London, Kent, Surrey and Sussex Pre-registration ... · Pre-registration Pharmacist Programme...

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London, Kent, Surrey and Sussex Pre-registration Pharmacist Programme Handbook 2019 - 2020

Transcript of London, Kent, Surrey and Sussex Pre-registration ... · Pre-registration Pharmacist Programme...

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London, Kent, Surrey and Sussex Pre-registration Pharmacist Programme

Handbook 2019 - 2020

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Contents A. Introduction ......................................................................................................................................... 4

A.1. NHS Constitution: the NHS belongs to us all ................................................................................ 5

A.2. Terminology .................................................................................................................................. 6

Guide to this Handbook ........................................................................................................................... 7

B. Regional Pharmacy Support ............................................................................................................... 8

B.1. The Health Education England London and South East Pharmacy Team ..................................... 8

B.2. Regional Course Programme ....................................................................................................... 8

B.2.1 Trainee Voice .......................................................................................................................... 9

B.2.2 Feedback and evaluation ........................................................................................................ 9

B.3 On-line Learning Environment (OLE) ............................................................................................. 9

B.3.1. OLE Resources .....................................................................................................................10

B.4. Objective Structured Clinical Examination (OSCE) ......................................................................11

B.4.1 Setting the Scene for OSCEs .................................................................................................11

B.4.2. OSCE Resources ..................................................................................................................12

B.4.3. Adjustments ..........................................................................................................................12

B.4.4 OSCE Quality Control ............................................................................................................12

B.4.5. OSCE Feedback ...................................................................................................................12

B.5. Trainee Representatives ..............................................................................................................12

B.5.1 Role of Local Trainee Representatives ...................................................................................14

B.5.2. Role of Regional Trainee Representatives ............................................................................14

B.6. E-portfolio ....................................................................................................................................15

B.7. Trainee Support ...........................................................................................................................15

B.7.1 Trainees Requiring Additional Support ...................................................................................15

B.7.2 Bullying and Harassment .......................................................................................................16

C. Learning in the Workplace .................................................................................................................17

C.1 Workplace Based Assessments ...................................................................................................19

C.1.1 Mini-Clinical Evaluation Exercise (mini-CEX) .........................................................................19

C.1.2 Case Based Discussion (CBD) ..............................................................................................22

C.1.3 Medication Related Consultation Framework (MRCF)............................................................24

C.2. Competence Based Training .......................................................................................................28

C.3. Evidence of Competence ............................................................................................................29

C.4. GPhC Performance Standards ....................................................................................................30

D. Guidance for Workplace Rotational Training Programmes .................................................................32

D.1. Further Guidance to Support Trainees during the Pre-registration Year ......................................33

E. Learning Outcomes for Pre-registration Training ................................................................................35

E1. Dispensary Services ........................................................................................................................36

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E2. Procurement and Drug Distribution Services ....................................................................................40

E3. Medicines Management ...................................................................................................................42

E4. Clinical Pharmacy ............................................................................................................................45

E5. Community Pharmacy ......................................................................................................................52

E6. Aseptic Preparative Services............................................................................................................56

Further Aseptic Preparative Services Activities................................................................................59

6.A Large Scale Hospital Pharmaceutical Manufacturing ................................................................59

6.B Quality Control and Quality Assurance ......................................................................................60

6.C Radiopharmacy .........................................................................................................................60

E7. Medicines Information Services ........................................................................................................62

E8. Mental Health ...................................................................................................................................68

E9. Children and Young People ............................................................................................................73

E10. NHS Commissioning ......................................................................................................................75

E11. Quality Improvement Projects ........................................................................................................77

E12. Assessment and Feedback ............................................................................................................80

