understands and fulfils own role as part of a multidisciplinary healthcare team diagnosing and managing complex ocular conditions and diseases. [Standards 7 and 10] 1.10 Understands the methods of selecting and fitting of contact lenses and the importance of aftercare regimes for patients with both rigid and soft contact lenses to maintain ocular health. [Standard 7] 1.11 Able to fit contact lenses, monitor anterior eye health and address any complications that may arise through these processes. [Standard 7] 1.12 Understands and applies knowledge of spectacle, contact lens and low vision aid design and materials, to provide patients with suitable optical appliances based on visual function, lifestyle, and occupational, sporting and protective needs. [Standard 7] 1.13 Ability to prepare, communicate and manage effective support and aftercare plans in collaboration with patients, and other colleagues where appropriate. [Standard 7]

07 September 2018 Page 17 of 33 PUBLIC C34(18) – ANNEX TWO 1.14 Demonstrates an understanding and ability to communicate with patients with diverse needs, including treating patients with disabilities. [Standards 7 and 2] 1.15 Understands and able to use peer-reviewed and clinical literature to make sound clinical judgements and is able to adapt to emerging standards or technology. [Standard 5]

Domain 2. A trusted eye health and vision professional 2.1 Understands the need to put patients’ interests first and demonstrates care and compassion for patients. [Standards 1 and 4] 2.2 Has knowledge of what is required for valid consent and the ability to gain this from patients. Shows an awareness and understanding of the legal obligations and differences in the provision of valid consent in the different nations of the UK, and differences in obtaining consent for children, young people and vulnerable adults. [Standard 3 in full] 2.3 Understands and recognises the need for professional boundaries in practice, particularly to avoid exploiting or unduly influencing patients or the public, whether politically, financially, sexually or by other means. [Standards 15 in full] 2.4 Understands and respects the principles and law relating to equality, diversity and inclusion, and does not discriminate when providing patient care. [Standard 13] 2.5 Is able to communicate effectively with patients, carers and colleagues and is able to adapt communication style where necessary to different situations and patients. Demonstrates a sensitive and supportive approach when communicating difficult news and is able to pick up on unspoken signals which could indicate a lack of understanding, discomfort or lack of consent. [Standard 2 in full] 2.6 Understands own personal responsibility to protect and safeguard patients, colleagues and others from harm, reducing the risk of abuse. Possesses knowledge of the legal requirements related to safeguarding, particularly in relation to children, young people and vulnerable patients. [Standards 11] 2.7 Understands and respects the need for patient privacy and demonstrates ability to maintain confidentiality in accordance with legislation and clinical governance principles. [Standard 14] 2.8 Understands and applies ethical principles and the law relevant to optical practice. Able to recognise and appropriately manage ethical dilemmas by using professional judgement. [Standards 6 and 16] 2.9 Understands the need for honesty and integrity to maintain public trust and confidence and demonstrates this behaviour recognising and responding appropriately if the health and safety of the public is put at risk. [Standard 16] 2.10 Understands the professional duty of candour and is able to demonstrate the elements of candour when things go wrong in a practice setting. [Standard 19 in full]

07 September 2018 Page 18 of 33 PUBLIC C34(18) – ANNEX TWO Domain 3. A safe and competent practitioner 3.1 Understands and is able to critically evaluate research and developments in optometry and vision science, including technology and translates theory into practice in varied clinical settings, across the range of conditions and patient groups reflective of patient need. [Standard 5] 3.2 Demonstrates knowledge, understanding and respect of the law and current regulatory standards relating to optical practice, including the role of the General Optical Council and the requirements of registration. [Standards 9 and 17] 3.3 Understands the need to raise concerns promptly if patient or public safety might be at risk. Demonstrates knowledge and ability of how concerns can be raised and escalated and confidence to engage in difficult conversations regarding concerns. [Standard 11] 3.4 Demonstrates the ability to maintain accurate, up to date and accessible patient records containing all necessary information, and able to adapt to a range of systems and formats including written and electronic. [Standards 8 in full and 9] 3.5 Understands the need for lifelong learning/continuing professional development in order to maintain, enhance and develop their practice for the good of patients and the public. Has the ability to reflect on their own practice by oneself or with others, drawing on a wide range of different information sources, such as significant events analysis, clinical audit, patient feedback and peer review. [Standard 5] 3.6 Understands that there are limits to their professional competence, knowledge, skills and experience and works within their scope of practice. [Standard 5] 3.7 Understands and able to describe what is required for a safe environment for patients and their own responsibility to ensure this is delivered. Able to adapt their own practice to accommodate different practice settings to ensure the maintenance of safety and has the confidence to take appropriate action if an environment is compromising patient safety. [Standard 12] 3.8 Ability to apply skills and professional judgement in the detection, diagnosis and management of patient care, doing the right thing and putting the patient first. [Standard 7] 3.9 Is able to deal appropriately and promptly with an emergency situation in practice, whether eye-related or medical emergency, taking into account their own scope of practice and training. [Standard 12]

Domain 4. A collaborative and effective colleague and manager 4.1 Understands the differences in healthcare systems in each of the four countries of the UK and can describe from the varied scope of individual experience the range of settings in which patients receive care including in remote and urban environments. [Standards 13 and 17] 4.2 Recognises the social, commercial/financial, legal and political context in which optometric practice is undertaken and has ability to manage these aspects of the role without compromising professional standards. [Standard 16] 07 September 2018 Page 19 of 33 PUBLIC C34(18) – ANNEX TWO 4.3 Respects and values the roles and contributions of other health and social care professionals within the healthcare system. Has the ability to work effectively in multidisciplinary health and social care teams across a range of health and social care settings and across organisational boundaries. [Standards 10 and 13] 4.4 Understands that there will be times when they need to consult or refer with other colleagues within or outside of the optical sector. Is aware of different referral mechanisms within the healthcare system and demonstrates respect for the contribution of other healthcare professionals. [Standard 6] 4.5 Understands the role of eye health and sight loss services within the wider public health context and the need for all health professionals to play a role in health promotion to address changing patient and social demographics. [Standard 1] 4.6 Understands the concept of clinical governance which may include, but is not limited to, infection control, information security, operating a complaints mechanism and using data from clinical audit or patient feedback to review and improve practice. Is able to use secure information management systems, clinical guidance and protocols and has the ability to adapt to different regimes at a local level by healthcare providers and employers and is able to adapt practice accordingly. [Standards 5, 12 and 18]

07 September 2018 Page 20 of 33 PUBLIC C34(18) – ANNEX THREE LEARNING OUTCOMES FOR DISPENSING OPTICIAN STUDENTS NB The referenced standards in brackets following each learning outcome refer to the GOC’s Standards of Practice for Optometrists and Dispensing Opticians. Domain 1. A knowledgeable and skilful clinician and scientist 1.1 Has a knowledge of relevant systemic and ocular development, anatomy, biology, physiology, pathophysiology and epidemiology to ocular conditions. [Standard 7] 1.2 Understands a wide range of ocular examination techniques, diagnostic procedures and diagnostic drugs. [Standard 7] 1.3 Understands and applies knowledge of theory, product and advancement in technology of ophthalmic lenses, in order to provide patients with the most appropriate optical appliances based on visual function, lifestyle, occupational, leisure and protective need. [Standard 7] 1.4 Understands and applies knowledge of anatomical features and development (especially in paediatric patients), and frame materials, features and construction, in order to provide (and adapt where necessary) the most appropriate fit of frame, mount or appliance to all patients. [Standard 7] 1.5 Understands and applies knowledge of geometric and visual optics, and accommodation, in order to evaluate refractive error and dispense spectacles. [Standard 7] 1.6 Understands and applies knowledge of low vision optics, to conduct a low vision assessment, and to dispense the most appropriate low vision devices. [Standard 7] 1.7 Accurately interprets clinical and refractive data to dispense the most appropriate optical appliance for the patient’s needs, recording how and why any adjustment against the prescription is made. [Standard 7] 1.8 Understands and recognises a range of common normal and abnormal ocular conditions and appropriately advises and/or refers patients where necessary to the most appropriate professional, including those external to the practice. [Standard 6 and 7] 1.9 Understands and fulfils own role as part of a multidisciplinary healthcare team in effectively dispensing complex prescriptions and can adapt to the requirements of the professional environment. [Standards 6 and 10] 1.10 Understands the methods of selecting and fitting of contact lenses and the importance of aftercare regimes for patients with both rigid and soft contact lenses to maintain ocular health. [Standard 7] 1.11 Ability to prepare, communicate and manage effective support and aftercare plans in collaboration with patients, and other colleagues where appropriate. [Standard 7] 1.12 Demonstrates an understanding and ability to communicate with patients with diverse needs, including dispensing patients with disabilities. [Standards 7 and 2] 1.13 Understands and able to use peer-reviewed and clinical literature to make sound clinical judgements and is able to adapt to emerging standards or technology. [Standard 5]

07 September 2018 Page 21 of 33 PUBLIC C34(18) – ANNEX THREE Domain 2. A trusted eye health and vision professional 2.1 Understands the need to put patients’ interests first and demonstrates care and compassion for patients. [Standards 1 and 4] 2.2 Has knowledge of what is required for valid consent and the ability to gain this from patients. Shows an awareness and understanding of the legal obligations and differences in the provision of valid consent in the different nations of the UK, and differences in obtaining consent for children, young people and vulnerable adults. [Standard 3 in full] 2.3 Understands and recognises the need for professional boundaries in practice, particularly to avoid exploiting or unduly influencing patients or the public, whether politically, financially, sexually or by other means. [Standard 15 in full] 2.4 Understands and respects the principles and law relating to equality, diversity and inclusion, and does not discriminate when providing patient care. [Standard 13] 2.5 Is able to communicate effectively with patients, carers and colleagues and is able to adapt communication style where necessary to different situations and patients. Demonstrates a sensitive and supportive approach when communicating difficult news and is able to pick up on unspoken signals which could indicate a lack of understanding, discomfort or lack of consent. [Standard 2 in full] 2.6 Understands own personal responsibility to protect and safeguard patients, colleagues and others from harm, reducing the risk of abuse. Possesses knowledge of the legal requirements related to safeguarding, particularly in relation to children, young people and vulnerable patients. [Standard 11] 2.7 Understands and respects the need for patient privacy and demonstrates ability to maintain confidentiality in accordance with legislation and clinical governance principles. [Standard 14] 2.8 Understands and applies ethical principles and the law relevant to optical practice. Able to recognise and appropriately manage ethical dilemmas by using professional judgement. [Standards 6 and 16] 2.9 Understands the need for honesty and integrity to maintain public trust and confidence and demonstrates this behaviour recognising and responding appropriately if the health and safety of the public is put at risk. [Standard 16] 2.10 Understands the professional duty of candour and is able to demonstrate the elements of candour when things go wrong in a practice setting. [Standard 19 in full]

07 September 2018 Page 22 of 33 PUBLIC C34(18) – ANNEX THREE 3.2 Demonstrates knowledge, understanding and respect of the law and current regulatory standards relating to optical practice, including the role of the General Optical Council and the requirements of registration. [Standards 9 and 17] 3.3 Understands the need to raise concerns promptly if patient or public safety might be at risk. Demonstrates knowledge and ability of how concerns can be raised and escalated and confidence to engage in difficult conversations regarding concerns. [Standard 11] 3.4 Demonstrates the ability to maintain accurate, up to date and accessible patient records containing all necessary information, and able to adapt to a range of systems and formats including written and electronic. [Standards 8 in full and 9] 3.5 Understands the need for lifelong learning/continuing professional development in order to maintain, enhance and develop their practice for the good of patients and the public. Has the ability to reflect on their own practice by oneself or with others, drawing on a wide range of different information sources, such as significant events analysis, clinical audit, patient feedback and peer review. [Standard 5] 3.6 Understands that there are limits to their professional competence, knowledge, skills and experience and works within their scope of practice. [Standard 5] 3.7 Understands and able to describe what is required for a safe environment for patients and their own responsibility to ensure this is delivered. Able to adapt their own practice to accommodate different practice settings to ensure the maintenance of safety and has the confidence to take appropriate action if an environment is compromising patient safety. [Standard 12] 3.8 Ability to apply skills and professional judgement in the detection, diagnosis and management of patient care, doing the right thing and putting the patient first. [Standard 7] 3.9 Is able to deal appropriately and promptly with an emergency situation in practice, whether eye-related or medical emergency, taking into account their own scope of practice and training. [Standard 12]

07 September 2018 Page 23 of 33 PUBLIC C34(18) – ANNEX THREE 4.4 Understands that there will be times when they need to consult or refer with other colleagues within or outside of the optical sector. Is aware of different referral mechanisms within the healthcare system and demonstrates respect for the contribution of other healthcare professionals. [Standard 6] 4.5 Understands the role of eye health and sight loss services within the wider public health context and the need for all health professionals to play a role in health promotion to address changing patient and social demographics. [Standard 1] 4.6 Understands the concept of clinical governance which may include, but is not limited to, infection control, information security, operating a complaints mechanism and using data from clinical audit or patient feedback to review and improve practice. Is able to use secure information management systems, clinical guidance and protocols and has the ability to adapt to different regimes at a local level by healthcare providers and employers and is able to adapt practice accordingly. [Standards 5, 12 and 18]

07 September 2018 Page 24 of 33 PUBLIC C34(18) – ANNEX FOUR LEARNING OUTCOMES FOR CONTACT LENS OPTICIANS

NB The referenced standards in brackets following each learning outcome refer to the GOC’s Standards of Practice for Optometrists and Dispensing Opticians. Domain 1. A knowledgeable and skilful clinician and scientist. 1.1 Has a knowledge of relevant systemic and ocular development, anatomy, biology, physiology, pathophysiology and epidemiology to ocular conditions. [Standard 7] 1.2 Understands a wide range of ocular examination techniques, diagnostic procedures and diagnostic drugs. [Standard 7] 1.3 Understands and applies knowledge of contact lens materials and product technology in order to provide patients with the most appropriate contact lenses based on visual function, lifestyle, occupational, leisure and protective need. [Standard 7] 1.4 Understands and applies knowledge of anatomical features and development (especially in paediatric patients), and contact lens materials, features and construction, in order to provide (and adapt where necessary) the most appropriate fit of contact lenses to all patients. [Standard 7] 1.5 Understands and applies knowledge of geometric and visual optics, and accommodation, in order to evaluate refractive error, and to properly fit the most appropriate contact lens for the use and needs of the patient. [Standard 7] 1.6 Understands and applies knowledge of low vision optics, to conduct a low vision assessment, and to dispense the most appropriate contact lenses. [Standard 7] 1.7 Accurately interprets clinical and refractive data to dispense the most appropriate contact lens for the patient’s needs, recording how and why any adjustment against the prescription is made. [Standard 7] 1.8 Understands and recognises a range of common normal and abnormal ocular conditions and appropriately advises and/or refers patients where necessary to the most appropriate professional, including those external to the practice. [Standards 6 and 7] 1.9 Understands and fulfils own role as part of a multidisciplinary healthcare team in effectively dispensing complex prescriptions and can adapt to the requirements of the professional environment. [Standards 6 and 10] 1.10 Understands the methods of selecting and fitting of contact lenses and the importance of aftercare regimes for patients with both rigid and soft contact lenses to maintain ocular health. [Standard 7] 1.11 Ability to fit contact lenses, monitor anterior eye health and address any complications that may arise through these processes 1.12 Ability to prepare, communicate and manage effective support and aftercare plans in collaboration with patients, and other colleagues where appropriate. [Standard 7] 1.13 Demonstrates an understanding and ability to communicate with patients with diverse needs, including dispensing patients with disabilities. [Standards 7 and 2]

07 September 2018 Page 25 of 33 PUBLIC C34(18) – ANNEX FOUR 1.14 Understands and able to use peer-reviewed and clinical literature to make sound clinical judgements and is able to adapt to emerging standards or technology. [Standard 5]

Domain 2. A trusted eye health and vision professional 2.1 Understands the need to put patients’ interests first and demonstrates care and compassion for patients. [Standards 1 and 4] 2.2 Has knowledge of what is required for valid consent and the ability to gain this from patients. Shows an awareness and understanding of the legal obligations and differences in the provision of valid consent in the different nations of the UK, and differences in obtaining consent for children, young people and vulnerable adults. [Standard 3 in full] 2.3 Understands and recognises the need for professional boundaries in practice, particularly to avoid exploiting or unduly influencing patients or the public, whether politically, financially, sexually or by other means. [Standard 15 in full] 2.4 Understands and respects the principles and law relating to equality, diversity and inclusion, and does not discriminate when providing patient care. [Standard 13] 2.5 Is able to communicate effectively with patients, carers and colleagues and is able to adapt communication style where necessary to different situations and patients. Demonstrates a sensitive and supportive approach when communicating difficult news and is able to pick up on unspoken signals which could indicate a lack of understanding, discomfort or lack of consent. [Standard 2 in full] 2.6 Understands own personal responsibility to protect and safeguard patients, colleagues and others from harm, reducing the risk of abuse. Possesses knowledge of the legal requirements related to safeguarding, particularly in relation to children, young people and vulnerable patients. [Standard 11] 2.7 Understands and respects the need for patient privacy and demonstrates ability to maintain confidentiality in accordance with legislation and clinical governance principles. [Standard 14] 2.8 Understands and applies ethical principles and the law relevant to optical practice. Able to recognise and appropriately manage ethical dilemmas by using professional judgement. [Standards 6 and 16] 2.9 Understands the need for honesty and integrity to maintain public trust and confidence and demonstrates this behaviour recognising and responding appropriately if the health and safety of the public is put at risk. [Standard 16] 2.10 Understands the professional duty of candour and is able to demonstrate the elements of candour when things go wrong in a practice setting. [Standard 19 in full]