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A. Introduction Welcome to the Health Education England London, Kent, Surrey and Sussex Pre-registration Pharmacist Programme Handbook. The pre-registration year is aimed at supporting the transition from pharmacy student to registered qualified pharmacist. In order to fulfil this goal, pre-registration pharmacists (trainees) will be required to demonstrate they have the requisite knowledge, skills, attitudes and behaviours which can be applied in a practice setting. Trainees will have gained some practical experience prior to commencing the pre-registration year; the next 12 months will further support this development in order to qualify as a competent and confident practising pharmacist. The General Pharmaceutical Council (GPhC) stipulates pharmacy graduates undertake a training period of at least 52 weeks in order to demonstrate their competence against a range of practical and professional criteria known as performance standards. Providing that the standards are met, trainees will be eligible to sit the registration assessment in order to join the register of practising pharmacists. For each of the main areas of practice, specific objectives and practice activities are recommended within this handbook to ensure that all Health Education England London and Kent, Surrey and Sussex commissioned trainees receive a consistent and comparable training experience. The practice activities can be used as evidence to demonstrate competence against relevant GPhC performance standards. The activities have been compiled by relevant specialists in the region and are endorsed by the Health Education England London and Kent, Surrey and Sussex (HEE LaSE) Pre-registration Pharmacist Programme Board. As professionalism is integral to being a pharmacist, over the course of the pre-registration year tremendous importance will be placed upon the development of professional values. There are six key elements of professionalism (Project Professionalism: ABIM, 2001): Altruism (giving priority to patient interests rather than self-interests). Accountability (being answerable to patients, society and profession). Excellence (conscientious effort to perform beyond ordinary expectation, and commitment to life-

long learning). Duty (free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high

standard of patient care). Honour and Integrity (being fair, truthful, straightforward and keeping to one’s word). Respect for others (respect for patients and families, colleagues, other healthcare professionals,

students and trainees).

The profession describes these values through the GPhC standards for pharmacy professionals. The nine principles within these standards are highlighted overleaf:

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All pharmacy professionals contribute to delivering and improving the health, safety and wellbeing of patients and the public. Professionalism and safe and effective practice are central to that role. Pharmacy professionals must:

1. provide person-centred care 2. work in partnership with others 3. communicate effectively 4. maintain, develop and use their

professional knowledge and skills 5. use professional judgement 6. behave in a professional manner 7. respect and maintain the person’s

confidentiality and privacy 8. speak up when they have concerns

or when things go wrong 9. demonstrate leadership

A.1. NHS Constitution: the NHS belongs to us all

In addition to professional values, pre-registration pharmacists will also follow the key NHS values set out in the NHS Constitution. The NHS Constitution establishes the principles and values of the NHS in England. It sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. As the training year is based in the NHS, it is very important that trainees are familiar with the NHS Constitution and key NHS values. Over the course of the training year more knowledge about these values will be gained and more importantly their value in practice for improving the patient experience and patient safety. The key values of the NHS are as follows, further details can be found at the link above.

Respect and dignity Commitment to quality of care Compassion

Improving lives Working together for patients Everyone counts

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Furthermore, all trainees as part of their contract with the employing organisation, are expected to fully comply with local requirements such as mandatory training, dress code, infection control and the organisation’s core values.

A.2. Terminology

In order to simplify terminology for individuals involved in the education of pharmacy professionals, reference to the following terms will be made throughout this handbook. Practice Supervisor (PS) someone who is selected, appropriately trained and who is responsible for overseeing a specified

trainee’s work and providing developmental feedback during a period of training. has the prerequisite assessment skills. supports learners to identify opportunities for learning in the workplace, supervises trainees on a day-

to-day basis and helps to identify trainees who may require additional support. involved in and contribute to a work-based learning culture.

For pre-registration pharmacists a PS will be the member of the pharmacy team in charge of a particular rotation.

Educational Supervisor (ES) someone who is selected and appropriately trained to be responsible for the overall supervision and

management of a specified trainee’s educational progress, during a period of training placement or series of placements.

responsible for the trainee’s educational agreement. This will include formal assessment and sign off. has an understanding of the range of learning, assessment and support opportunities for learning in

the workplace, works collaboratively with colleagues to monitor and support learner's progression and fosters learner autonomy.

identifies and supports trainees requiring additional support, including interfacing with employment performance management procedures.

For pre-registration pharmacists the ES is the GPhC pre-registration tutor.

Educational Programme Director (EPD) someone who oversees one or more entire training programmes locally, regionally, or both, developing

and implementing programmes together with external bodies and local teams. ensures that quality criteria are met, including resource, appropriately trained ES and PS and

monitoring of progress and equal opportunities. For pre-registration pharmacists the EPD leads the pre-registration training within the employing organisation.

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Guide to this Handbook The symbols below will be used within this handbook.

Denotes a form/tool that can be found on the HEE LaSE Pharmacy On-line Learning Environment (OLE) within the Course and Programme Support Materials section. (section B.3)

Refers to an e-learning exercise that can be found on the HEE LaSE Pharmacy OLE. (section B.3)

Refers to relevant further reading resources

Denotes a link to recommended external e-learning resource

Refers to where information in the text cross references to another section within the handbook.

Denotes an opportunity for the trainee to be involved in patient care.

Denotes an opportunity for the trainee to be involved in inter-professional education

Form found on HEE LaSE OLE (Course Materials Section)

HEE LaSE OLE

Reading Resource

External e-Learning

Patient Involvement

Inter-professional Education

Cross Reference to

XXX

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B. Regional Pharmacy Support Health Education England (HEE) London and South East Pharmacy Team (LaSE) support all NHS organisations across London, Kent, Surrey and Sussex who employ HEE commissioned pre-registration pharmacists. The team consists of pharmacists, pharmacy technicians and administrative staff who commission, develop, co-ordinate and provide training according to identified workforce needs within the region. For pre-registration pharmacists, the team’s roles and responsibilities are to: co-ordinate the planning and allocation of pre-registration pharmacist training posts to NHS

organisations. co-ordinate the marketing of NHS pre-registration pharmacist posts in London, Kent, Surrey and

Sussex. organise, deliver and evaluate a regional programme of courses and on-line learning to supplement

workplace training. formatively assess the clinical competence of pre-registration pharmacists. commission training and support for educational supervisors. support educational supervisors in identifying and managing trainees requiring additional support. make recommendations for rotations and training. quality manage pre-registration pharmacist training programmes. manage the administration of e-portfolio for pre-registration pharmacists.

B.1. The Health Education England London and South East Pharmacy Team

Contact details for the HEE LaSE Pharmacy team members who support the pre-registration pharmacist programme are available on our website. 36TU For any queries relating to pre-registration training, either at base or regionally, trainees are encouraged to discuss these with your educational supervisor in the first instance. However, if further assistance is required trainees can contact the regional pharmacy team. For general enquiries, contact [email protected] U36T. For confidential issues, contact one of the pharmacists or pharmacy technicians within the team. B.2. Regional Course Programme

Throughout the year, trainees will attend a series of regional courses and access on-line learning activities that have been designed to complement the practical experience that will be gained in the workplace. Full attendance and participation is expected at all HEE courses and events.

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B.2.1 Trainee Voice

During each regional course, trainees will have the opportunity to talk to a trainee representative selected from the cohort of London, Kent, Surrey and Sussex pre-registration pharmacists, in addition to members of the HEE LaSE Pharmacy team. Trainees should use these opportunities to inform trainee representatives and the Pharmacy team about their training experiences to date (see section B.5).

B.2.2 Feedback and evaluation

Courses are continually developed and improved and trainees will be asked to complete an evaluation form at the end of each course in order to contribute to this process. B.3 On-line Learning Environment (OLE)

The website address for the HEE LaSE Pharmacy On-line Learning Environment (OLE) is 36Thttps://moodlelasepharmacy.hee.nhs.uk/ HEE uses Moodle as the platform for the OLE and trainees will be provided with log-in details at the start of the pre-registration training year. Moodle can be accessed on most iOS and Android devices. On laptops, it is necessary to ensure the latest internet browsers are being used for Moodle to function properly. HEE LaSE Pharmacy is committed to reducing paper consumption and trainees will be encouraged to access supporting materials through Moodle during courses, using personal tablets/laptop/smart phones.

What does this mean during the pre-registration year? Course titles, dates, venue information and anticipated content will be available on the HEE LaSE Pharmacy website: https://www.lasepharmacy.hee.nhs.uk/pre-reg-trainees/pre-registration-trainee-pharmacists/our-training-programme/regional-training-2019-20 Further details about course programmes which will include specific timings of the day and venue directions will be emailed to trainees at least two weeks before the course. Some courses may have supplementary learning to be completed before the day and this will be communicated to trainees in advance. Trainees are expected to attend all courses on the allocated date, if unable to attend a course for any reason this should be discussed with the educational supervisor and the HEE LaSE Pharmacy team notified in writing to [email protected] as soon as possible. Attendance at a course or assessment day should be treated as a normal working day, any lateness and/or unprofessional behaviour will be reported to the ES. For security and identification purposes, trainees should wear trust ID badges and sign the register to confirm attendance.

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Most on-line learning resources are available to access from the beginning of the year however there are some aspects that will be released throughout the year e.g. GPhC Registration Assessment Style Questions and Reference Source Questions.

B.3.1. OLE Resources

Throughout this handbook where OLE resources are available, they will be highlighted using this symbol. Within the OLE trainees will find the following resources:

OLE Course Name Contents Suggested Completion Dates

Course and Programme Support Materials

This section includes course and programme support materials: Regional pre-registration handbook 2019-20 Pre-registration pharmacist survival guide Forms and templates that are referred to within

the handbook. Course material to include pre-course work,

presentations, learning materials and post-course work.