07 September 2018 Page 26 of 33 PUBLIC C34(18) – ANNEX FOUR clinical settings, across the range of conditions and patient groups reflective of patient need. [Standard 5] 3.2 Demonstrates knowledge, understanding and respect of the law and current regulatory standards relating to optical practice, including the role of the General Optical Council and the requirements of registration. [Standards 9 and 17] 3.3 Understands the need to raise concerns promptly if patient or public safety might be at risk. Demonstrates knowledge and ability of how concerns can be raised and escalated and confidence to engage in difficult conversations regarding concerns. [Standard 11] 3.4 Demonstrates the ability to maintain accurate, up to date and accessible patient records containing all necessary information, and able to adapt to a range of systems and formats including written and electronic. [Standards 8 in full and 9] 3.5 Understands the need for lifelong learning/continuing professional development in order to maintain, enhance and develop their practice for the good of patients and the public. Has the ability to reflect on their own practice by oneself or with others, drawing on a wide range of different information sources, such as significant events analysis, clinical audit, patient feedback and peer review. [Standard 5] 3.6 Understands that there are limits to their professional competence, knowledge, skills and experience and works within their scope of practice. [Standard 5] 3.7 Understands and able to describe what is required for a safe environment for patients and their own responsibility to ensure this is delivered. Able to adapt their own practice to accommodate different practice settings to ensure the maintenance of safety and has the confidence to take appropriate action if an environment is compromising patient safety. [Standard 12] 3.8 Ability to apply skills and professional judgement in the detection, diagnosis and management of patient care, doing the right thing and putting the patient first. [Standard 7] 3.9 Is able to deal appropriately and promptly with an emergency situation in practice, whether eye-related or medical emergency, taking into account their own scope of practice and training. [Standard 12]

07 September 2018 Page 27 of 33 PUBLIC C34(18) – ANNEX FOUR disciplinary health and social care teams across a range of health and social care settings and across organisational boundaries. [Standards 10 and 13] 4.4 Understands that there will be times when they need to consult or refer with other colleagues within or outside of the optical sector. Is aware of different referral mechanisms within the healthcare system and demonstrates respect for the contribution of other healthcare professionals. [Standard 6] 4.5 Understands the role of eye health and sight loss services within the wider public health context and the need for all health professionals to play a role in health promotion to address changing patient and social demographics. [Standard 1] 4.6 Understands the concept of clinical governance which may include, but is not limited to, infection control, information security, operating a complaints mechanism and using data from clinical audit or patient feedback to review and improve practice. Is able to use secure information management systems, clinical guidance and protocols and has the ability to adapt to different regimes at a local level by healthcare providers and employers and is able to adapt practice accordingly. [Standards 5, 12 and 18]

07 September 2018 Page 28 of 33 PUBLIC C34(18) – ANNEX SIX LEARNING OUTCOMES FOR CET

Key:

Optometrists Dispensing Opticians Contact Lens Opticians

Domain 1. A knowledgeable and skilful clinician and scientist. 1.1 Has a knowledge of relevant systemic and ocular development, anatomy, biology, physiology, pathophysiology and epidemiology to ocular conditions. 1.2 Ability to conduct an adequate assessment for the purposes of the optical consultation, including where necessary any relevant medical, family and social history of the patient. This may include current symptoms, personal beliefs or cultural factors. 1.3 Understands and able to apply a wide range of ocular examination techniques, diagnostic procedures and diagnostic drugs to examine the eye health of the patient. 1.3 Understands a wide range of ocular examination techniques, diagnostic procedures and diagnostic drugs. 1.3 Understands a wide range of ocular examination techniques, diagnostic procedures and diagnostic drugs. 1.4 Understands and applies knowledge of visual processing to the measurement and management of normal and abnormal visual function. 1.4 Understands and applies knowledge of theory, product and advancement in technology of ophthalmic lenses, in order to provide patients with the most appropriate optical appliances based on visual function, lifestyle, occupational, leisure and protective need. 1.4 Understands and applies knowledge of anatomical features and development (especially in paediatric patients), and frame materials, features and construction, in order to provide (and adapt where necessary) the most appropriate fit of frame, mount or appliance to all patients. 1.4 Understands and applies knowledge of contact lens materials and product technology in order to provide patients with the most appropriate contact lenses based on visual function, lifestyle, occupational, leisure and protective need. 1.4 Understands and applies knowledge of anatomical features and development (especially in paediatric patients), and contact lens materials, features and construction, in order to provide (and adapt where necessary) the most appropriate fit of contact lenses to all patients. 1.5 Understands and applies knowledge of geometric and visual optics, and accommodation, to evaluate refractive error and to prescribe spectacles, contact lenses or low vision devices. 1.5 Understands and applies knowledge of geometric and visual optics, and accommodation, in order to evaluate refractive error and dispense spectacles.

07 September 2018 Page 29 of 33 PUBLIC C34(18) – ANNEX SIX 1.5 Understands and applies knowledge of geometric and visual optics, and accommodation, in order to evaluate refractive error, and to properly fit the most appropriate contact lens for the use and needs of the patient. 1.6 Understands and applies knowledge of low vision optics, to conduct a low vision assessment, and to dispense the most appropriate low vision devices. 1.6 Understands and applies knowledge of low vision optics, to conduct a low vision assessment, and to dispense the most appropriate contact lenses. 1.7 Ability to analyse and process the information obtained during assessment and examination of the patient to form a differential diagnosis. Able to make a reasoned final diagnosis using professional judgement. 1.7 Accurately interprets clinical and refractive data to dispense the most appropriate optical appliance for the patient’s needs, recording how and why any adjustment against the prescription is made. 1.7 Accurately interprets clinical and refractive data to dispense the most appropriate contact lens for the patient’s needs, recording how and why any adjustment against the prescription is made. 1.8 Diagnoses and manages a common range of normal and abnormal ocular conditions and disease. 1.8 Understands and recognises a range of common normal and abnormal ocular conditions and appropriately advises and/or refers patients where necessary to the most appropriate professional, including those external to the practice. 1.8 Understands and recognises a range of common normal and abnormal ocular conditions and appropriately advises and/or refers patients where necessary to the most appropriate professional, including those external to the practice. 1.9 Understands and applies knowledge of pharmaceuticals, pharmacology and microbiology to patient care. Understands the principles of independent prescribing and the legislation relating to the use and supply of exempt and controlled drugs. 1.10 Understands and fulfils own role as part of a multidisciplinary healthcare team diagnosing and managing complex ocular conditions and diseases. 1.10 Understands and fulfils own role as part of a multidisciplinary healthcare team in effectively dispensing complex prescriptions and can adapt to the requirements of the professional environment. 1.10 Understands and fulfils own role as part of a multidisciplinary healthcare team in effectively dispensing complex prescriptions and can adapt to the requirements of the professional environment. 1.11 Able to fit contact lenses, monitor anterior eye health and address any complications that may arise through these processes. 1.11 Ability to fit contact lenses, monitor anterior eye health and address any complications that may arise through these processes

07 September 2018 Page 30 of 33 PUBLIC C34(18) – ANNEX SIX 1.12 Understands the methods of selecting and fitting of contact lenses and the importance of aftercare regimes for patients with both rigid and soft contact lenses to maintain ocular health. 1.13 Understands and applies knowledge of spectacle, contact lens and low vision aid design and materials, to provide patients with suitable optical appliances based on visual function, lifestyle, and occupational, sporting and protective needs. 1.14 Ability to prepare, communicate and manage effective support and aftercare plans in collaboration with patients, and other colleagues where appropriate. 1.15 Demonstrates an understanding and ability to communicate with patients with diverse needs, including treating patients with disabilities. 1.16 Understands and able to use peer-reviewed and clinical literature to make sound clinical judgements and is able to adapt to emerging standards or technology.

07 September 2018 Page 31 of 33 PUBLIC C34(18) – ANNEX SIX 2.9 Understands the need for honesty and integrity to maintain public trust and confidence and demonstrates this behaviour recognising and responding appropriately if the health and safety of the public is put at risk. [Standard 16] 2.10 Understands the professional duty of candour and is able to demonstrate the elements of candour when things go wrong in a practice setting. [Standard 19 in full]

Domain 3. A safe and competent practitioner 3.1 Understands and is able to critically evaluate research and developments in optometry and vision science, including technology and translates theory into practice in varied clinical settings, across the range of conditions and patient groups reflective of patient need. [Standard 5] 3.2 Demonstrates knowledge, understanding and respect of the law and current regulatory standards relating to optical practice, including the role of the General Optical Council and the requirements of registration. [Standards 9 and 17] 3.3 Understands the need to raises concerns promptly if patient or public safety might be at risk. Demonstrates knowledge and ability of how concerns can be raised and escalated and confidence to engage in difficult conversations regarding concerns. [Standard 11] 3.4 Demonstrates the ability to maintain accurate, up to date and accessible patient records containing all necessary information, and able to adapt to a range of systems and formats including written and electronic. [Standards 8 in full and 9] 3.5 Understands the need for lifelong learning/continuing professional development in order to maintain, enhance and develop their practice for the good of patients and the public. Has the ability to reflect on their own practice by oneself or with others, drawing on a wide range of different information sources, such as significant events analysis, clinical audit, patient feedback and peer review. [Standard 5] 3.6 Understands that there are limits to their professional competence, knowledge, skills and experience and works within their scope of practice. [Standard 5] 3.7 Understands and able to describe what is required for a safe environment for patients and their own responsibility to ensure this is delivered. Able to adapt their own practice to accommodate different practice settings to ensure the maintenance of safety and has the confidence to take appropriate action if an environment is compromising patient safety. [Standard 12] 3.8 Ability to apply skills and professional judgement in the detection, diagnosis and management of patient care, doing the right thing and putting the patient first. [Standard 7] 3.9 Is able to deal appropriately and promptly with an emergency situation in practice, whether eye-related or medical emergency, taking into account their own scope of practice and training. [Standard 12]