Throughout the year

Assessment and Feedback

Hints, tips and activities to develop skills in the assessing and providing feedback to, others

Later stage of the year

Calculations Support Explanation and methodology to aid

pharmaceutical maths and calculations. Practice GPhC assessment questions

Throughout the year

Clinical Support

Clinical case studies BNF quizzes GPhC assessment questions Medicines management quizzes

Throughout the year

Quality Improvement Project

Hints and tips to assist project completion, with suggested timelines

As per department requirements

Recruitment and Selection

Hints and tips to assist application and interviewing processes

Available from December

OLE course support is available by contacting [email protected] 36T.

What does this mean to trainees during the pre-registration year? There are numerous resources available to trainees throughout the training year to support development including revision for the GPhC registration assessment.

Educational Supervisors are encouraged to set deadlines and track progress with OLE engagement throughout the year. HEE LaSE Pharmacy are able to monitor OLE engagement where necessary.

HEE LaSE OLE

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B.4. Objective Structured Clinical Examination (OSCE)

In order to help trainees, assess and improve their clinical competence, HEE LaSE Pharmacy runs mandatory formative Objective Structured Clinical Examinations (OSCEs) in February. OSCEs test application of clinical knowledge and communication/interpersonal and problem-solving skills (i.e. they test that trainees ‘can do’ rather than ‘knows how to do’ an activity). They have been used widely in medicine since the 1970s and are shown to be a valid and robust method of testing these skills.

B.4.1 Setting the Scene for OSCEs

There will be a mix of manned (interaction with an actor) and unmanned stations. Each station will be 9 minutes long. Topics for OSCEs vary depending on current learning requirements from EPDs, GPhC registration

assessment (framework, learning points and exam exerts) and national safety issues plus whether it will be a manned or unmanned OSCE station.

Examples include:

Manned Unmanned Area Actor: healthcare professional, patient, relative

Ward, dispensary, com

munity

etc.

Skills tested: • Medication

history/reconciliation • Counselling • Consultation • Advice provision • Influencing prescribing • Documentation • Conflict

Skills tested: • Medication history/reconciliation • Screening • Recommendations • Documentation • Calculations • Information retrieval • GPhC registration assessment-

based artefact questions (e.g. SPCs, BNF excerpts)

What does this mean during the pre-registration year? OSCEs provide a safe environment to enable formative assessment of trainees and the

provision of feedback to highlight strengths and areas for development to help shape the pre-registration year.

They are timed so that feedback will be available for the 39-week progress review. OSCEs test skills for the GPhC registration assessment and skills required as a registered

pharmacist.

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B.4.2. OSCE Resources

Practice OSCEs that can be run in-house will be provided to organisations. These are not mandatory. All paperwork for these practice OSCEs will be made available on the OLE so that trainees can review the stations in preparation for the formative OSCEs in February. Templates used in the OSCEs plus guidelines and other revision aids will be made available on the OLE. It is recommended that trainees review these to become familiar with the paperwork that will be used and the standards that are expected. B.4.3. Adjustments

Reasonable adjustments can be provided for trainees that request these in advance of the OSCE e.g. due to a learning disability. Evidence is required. Each request will be reviewed by the OSCE lead who will confirm what can be done to support the trainee. B.4.4 OSCE Quality Control

All OSCE assessors will have undergone assessor training and an OSCE Exam Board monitors and reviews the quality and appropriateness of stations pre and post-assessment. B.4.5. OSCE Feedback

Written individualised feedback plus the GPhC performance standards that each station is testing are provided to all trainees. Patient safety issues will be additionally highlighted. B.5. Trainee Representatives

The diagram overleaf shows how feedback from local and regional pre-registration pharmacist trainee representatives and educational supervisors, practice supervisors and educational programme directors feeds into different local or regional meetings.

Forms found on HEE LaSE OLE (Course Materials Section)

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Key:

PRP Pre-registration Pharmacist

EPD Educational Programme Director Oversees all pre-registration pharmacist training within your organisation

ES Educational Supervisor Your GPhC named tutor responsible for your overall supervision and your formal assessment and sign off.

PS Practice Supervisor

Responsible for overseeing a specified trainee’s work and providing developmental feedback during a period of training (e.g. during a rotation). May be a non-pharmacist

LAB Local Academic Board

Chaired by the director of medical education (DME) and responsible for the quality of medical, dental, pharmacy and library services within a trust

LFG Local Faculty Group Exercise quality control over a pre-registration programme.

HEE London and Kent Surrey and Sussex Quality Teams

Health Education England London and Kent, Surrey and Sussex Quality Teams

Regional teams monitoring quality of training of HEE commissioned trainees, highlighting good practice and suggesting areas for improvement.

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B.5.1 Role of Local Trainee Representatives

Local trainee representatives will be nominated within each trust to facilitate constructive dialogue between the pharmacy trainees at the trust and the pharmacy Local Faculty Group (LFG). The LFG reports to the trust Local Academic Board (or equivalent) and this is the reporting mechanism for dealing with local training issues. It is important that trainees are trained for this role and trainees should speak to their EPD to find out more about how the LFG is set up locally and how trainees input and provide feedback. Training materials are available on the OLE.

B.5.2. Role of Regional Trainee Representatives

During the training year there will be 6 main trainee representatives who will each represent a training group plus 6 co-representatives who will deputise for any of the main representatives. The primary role of a trainee representative is to seek, collate and report the opinions of other trainees on local and regional training and act as the “trainee voice” at the HEE LaSE Pre-registration Pharmacist Programme Board. Specific roles and responsibilities include: Being a point of contact and representing the views of the trainees at programme board meetings. Disseminating information and outcomes of the board meetings to other trainees via the local trainee

representatives. Highlighting common themes and pertinent issues identified following regular liaison with other

trainees, for inclusion on programme board meeting agendas. Attending and participating in HEE Quality Monitoring visits to trusts with the purpose of:

o Ensuring standards for the delivery of pharmacy education are being met. o Improving quality of education and training. o Identifying issues and good practice. o Highlighting concerns (education related only, not quality of service).

Attending and participating in any other HEE LaSE Pharmacy business (e.g. working groups, recruitment events) as deemed appropriate by HEE LaSE Pharmacy.

Reviewing and offering a trainee perspective on written materials produced by the HEE LaSE Pharmacy team.

What does this mean during the pre-registration year?

All trainees have a role to play by engaging and responding to feedback requests from trainee representatives who will represent their views at regional meetings. Feedback is not limited to negative opinion – it is also important that trainees share views about things that are going well or any ideas or good practice.

Issues that are specific to an organisation should be addressed through local trainee representatives for escalation through the LFG (who are accountable to the LAB). It can be useful to alert the regional representative to these issues too so that they can flag up any common themes to the regional pre-registration pharmacist programme board.

It is not the role of the trainee representatives to deal with personal grievances or individualised learning challenges as there are more appropriate sources of help and support available such as local Human Resources and Occupational Health departments, HEE LaSE Pharmacy Trainees Requiring Additional Support guidance and the HEE Professional Support Unit etc.

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B.6. E-portfolio

The VQManager e-portfolio developed by Skillwise UK is designed to facilitate better portability, flexibility and accessibility of the evidence generated by the trainee. The system also provides a method of ensuring the authenticity of the trainee’s work (using electronic signatures), and a formative assessment can be undertaken against the GPhC performance standards. This helps trainees and ESs to monitor progress throughout the training period and to seek/provide support where necessary. All trainees are required to compile their portfolio of evidence electronically. Following registration onto the pre-registration pharmacist programme, trainees will receive log-in details for the e-portfolio and an e-portfolio handbook on using the system. Use of e-portfolio is mandatory and all evidence and educational supervisor/trainee meeting logs must be entered and documented on VQManager. Each organisation will have a ‘super-user’ within the pharmacy department who is fully trained in using the e-portfolio system and their role will be to train other users (trainees and educational supervisors) on using this system. It is recommended that this training is conducted with the trainee during their local induction period. It is very important that new users make every attempt to fully utilise the training and help tools available to understand and use the system effectively and to resolve any issues. Please note: It is important that the HEE LaSE Pharmacy team has up-to-date information on all trainees and their educational supervisors. All trainees are required to complete the 36TTrainee Change Form36T if there are changes within their personal details, employer or educational supervisor. B.7. Trainee Support

From time to time during the training year, trainees may require extra support. The HEE LaSE Pharmacy team supports educational supervisors in identifying and managing Trainees Requiring Additional Support (TRAS). Trainees can also self-refer themselves as a TRAS and guidance will be offered to any trainee who does so. B.7.1 Trainees Requiring Additional Support