07 September 2018 Page 32 of 33 PUBLIC C34(18) – ANNEX SIX Domain 4. A collaborative and effective colleague and manager 4.1 Understands the differences in healthcare systems in each of the four counties of the UK and can describe from the varied scope of individual experience the range of settings in which patients receive care including in remote and urban environments. [Standard 13 and 17] 4.2 Recognises the social, commercial/financial, legal and political context in which optometric practice is undertaken and has ability to manage these aspects of the role without compromising professional standards. [Standard 16] 4.3 Respects and values the roles and contributions of other health and social care professionals within the healthcare system. Has the ability to work effectively in multidisciplinary health and social care teams across a range of health and social care settings and across organisational boundaries. [Standards 10 and 13] 4.4 Understands that there will be times when they need to consult or refer with other colleagues within or outside of the optical sector. Is aware of different referral mechanisms within the healthcare system and demonstrates respect for the contribution of other healthcare professionals. [Standard 6] 4.5 Understands the role of eye health and sight loss services within the wider public health context and the need for all health professionals to play a role in health promotion to address changing patient and social demographics. [Standard 1] 4.6 Understands the concept of clinical governance which may include, but is not limited to, infection control, information security, operating a complaints mechanism and using data from clinical audit or patient feedback to review and improve practice. Is able to use secure information management systems, clinical guidance and protocols and has the ability to adapt to different regimes at a local level by healthcare providers and employers and is able to adapt practice accordingly. [Standards 5, 12 and 18]

07 September 2018 Page 33 of 33 Prescribing Framework

C34(18) - ANNEX FIVE

A Competency Framework for all Prescribers

Publication date: July 2016 Review date: July 2020

NICE has accredited the process used by the Royal Pharmaceutical Society to produce its professional guidance and standards. Accreditation is valid for 5 years from 17 February 2017.

For full details on NICE accreditation visit: www.nice.org.uk/accreditation CONTENTS

1.0 INTRODUCTION 2

2.0 HOW THE FRAMEWORK WAS UPDATED 3

3.0 PURPOSE AND USES OF THE FRAMEWORK 4

4.0 SCOPE OF THE FRAMEWORK 7 CONTENTS 5.0 THE ROLE OF PROFESSIONALISM 8

6.0 THE PRESCRIBING COMPETENCY FRAMEWORK 9

7.0 PUTTING THE FRAMEWORK INTO PRACTICE 15

GLOSSARY 16

REFERENCES 17

APPENDIX 1 HOW THE FRAMEWORK WAS UPDATED 18

APPENDIX 2 ACKNOWLEDGEMENTS 20

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 1 1.0 INTRODUCTION

Medicines are used more than any other intervention by To support all prescribers to prescribe effectively a patients to manage their medical conditions. Both the single prescribing competency framework was published number of medicines prescribed and the complexity of by the National Prescribing Centre/National Institute the medicines regimes that patients take are increasing. for Health and Clinical Excellence (NICE) in 20127. As the population ages and multiple co-morbidities Based on earlier profession specific prescribing become more prevalent, polypharmacy is increasingly competency frameworks8,9,10,11 the framework was becoming the norm for patients1,2. This increase in developed because it became clear that a common complexity means that besides developing and maintaining set of competencies should underpin prescribing prescribing competency for individual conditions, regardless of professional background. prescribers have the challenge of keeping up to date with The 2012 framework is now in wide use across the UK new medicines as they come onto the market and being

(see ‘Uses of the framework’ – Section 3) and was due INTRODUCTION aware of the potential for interaction between medicines

for review in 2014. NICE and Health Education England 1.0 in patients with multiple co-morbidities3. approached the Royal Pharmaceutical Society (RPS) to When prescribed and used effectively medicines have manage the update of the framework on behalf of all the the potential to significantly improve the quality of lives prescribing professions in the UK. The RPS agreed to and improve patient outcomes. However, the challenges update the competency framework in collaboration with associated with prescribing the right medicines and patients and the other prescribing professions many of supporting patients to use them effectively should not whose professional bodies have endorsed this be underestimated. There is a considerable amount of updated framework. evidence nationally and internationally to demonstrate Going forward the RPS will continue to publish that much needs to be done to improve the way that (and maintain) the updated competency framework we prescribe and support patients in effective in collaboration with the other prescribing professions. medicines use4,5,6. The framework will be published on the RPS website Doctors are by far the largest group of prescribers who, for all regulators, professional bodies, prescribing along with dentists, are able to prescribe on registration. professions and patients to use. They have been joined over the last fifteen years by independent and supplementary prescribers from a range of other healthcare professions who are able to prescribe within their scope of practice once they have completed an approved education programme. This extension of prescribing responsibilities to other professional groups is likely to continue where it is safe to do so and there is clear patient benefit.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 2 2.0 HOW THE FRAMEWORK WAS UPDATED

A project steering group consisting of prescribers from Multi professional input into the updating process and across all the professions and patients (see Appendix 2 dissemination post publication was supported by regular for membership) updated the framework using a process engagement with an external reference group of over consistent with the development of previous competency seventy organisations and individuals including professional frameworks. For full details of the process used to update regulators, professional bodies, patient groups and higher the framework see Appendix 1. education institutes. See Appendix 2 for membership.

The updating process included a six week consultation of the draft competency framework to which almost one hundred organisations and individuals responded.

To ensure the framework has applicability across the UK, a strategic level Project Board consisting of representatives of the Chief Pharmaceutical Officers England, Scotland, Wales and Northern Ireland as well as Health Education England, NHS Education for Scotland and NICE supported the update of the HOW THE FRAMEWORK WAS UPDATED framework. See Appendix 2 for membership. 2.0

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 3 3.0 PURPOSE AND USES OF THE FRAMEWORK

A competency is a quality or characteristic of a person The prescribing competency framework can be used by that is related to effective performance. Competencies any prescriber at any point in their career to underpin can be described as a combination of knowledge, professional responsibility for prescribing. It can also be skills, motives and personal traits. Competencies help used by regulators, education providers, professional individuals and their organisations look at how they organisations and specialist groups to inform standards, do their jobs. A competency framework is a collection the development of education, and to inform guidance of competencies thought to be central to effective and advice. It provides the opportunity to bring performance. Development of competencies should professions together and harmonise education for therefore help individuals to continually improve their prescribers by offering a competency framework for performance and to work more effectively. all prescribers.

If acquired and maintained, the prescribing competencies The prescribing competency framework has a wide in this framework, will help healthcare professionals to range of uses and the previous version has already been be safe, effective prescribers who are able to support extensively used in practice. Uses of the framework are patients to get the best outcomes from their medicines. highlighted here along with some examples of practice. More examples of how the framework can and has been

used can be found on the RPS website. The framework

PURPOSE AND USES OF THE FRAMEWORK can be used to: 3.0

1. Inform the design and delivery of education programmes, for example through validation of educational sessions (including rationale for need), and as a framework to structure learning and assessment. “I have used the prescribing competency framework in designing a seven week teaching programme for fifth year medical undergraduates, the effectiveness of which has been demonstrated by a pre- and post- teaching assessment that allows the students to demonstrate competency in many of the areas identified in the framework (calculations, identifying adverse drug reactions, considering contraindications to therapies, use of formularies).” – Medical Education, NHS – Betsi Cadwaladr University Health Board

2. Help healthcare professionals prepare to prescribe and provide the basis for on-going continuing education and development programmes, and revalidation processes. For example, use as a framework for a portfolio to demonstrate competency in prescribing. “Non-medical prescribing courses in the North West region are all structured around the prescribing competency framework so prescribers are familiar with its contents prior to qualification. I expect every non-medical prescriber in my organisation to be familiar with the framework and I direct new prescribers and those new to the organisation to it at our first meeting. Personally I intend to use the framework to evidence how I have stayed up to date as a prescriber as part of the Nursing and Midwifery Council revalidation process.” – Non-medical prescribing lead, East Lancashire Hospitals NHS Trust

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 4 3. Help prescribers identify strengths and areas for development through self-assessment, appraisal and as a way of structuring feedback from colleagues. “At City Health Care Partnership the competency framework forms the basis of a passport for all non-medical prescribers. All prescribers receive a passport when they join the organisation or are newly qualified. Having the competencies in the passport allows prescribers to reflect on their prescribing and helps them to structure their CPD records as well as informing clinical supervision discussions. As an organisation we expect prescribers to ensure that the competencies are demonstrated in their prescribing practice.” – City Health Care Partnership, Hull

4. Provide professional organisations or specialist groups with a basis for the development of levels of prescribing competency, for example, from recently qualified prescriber through to advanced prescriber. “Within NHS Greater Glasgow and Clyde Addiction Services the competency framework forms part of our non-medical prescribing Operational Policy. The policy is a working document which follows on from our Service’s non-medical prescribing Strategy for the period 2015-2020. Within our policy there are three levels of prescribers based on qualification status, level of experience and clinical competence. The competency framework is used to support the progression of prescribers through prescribing levels and supports designated medical prescribers and line managers to assess competence and clinical expertise. – NHS Greater Glasgow and Clyde Addiction Services PURPOSE AND USES OF THE FRAMEWORK 3.0

5. Stimulate discussions around prescribing competencies and multidisciplinary skill mix at an organisational level.

6. Inform organisational recruitment processes to help frame questions and benchmark candidates prescribing experience.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 5 7. Inform the development of organisational systems and processes that support safe effective prescribing, for example, local clinical governance frameworks. “The competency framework has been included within the organisation’s three yearly revalidation programme for nurse prescribers. Other allied health professional prescribers and pharmacist prescribers will also be asked to complete revalidation. Throughout the three years the framework will be used as part of individual prescriber’s appraisals and supervision.” – Northumberland Tyne and Wear NHS Foundation Trust

8. Inform the development of education curricula and relevant accreditation of prescribing programmes for all prescribing professions. “The framework has been used to underpin the outline curriculum frameworks for supplementary and independent prescribing to be used by radiographers (this also includes a framework for a conversion course for existing therapeutic radiographer supplementary prescribers to become independent prescribers).” – The Society and College of Radiographers PURPOSE AND USES OF THE FRAMEWORK 3.0

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 6 4.0 SCOPE OF THE FRAMEWORK

The key points to note about the scope of the prescribing � It reflects the key competencies needed by all framework are that: prescribers; it should not be viewed as a curriculum but rather the basis on which one can be built. � It is a generic framework for any prescriber � It applies equally to independent prescribers and (independent or supplementary) regardless of to supplementary prescribers but the latter should their professional background. It therefore does contextualise the framework to reflect the structures not contain statements that relate only to specialist imposed by entering into a supplementary prescribing areas of prescribing. relationship (see Glossary). � It must be contextualised to reflect different areas of practice and levels of expertise.

“The General Pharmaceutical Council sets standards for the education and training of pharmacists to become prescribers. These standards require that the curriculum of a prescribing programme reflect relevant curriculum guidance, which includes the prescribing competency framework. Our prescribing SCOPE OF THE FRAMEWORK

standards work in conjunction with the competency framework and other standard for pharmacy 4.0 professionals, to help ensure consistency and quality in programme design.” – The General Pharmaceutical Council

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 7 5.0 THE ROLE OF PROFESSIONALISM

To sharpen the focus of the prescribing competency These include the importance of maintaining a patient- framework and maintain the focus on key prescribing centred approach when speaking to patients/carers, competencies, a change to this update is the removal maintaining confidentiality, the need for continuing of several statements that relate to the application of professional development and the importance of professionalism. However it is important to recognise forming networks for support and learning. that healthcare professionals need to apply professionalism To encourage prescribers to reflect on their wider to all aspects of their practice in line with their own professional practice and how it might apply to prescribing professional codes of conduct, standards and guidance. examples of these behaviours have been captured below Whilst the framework does contain a competency on under the heading Apply Professionalism. This is not an prescribing professionally, there are elements of wider exhaustive list and prescribers are encouraged to use professional practice that will impact on how healthcare their own professional codes and guidance alongside the professionals behave when they prescribe. competency framework.

APPLY PROFESSIONALISM THE ROLE OF PROFESSIONALISM OF ROLE THE

Always introduces self and role to the patient and carer. 5.0

Adapts consultations to meet the needs of different patients/carers (e.g. for language, age, capacity, physical or sensory impairments).

Undertakes the consultation in an appropriate setting taking account of confidentiality, consent, dignity and respect.

Maintains patient confidentiality in line with best practice and regulatory standards and contractual requirements.

Takes responsibility for own learning and continuing professional development.

Learns and improves from reflecting on practice and makes use of networks for support, reflection and learning.

Recognises when safe systems are not in place to support prescribing and acts appropriately.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 8 6.0 THE PRESCRIBING COMPETENCY FRAMEWORK

The competency framework (illustrated below) sets of the ten competency dimensions there are statements out what good prescribing looks like. There are ten which describe the activity or outcomes prescribers competencies split into two domains. Within each should be able to demonstrate.

G GOV IBIN ERN CR AN ES C R NSULTA E P CO TI E O H N T

PATIENT THE PRESCRIBING COMPETENCY FRAMEWORK 6.0 c om -6 petencies 1

com 0 petencies 7-1

THE CONSULTATION PRESCRIBING GOVERNANCE 1. Assess the patient 7. Prescribe safely 2. Consider the options 8. Prescribe professionally 3. Reach a shared decision 9. Improve prescribing practice 4. Prescribe 10. Prescribe as part of a team 5. Provide information 6. Monitor and review

Figure 1 The prescribing competency framework

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 9 THE CONSULTATION (COMPETENCIES 1-6)

1: ASSESS THE PATIENT

1.1 Takes an appropriate medical, social and medication history1 including allergies and intolerances.

1.2 Undertakes an appropriate clinical assessment.

1.3 Accesses and interprets all available and relevant patient records to ensure knowledge of the patient’s management to date.

1.4 Requests and interprets relevant investigations necessary to inform treatment options.

1.5 Makes, confirms or understands, the working or final diagnosis by systematically considering the various possibilities (differential diagnosis).

1.6 Understands the condition(s) being treated, their natural progression and how to assess their severity, deterioration and anticipated response to treatment.

1.7 Reviews adherence to and effectiveness of current medicines.

1.8 Refers to or seeks guidance from another member of the team, a specialist or a prescribing information source when necessary. THE PRESCRIBING COMPETENCY FRAMEWORK

6.0 2: CONSIDER THE OPTIONS

2.1 Considers both non-pharmacological (including no treatment) and pharmacological approaches to modifying disease and promoting health.

2.2 Considers all pharmacological treatment options including optimising doses as well as stopping treatment (appropriate polypharmacy, de-prescribing).

2.3 Assesses the risks and benefits to the patient of taking or not taking a medicine or treatment.

2.4 Applies understanding of the mode of action and pharmacokinetics of medicines and how these may be altered (e.g. by genetics, age, renal impairment, pregnancy).

2.5 Assesses how co-morbidities, existing medication, allergies, contraindications and quality of life impact on management options.

2.6 Takes into account any relevant patient factors (e.g. ability to swallow, religion) and the potential impact on route of administration and formulation of medicines.

2.7 Identifies, accesses, and uses reliable and validated sources of information and critically evaluates other information.

2.8 Stays up-to-date in own area of practice and applies the principles of evidence-based practice, including clinical and cost-effectiveness.

1 This includes current and previously prescribed and non-prescribed medicines, on-line medicines, supplements, complementary remedies, illicit drugs and vaccines.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 10 2: CONSIDER THE OPTIONS (CONTINUED)

2.9 Takes into account the wider perspective including the public health issues related to medicines and their use and promoting health.

2.10 Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship measures.2

3: REACH A SHARED DECISION

3.1 Works with the patient/carer3 in partnership to make informed choices, agreeing a plan that respects patient preferences including their right to refuse or limit treatment.

3.2 Identifies and respects the patient in relation to diversity, values, beliefs and expectations about their health and treatment with medicines.

3.3 Explains the rationale behind and the potential risks and benefits of management options in a way the patient/carer understands.

3.4 Routinely assesses adherence in a non-judgemental way and understands the different reasons non-adherence can occur (intentional or non-intentional) and how best to support patients/carers.

3.5 Builds a relationship which encourages appropriate prescribing and not the expectation that a prescription THE PRESCRIBING COMPETENCY FRAMEWORK

will be supplied. 6.0

3.6 Explores the patient/carers understanding of a consultation and aims for a satisfactory outcome for the patient/carer and prescriber.

4: PRESCRIBE

4.1 Prescribes a medicine4 only with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and unwanted effects.

4.2 Understands the potential for adverse effects and takes steps to avoid/minimise, recognise and manage them.

4.3 Prescribes within relevant frameworks for medicines use as appropriate (e.g. local formularies, care pathways, protocols and guidelines).

4.4 Prescribes generic medicines where practical and safe for the patient and knows when medicines should be prescribed by branded product.

4.5 Understands and applies relevant national frameworks for medicines use (e.g. NICE, SMC, AWMSG5 and medicines management/optimisation) to own prescribing practice.

2 See also Expert Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) and Public Health England (PHE) prescribing competencies. https://www.gov.uk/government/publications/antimicrobial-prescribing-and-stewardship-competencies 3 The term carer is used throughout the prescribing competency framework as an umbrella term that covers care givers, parents and patient advocates or representatives. 4 For the purpose of the framework medicines can be taken to include all prescribable products. 5 NICE – National Institute for Health and Clinical Excellence; SMC – Scottish Medicines Consortium; AWMSG – All Wales Medicines Strategy Group

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 11 4: PRESCRIBE (CONTINUED)

4.6 Accurately completes and routinely checks calculations relevant to prescribing and practical dosing.

4.7 Considers the potential for misuse of medicines.

4.8 Uses up-to-date information about prescribed medicines (e.g. availability, pack sizes, storage conditions, excipients, costs).

4.9 Electronically generates or writes legible unambiguous and complete prescriptions which meet legal requirements.

4.10 Effectively uses the systems necessary to prescribe medicines (e.g. medicine charts, electronic prescribing, decision support).

4.11 Only prescribes medicines that are unlicensed, ‘off-label’, or outside standard practice if satisfied that an alternative licensed medicine would not meet the patient’s clinical needs6.

4.12 Makes accurate legible and contemporaneous records and clinical notes of prescribing decisions.

4.13 Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/ information.

THE PRESCRIBING COMPETENCY FRAMEWORK 5: PROVIDE INFORMATION THE PRESCRIBING COMPETENCY FRAMEWORK 6.0 6.0

5.1 Checks the patient/carer’s understanding of and commitment to the patient’s management, monitoring and follow-up.

5.2 Gives the patient/carer clear, understandable and accessible information about their medicines (e.g. what it is for, how to use it, possible unwanted effects and how to report them, expected duration of treatment).

5.3 Guides patients/carers on how to identify reliable sources of information about their medicines and treatments.

5.4 Ensures that the patient/carer knows what to do if there are any concerns about the management of their condition, if the condition deteriorates or if there is no improvement in a specific time frame.

5.5 When possible, encourages and supports patients/carers to take responsibility for their medicines and self-manage their conditions.

6 At the time of publication only doctors, dentists, nurses and pharmacists are able to independently prescribe unlicensed medicines

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 12 6: MONITOR AND REVIEW

6.1 Establishes and maintains a plan for reviewing the patient’s treatment.

6.2 Ensures that the effectiveness of treatment and potential unwanted effects are monitored.

6.3 Detects and reports suspected adverse drug reactions using appropriate reporting systems.

6.4 Adapts the management plan in response to on-going monitoring and review of the patient’s condition and preferences.

PRECRIBING GOVERNANCE (COMPETENCIES 7-10)

7: PRESCRIBE SAFELY

7.1 Prescribes within own scope of practice and recognises the limits of own knowledge and skill.

7.2 Knows about common types and causes of medication errors and how to prevent, avoid and detect them.

7.3 Identifies the potential risks associated with prescribing via remote media (telephone, email or through a third party) and takes steps to minimise them. THE PRESCRIBING COMPETENCY FRAMEWORK 7.4 Minimises risks to patients by using or developing processes that support safe prescribing particularly in areas 6.0 of high risk (e.g. transfer of information about medicines, prescribing of repeat medicines).

7.5 Keeps up to date with emerging safety concerns related to prescribing.

7.6 Reports prescribing errors, near misses and critical incidents, and reviews practice to prevent recurrence.

8: PRESCRIBE PROFESSIONALLY

8.1 Ensures confidence and competence to prescribe are maintained.

8.2 Accepts personal responsibility for prescribing and understands the legal and ethical implications.

8.3 Knows and works within legal and regulatory frameworks affecting prescribing practice (e.g. controlled drugs, prescribing of unlicensed/off label medicines, regulators guidance, supplementary prescribing).

8.4 Makes prescribing decisions based on the needs of patients and not the prescriber’s personal considerations.

8.5 Recognises and deals with factors that might unduly influence prescribing (e.g. pharmaceutical industry, media, patient, colleagues).

8.6 Works within the NHS/organisational/regulatory and other codes of conduct when interacting with the pharmaceutical industry.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 13 9: IMPROVE PRESCRIBING PRACTICE

9.1 Reflects on own and others prescribing practice, and acts upon feedback and discussion.

9.2 Acts upon colleagues’ inappropriate or unsafe prescribing practice using appropriate mechanisms.

9.3 Understands and uses available tools to improve prescribing (e.g. patient and peer review feedback, prescribing data analysis and audit).

10: PRESCRIBE AS PART OF A TEAM

10.1 Acts as part of a multidisciplinary team to ensure that continuity of care across care settings is developed and not compromised.

10.2 Establishes relationships with other professionals based on understanding, trust and respect for each other’s roles in relation to prescribing.

10.3 Negotiates the appropriate level of support and supervision for role as a prescriber.

10.4 Provides support and advice to other prescribers or those involved in administration of medicines where appropriate. THE PRESCRIBING COMPETENCY FRAMEWORK 6.0

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 14 7.0 PUTTING THE FRAMEWORK INTO PRACTICE

A range of resources can be found on the RPS website To further stimulate use of the framework to help stimulate use of the competency framework prescribers or organisations using it are encouraged in practice these include: to contact the Royal Pharmaceutical Society (RPS) at [email protected] to share their examples of � FAQs the framework’s application in practice. These examples � a downloadable word template version of will be shared through the RPS website and will help the framework inform future updates of the framework. � PowerPoint presentation � practice examples from organisations and individuals who have been using the competency framework.

“The Northern Ireland Centre for Pharmacy Learning and Development (NICPLD) has embedded the competency framework into a practice portfolio which forms part of our accredited independent pharmacist prescribing programme. All pharmacists use the practice portfolio to document their developing competency over the course of the programme with the expectation that pharmacists document their competency

against most statements in the competency framework before qualifying as a prescriber. The practice PUTTING THE FRAMEWORK INTO PRACTICE

portfolio is submitted to NICPLD for assessment and must be passed independently of all other elements 7.0 of the course to qualify as a prescriber.” – The Northern Ireland Centre for Pharmacy Learning and Development

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 15 GLOSSARY

Polypharmacy Polypharmacy means “many medications” and has often been defined to be present when a patient takes five or more medications. Polypharmacy is not necessarily a bad thing, it can be both rational and required however it is important to distinguish appropriate from inappropriate polypharmacy.

Inappropriate When one or more drugs are prescribed that are not or no longer needed, either because: (a) polypharmacy there is no evidence based indication, the indication has expired or the dose is unnecessarily high; (b) one or more medicines fail to achieve the therapeutic objectives they are intended to achieve;

(c) one, or the combination of several drugs cause inacceptable adverse drug reactions (ADRs), or GLOSSARY put the patient at an unacceptably high risk of such ADRs, or because (d) the patient is not willing or able to take one or more medicines as intended.

Appropriate When: (a) all drugs are prescribed for the purpose of achieving specific therapeutic objectives that polypharmacy have been agreed with the patient; (b) therapeutic objectives are actually being achieved or there is a reasonable chance they will be achieved in the future; (c) drug therapy has been optimised to minimise the risk of ADRs and (d) the patient is motivated and able to take all medicines as intended.

Deprescribing The process of stopping or reducing medicines with the aim of eliminating problematic (inappropriate) polypharmacy, and then monitoring the individual for unintended adverse effects or worsening of disease. It is essential to involve the individual (and their carer) closely in deprescribing decisions in order to build and maintain their confidence in the process.

Non-medical Non-medical prescribing is prescribing by specially trained nurses, optometrists, pharmacists, prescribing physiotherapists, podiatrists, radiographers and dietitians working within their clinical competence as either independent and/or supplementary prescribers.

Independent Independent prescribing is prescribing by a practitioner, who is responsible and accountable for the prescribing assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing. In practice, there are TWO distinct forms of non-medical independent prescriber. i) At time of publication an independent prescriber may be a specially trained nurse, pharmacist, optometrist, physiotherapist, therapeutic radiographer or podiatrist who can prescribe licensed medicines within their clinical competence. Nurse and pharmacist independent prescribers can also prescribe unlicensed medicines and controlled drugs. ii) A community practitioner nurse prescriber (CPNP), for example district nurse, health visitor or school nurse, can independently prescribe from a limited formulary called the Nurse Prescribers’ Formulary for Community Practitioners, which can be found in the British National Formulary (BNF).

Supplementary Supplementary prescribing is a voluntary partnership between a doctor or dentist and a prescribing supplementary prescriber to prescribe within an agreed patient-specific clinical management plan (CMP) with the patient’s agreement. Nurses, optometrists, pharmacists, physiotherapists, podiatrists, radiographers and dietitians may become supplementary prescribers and once qualified may prescribe any medicine within their clinical competence, according to the CMP.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 16 REFERENCES

1. Duerden M, Avery T, Payne R. Polypharmacy and Medicines Optimisation. Making it safe and Sound. Kings Fund 2013. http://www.kingsfund.org.uk/publications/polypharmacy-and-medicines-optimisation 2. NHS Scotland. Polypharmacy Guidance. March 2015. http://www.sign.ac.uk/pdf/polypharmacy_guidance.pdf and available as an App from http://www.knowledge.scot.nhs.uk/home/tools-and-apps/mobile-knowledge/search.aspx?devi ce=None&q=polypharmacy&p=1&rpp=20 or by searching the iTunes and Google Play app stores. The Web Version of the app is available at http://www.polypharmacy.scot.nhs.uk/ 3. National Institute for Health and Clinical Excellence. Multimorbidity: clinical assessment and management. Expected publication September 2016. https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0704 4. Royal Pharmaceutical Society. Medicines optimisation: helping patients to make the most of medicines. May 2014 REFERENCES https://www.rpharms.com/promoting-pharmacy-pdfs/helping-patients-make-the-most-of-their-medicines.pdf 5. National Institute for Health and Clinical Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. March 2015. https://www.nice.org.uk/guidance/ng5 6. Department of Health, Social Services and Public Safety. Northern Ireland Medicines Optimisation Quality Framework. March 2016 https://www.health-ni.gov.uk/sites/default/files/consultations/dhssps/medicines-optimisation-quality- framework.pdf 7. National Prescribing Centre. A single competency framework for all prescribers. May 2012 8. National Prescribing Centre. Maintaining Competency in Prescribing. An outline framework to help nurse prescribers. First Edition. November 2001. 9. National Prescribing Centre. Maintaining Competency in Prescribing. An outline framework to help nurse supplementary prescribers. March 2003. 10. National Prescribing Centre. Maintaining Competency in Prescribing. An outline framework to help pharmacist supplementary prescribers. First Edition. March 2003. 11. National Prescribing Centre and General Optical Council. Competency framework for prescribing optometrists. First Edition. May 2004. 12. National Prescribing Centre. Maintaining Competency in Prescribing. An Outline Framework to help Allied Health Professional Supplementary Prescribers. First Edition. July 2004. 13. National Prescribing Centre. Maintaining Competency in Prescribing. An outline framework to help pharmacist prescribers. Second Edition. October 2006. 14. Whiddett S, Hollyforde, S. The Competencies Handbook. Institute of Personnel and Development, 1999.

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 17 APPENDIX 1 HOW THE FRAMEWORK WAS UPDATED

The process used to update the framework is illustrated and extensive use of the framework in practice, that the below. It is consistent with the methodology used to 2012 framework was broadly fit for purpose. The process develop and refine the previous prescribing competency used to update the framework is proportionate to that frameworks published by the National Prescribing Centre view and reflects an iterative development of the content. and NICE.

The update of the framework was a review of an existing resource widely used in practice. The project steering group concluded, based on a literature view

DEVELOPMENT PROCESS ENGAGEMENT STRATEGY

Literature review HOW THE FRAMEWORK WAS UPDATED

Steering group update framework (taking into account literature review) ENGAGEMENT WITH WIDER STAKEHOLDERS VIA EXTERNAL APPENDIX 1 REFERENCE GROUP Validation group review updated framework

Open consultation for external review (6 weeks)

Steering group meeting to review comments

STRATEGIC SUPPORT ACROSS THE UK THROUGH THE Comments incorporated PROJECT BOARD

Framework finalised

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 18 ENGAGEMENT STRATEGY framework were agreed using a consensus process and members of the validation group were asked to declare The prescribing competency framework will be used by conflicts of interest*. See appendix 2 for membership. a range of healthcare professions. An external reference As a result of the steering group review and validation group comprising regulators, professional organisations group scrutiny refinements were made to the framework and other relevant and interested stakeholder groups that included: was constituted. Webinars were held with the group

three times over the duration of the project to keep ▼ Removal of statements that relate more generally members of the group informed about progress and to to professional practice (see section 4). stimulate discussion about how the framework might be disseminated and used once published. See Appendix 2 ▼ Reordering of the framework into ten competencies for membership. that have been grouped into two competency areas.

▼ Addition of new statements or modification of The update of the prescribing competency framework existing statements to include omissions identified was ‘project sponsored’ at a strategic level by a Project through the literature review. Board to help ensure UK wide applicability. Membership consisted of representatives of the Chief Pharmaceutical ▼ Deletion of statements felt to be less relevant to Officers England, Scotland, Wales and Northern Ireland prescribing or where duplication became apparent as well as Health Education England, NHS Education for as the structure of the framework was updated. Scotland, The Welsh Assembly and NICE. See Appendix 2 for membership. ▼ Editing of statements for clarity or consistency of terminology.

DEVELOPMENT PROCESS ▼ Splitting of statements for clarity or to fit with the reordered structure of the framework. An external lead author was commissioned by the RPS to APPENDIX 1 HOW THE FRAMEWORK WAS UPDATED ensure that the process for updating of the competency ▼ Improving the wording of statements. framework was independent. The competency document was posted on the RPS A literature review was undertaken in October 2015 website for six weeks for open consultation. to identify key evidence relating to competency and good The external reference group, project board and steering practice in prescribing since the publication of the 2012 group were all asked to draw attention to the availability single competency framework. of the framework for comment. Ninety five responses to the consultation were received. A steering group with prescribers from all the professions able to prescribe and patient representatives Comments from the consultation were reviewed by the used a consensus process to review and update the steering group and those that were in scope and relevant competency framework in the context of the literature were incorporated into the prescribing framework. review. The multidisciplinary nature of the group ensured The project steering group used a consensus process the generic nature of the framework was maintained – to agree all final refinements to the framework. Consensus see Appendix 2 for membership. The group was chaired was achieved. by the independent lead author and all members were STATEMENT OF FUNDING asked to declare conflicts of interest * which were managed in line with RPS Professional standards, guidance The update to this framework has been wholly funded by and frameworks process development manual. the RPS who have not received any payment from a third A separate group of existing prescribers (again reflecting all party for its development. Further information on “How groups able to prescribe) and patients validated the the RPS is funded” can be viewed in Professional updated framework in a focus group setting to ensure standards, guidance and frameworks process that the changes made by the steering group were in line development manual. with current prescribing practice and were understandable to prescribers. Refinements made to the *Declarations are available upon request by e-mailing [email protected]. A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 19 APPENDIX 2 ACKNOWLEDGEMENTS

STEERING GROUP MEMBERS

Professor Angela Director of the Centre for Inter-Professional Postgraduate Education and Training, Alexander University of Reading

Extended Scope Physiotherapist – Locomotor Service, Dave Baker Homerton University Hospital NHS Foundation Trust and Complete Physio Limited

Pharmacy Local Professional Network Chair (formerly Director at the National Prescribing Dr Jane Brown Centre), Greater Manchester

Advanced Therapy Radiographer and Non-Medical Prescriber, Hazel Boyce University Hospitals Bristol NHS Foundation Trust

Richard Harris Professional Development Pharmacist, H.I.Weldrick Ltd

Angie Hill Director of Nursing and Professions – Primary Care, Care Uk APPENDIX 2 ACKNOWLEDGEMENTS

Karen Hodson Programme Director of the Pharmacist Independent Prescribing Programme, Cardiff University

Fran Husson Lay representative

Programme Director, Independent Prescribing; and Practice Pharmacist and Independent Parbir Jagpal Prescriber, University of Birmingham and Dudley Clinical Commissioning Group

Advanced Clinical Pharmacist Prescriber in Primary Care, Fiona Jones Betsi Cadwaladr University Health Board and Member of Welsh Pharmacy Board

Teresa Kearney Nurse Prescriber, Association of Nurse Prescribers

Director of Postgraduate General Practice Education, Northern Ireland Medical and Dental Dr Claire Loughrey Training Agency

Professor Medical Director, Prescribing, Prescribing Safety Assessment, University of Edinburgh Simon Maxwell

Dr James McKinlay General Practitioner

Dr Nikolaus Palmer Dental Surgeon, British Dental Association

Catherine Lead author and consultant to RPS Picton (chair)

Professor Professor of Pharmacy Practice, Head of Pharmacy Practice Division, Jane Portlock University of Portsmouth

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 20 Consultant Podiatrist – Diabetes Professional lead for Podiatry and Visiting Lecturer (Univer- Debbie Sharman sity of Southampton), Dorset HealthCare University Foundation Trust

Consultant Pharmacist: Critical care, Consultant Pharmacist and Independent Prescriber, Mark Tomlin University Hospital Southampton NHS Foundation Trust

Senior Lecturer/Honorary Consultant, Kings College London (Guy’s & St Thomas’ NHS Dr Andy Webb Foundation Trust/ King’s Health Partners)

Alison Weston Principal Optometrist, St James’s University Hospital, Leeds

Nigel Westwood Lay representative

Professor Emeritus Professor, Dental School, Glasgow University David Wray

PROJECT BOARD MEMBERS

Margaret Allen Director, Wales Centre for Pharmacy Professional Education APPENDIX 2 ACKNOWLEDGEMENTS (representing Roger Walker, Chief Pharmaceutical Officer for Wales)

Michele Cossey Head of Clinical Strategy / Regional Pharmaceutical Advisor NHS England (North), (representing Keith NHS England (North) Ridge, Chief Pharmaceutical Officer for England)

Cathy Harrison Senior Principal Pharmaceutical Officer, Department of Health, Northern Ireland (representing Mark Timoney, Chief Pharmaceutical Officer for Northern Ireland)

Alpana Mair Deputy Chief Pharmaceutical Officer Scotland, Scottish Government (representing Rosemarie Parr, Chief Pharmaceutical Officer for Scotland)

Patricia Saunders Senior Education and Training Policy Manager, Health Education England

Jonathan Underhill Associate Director, Medicines and Prescribing Centre, National Institute for Health and Care Excellence

Anne Watson Associate Director of Pharmacy, NHS Education for Scotland

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 21 VALIDATION GROUP MEMBERS

Patricia Armstrong Pharmacist Assistant Professional Support Manager, Boots

Course leader for Independent and Supplementary Nurse Prescribing, Sue Axe Buckinghamshire New University

Dr Gill Beck General Practitioner

Dr Mohsin Choudry National Medical Director’s Clinical Fellow, Royal College of Physicians, London

Professor Robin Secretary of the Joint Specialist Committee of the Royal College of Physicians and the E Ferner British Pharmacological Society

Penny Fletcher Senior lead pharmacist, Women and Children, Imperial College Healthcare NHS Trust

Nurse Practitioner/ Practice Nurse Advisor, working for Pencester Health Surgery Sue Gassor Dover/South East CSU.

Director of Taught Postgraduate Programmes, Department of Pharmacy and Pharmacology, Nick Haddington University of Bath APPENDIX 2 ACKNOWLEDGEMENTS

Peter Hawkes Lay representative

Dr Rebecca Consultant Nurse & Senior Lecturer Emergency Care, Non Medical Prescribing Trust Lead, Hoskins University Hospitals Bristol NHS Foundation Trust

Dr Catrin Jones FY2 Doctor South East Scotland Deanery

Jancis Kinsman Lung specialist radiographer, Bristol Cancer Institute

Dr Kerry Layne Clinical PhD Student, King’s College London

Professor Programme Lead BSc Optometry, Programme Lead Post-graduate Ocular Gunter Loffler Therapeutics Programme, Glasgow Caledonian University

Nicky Mackenzie Independent Prescribing Physiotherapist, Musculoskeletal Therapy Team Leader

Nick Masucci Consultant Podiatrist, Ashford & St Peter’s NHS Trust

MScOptom FCOptom DipTP(IP) ProfCertMedRet FAAO FEAOO FIACLE FBCLA, Nicholas J. Rumney Federation of Ophthalmic and Dispensing Opticians (FODO)

General and Cosmetic Dentist and Doctor. Examiner, Royal College of Physicians Dr Robert Rutland & Surgeons. Medical Appraiser.

Andy Sharman Specialist Paramedic – Urgent and Emergency Care

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 22 Dr Jude Tweedie Clinical Fellow, Royal College of Physicians

Professor Cate School of Medicine, Pharmacy and Health, Durham University Whittlesea

EXTERNAL REFERENCE GROUP MEMBERS

Catherine Lead Pharmacist, Pharmicus, CBC Armstrong

Dr Diane Antimicrobial Resistance Programme; Public Health England Ashiru-Oredope

Course leader for Independent and Supplementary Nurse Prescribing, Sue Axe Buckinghamshire New University

Lead Clinical Nurse Specialist In-patient Pain Service, Western Sussex Hospitals Inge Bateman NHS Foundation Trust APPENDIX 2 ACKNOWLEDGEMENTS Dianne Bell Senior Learning Developmen Pharmacist, Centre for Pharmacy Postgraduate Education

Kate Bennett Tissue Viability Specialist Nurse

Jayne Bridge NMP lead for MerseyCare NHS

Christine Buicke Policy Manager, General Medical Council

Stephanie Butler Lead Specialist Renal Pharmacist and Independent Prescriber

Dr Wendy Caddye Senior Clinical Nurse Specialist Inpatient Pain Management BSUH NHS Trust

Ian Cameron Managing Director, Cameron Optometry Ltd

Nicole Casey Policy Manager, Health and Care Professions Council

Lisa Chaters Advanced Neonatal Nurse Practitioner

Cheshire and Wirral partnership, Advanced Paediatric Nurse Practitioner / Nurse Clinician Tanya Downes GP out of hours

Marcus Dye Standards Manager, General Optical Council

Gerald Ellis Associate Director Pharmacy Transformation, Newark and Sherwood CCG

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 23 Professor Robin Secretary of the Joint Specialist Committee of the Royal College of Physicians and the Ferner British Pharmacological Society

Matthew Managing Director A&E and Acute Medicine Fitzpatrick

Helen Flint For British Oncology Pharmacy Association

Christina Freeman Professional Officer: policy, guidance and advice, Society and College of Radiographers

Nurse Practitioner/ Practice Nurse Advisor working for Pencester Health Surgery Sue Gassor Dover/South East CSU.

Mohit Gupta Consultant ophthalmologist, Royal College of Ophthalmologists.

Nicholas Director of Taught Postgraduate Programmes, Department of Pharmacy and Haddington Pharmacology, University of Bath

Sophie Harper Principal Optometrist Cataract Services, Manchester Royal Eye Hospital APPENDIX 2 ACKNOWLEDGEMENTS Clare Worrall Hill Professional Engagement Manager, Parkinson’s UK

Dianne Hogg Non-medical Prescribing Lead, Queen’s Nurse, East Lancashire Hospitals NHS Trust

Sue Hudson Clinical specialist podiatrist, working for East Lancashire Hospital Trust

Senior Clinical Pharmacist-Antibiotics and NMP Co-Lead, Mid Cheshire Hospitals Jen Hulme NHS Foundation Trust

Dr Mani Hussain Chair Shropshire & Staffordshire Pharmacy LPN NHS England

Dr Farah Jameel GP, British Medical Association

Sally Jarmain Non-Medical Prescribing Lead, Northern Devon Healthcare Trust

NMP & Advanced Nurse Practitioner (in training) at Salford Royal Hospitals Lindsay Johnston NHS Foundation Trust – Emergency Department

Anja St Clair Jones Lead Pharmacist Digestive Diseases Centre BSUH NHS Trust

Consultant Nurse and Non-Medical Prescribing Lead’ Oxford University Hospitals Jan Keenan NHS Foundation Trust

Menaz Kermali Specialist Pharmacist CMHT, Berkshire Healthcare Foundation Trust

Director of Prescribing Education, Centre for Professional Development and Jacqui Kinsey Lifelong Learning, school of Pharmacy, Keele University

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 24 Professor John College of Optometrists, Professor of Clinical Visual Science, City University London Lawrenson

Dr Fran Lloyd NI Centre for Pharmacy Learning and Development

Professor; Programme Lead – BSc Optometry; Programme Lead – Post-graduate Ocular Prof Gunter Loffler Therapeutics Programme, Glasgow Caledonian University

Sue Lyne Advanced Community Nurse Practitioner, East Sussex Healthcare NHS Trust (ESHT)

Nicky Mackenzie Musculoskeletal Therapy Team Leader, Sandwell and Birmingham NHS trusts

Helen Marriott AHP Medicines Project Lead, NHS England

Joanne Martin Quality Assurance Manager, General Pharmaceutical Council

Dr Arianne Matlin Health and Science Policy Advisor, British Dental Association

Senior Lecturer in Pharmacy Practice, School of Pharmacy and Biomolecular Sciences, Claire May University of Brighton APPENDIX 2 ACKNOWLEDGEMENTS

Nick Masucci Consultant Podiatrist (podiatric surgeon), Barts and the London

Michelle McCorry Pharmaceutical Society of Northern Ireland

Maire McManus Principal Pharmacist, Medicines Division – Antrim Area Hospital.

Queens Nurse, Senior Lecturer / Programme Leader – Non Medical Prescribing. Eleri Mills School of Social and Life Sciences, Wrexham Glyndwr University, Wales.

Kuljit Nandhara Lead Pharmacist at Birmingham and Solihull Mental Health Trust

Ruth Newton For British Pharmaceutical Nutrition Group

JP Nolan Royal College of Nursing

Assistant Director for Distance Learning and Course Director Pharmacist Prescribing Laura O’Loan course, NI Centre for Pharmacy Learning and Development

Emma Pilkington Cystic Fibrosis Physiotherapist

Celia Proudfoot TB nurse specialist

Najia Qureshi Head of Education and Professional Development, The British Dietetic Association

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 25 Senior Lecturer Non-Medical Prescribing, School of Health & Social Care, Bernadette Rae London South Bank University

Martin C HMP Garth Healthcare, Lancashire Care NHS Foundation Trust Richardson

MScOptom FCOptom DipTP(IP) ProfCertMedRet FAAO FEAOO FIACLE FBCLA. Nicholas Rumney Federation of Ophthalmic and Dispensing Opticians (FODO)

Sharon Shaw ELMS Clinical Lead Nurse, Safeguarding Lead, NMP lead

Suzie Shepherd Lay patient representative. RCP PCN, BSR VICE CHAIR

Sam Sherrington Association of Nurse Prescribing

Andrew Simpson ANNP, Neonatal Intensive Care Unit, Royal Oldham Hospital

Programme Manager, Scottish Dental Clinical Effectiveness Programme, Doug Stirling Dundee Dental Education Centre APPENDIX 2 ACKNOWLEDGEMENTS Assistant Director: Education and Standards Education, Standards and Policy Directorate, Anne Trotter Nursing and Midwifery Council

Kevin Wallace The Association of Optometrists

Helen Ward Associate Professor Non-Medical Prescribing, London South Bank University

Professor Cate Professor of Pharmacy Practice, School of Medicine, Pharmacy and Health, Whittlesea Durham University

Lesley Woods Nurse practitioner, urgent care, Burnley General

UHMB Quality Assurance Matron, Senior Clinical Leader/Nurse Practitioner, NMP Lead, Sally Young University Hospitals Morecambe Bay NHS Trust

RPS TEAM MEMBERS

Dr Catherine Director of Professional Development and Support Duggan

Ruth Wakeman Assistant Director of Professional Development and Support

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 26 LITERATURE REVIEW

Miriam Gichuhi Pharmacist Consultant

Barry Jubraj Clinical Senior Lecturer in Medicines Optimisation, King’s College London

CONSULTATION RESPONDENTS

RPS would like to thank all the individuals and organisations who sent in comments on the draft framework. In all 95 individuals and organisations responded to the consultation. APPENDIX 2 ACKNOWLEDGEMENTS

A COMPETENCY FRAMEWORK FOR ALL PRESCRIBERS 27 The Royal Pharmaceutical Society (RPS) is the professional body for pharmacists in Great Britain.