A TRAS describes a trainee who, for whatever reason, needs extra help and support to deal with problem(s) that are interfering with the completion of pre-registration training. These may or may not be work-related. Identifying a trainee as requiring additional support is not to label them, but to set in motion a process so that they may complete their training successfully. If necessary, a representative from the regional pharmacy team may visit a trainee and their ES in the workplace during the pre-registration training year. This will provide an opportunity to review progress with practice activities and the GPhC performance standards and to find the best way of supporting the trainee through the remainder of the training year. Trainees and ESs can contact the pharmacy team with queries. More information is available from the HEE LaSE Pharmacy website where a TRAS reference guide can be downloaded. Trainees across London, Kent, Surrey and Sussex can access the services of the HEE Professional Support Unit during their training year and further information about the services available can be found on the HEE LaSE Pharmacy website. https://www.lasepharmacy.hee.nhs.uk/training-1/supervisor-training/trainees-requiring-additional-support/

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B.7.2 Bullying and Harassment

Bullying and harassment is taken very seriously by Health Education England. Guidance should be read in conjunction with the employer’s guidance on the subject, as employers carry the legal responsibility for such issues.

The following definitions may help to clarify such behaviour:

Bullying: offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means that undermine, humiliate, denigrate or injure the person to whom it is directed.

Firm supervision in the workplace, which may include constructive, developmental feedback, is not considered bullying.

Harassment: unwanted conduct related to sex, gender reassignment, race or ethnic or national origin, disability, sexual orientation, religion or belief, age or any other personal characteristic.

Any trainee who thinks they are being bullied and/ or harassed should:

1. Speak to someone – if the first contact is not helpful, the trainee should speak to someone else. 2. Keep a record – all incidents should be diarised and documentation as specific as possible.

For more guidance and information employing organisations policies should be referred to.

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C. Learning in the Workplace

Learning in the workplace is a very different experience to learning in an academic institution. Trainees learning to date will have included lectures, problem-based learning in groups, practical sessions and self-study, focussed mainly on building the knowledge required as a pharmacist. The aim of the pre-registration year is to facilitate and enable the trainee to apply their knowledge in practice, which requires both a different approach to learning, and a different method of training by workplace supervisors. How is pre-registration learning different? As undergraduates, trainees will have been mainly required to “know” or “know how”, with some degree

of “show how” depending on their MPharm programme, however during the pre-registration year they are expected to “show how” or “do”, which relies on trainees having and acting upon opportunities in practice.

There will be greater focus on observation of supervisors in the workplace by trainees, leading to observation of the trainee in practice by supervisors.

Supervisors will make trainees aware of learning opportunities, however as trainees progress, they should be able to identify their own learning needs and associated learning opportunities.

There will be curricula and learning outcomes that trainees will need to complete simultaneously e.g. a rotational time table and associated learning, regional learning objectives (from this handbook), reviewing the BNF and working towards covering the GPhC registration assessment framework. These activities should all complement each other and juggling these simultaneously will require the trainee to have good time management and prioritisation skills.

Trainees are asked to reflect on their experiences to improve their practice. This will be assessed via an evidence submission process and discussed at regular meetings with the educational supervisor.

Trainees can be assessed in practice using formative assessment tools such as Mini Clinical Evaluation Exercise (Mini-CEX), Case Based Discussion (CBD) and Medication Related Consultation Framework (MRCF), which are used to highlight areas of good practice and to identify areas for further development. These tools are primarily designed to improve practice and enable trainees to strive for excellence.

Educational supervisors will monitor learning and progress via progress review meetings. To support these meetings, a checklist is available on the OLE.

The importance of observation Many complex processes underpin the provision of pharmaceutical care, ranging from using various dispensing systems to clinically assessing prescriptions and liaising with health professionals and patients. An understanding of, and adherence to, the procedures associated with these processes is vital. Making the most of observing others in practice and taking the opportunity to ask questions of those the trainee is watching are vital. Trainees should think about the task being undertaken and what they need to know to be able to undertake the task independently. Practice supervisors should explain what they are doing. If they do not, trainees are encouraged to ask that they do so. If a trainee does not understand something, they should always ask at an appropriate time. Having concrete experiences and making the most of opportunities The pre-registration year is a unique time for trainees to make the most of having a more experienced professional to work alongside, learn and gain feedback from. As qualified pharmacists are expected to effectively provide pharmaceutical care and to communicate successfully with patients and healthcare professionals, trainees should therefore practice these skills regularly, through workplace supervised learning. Feedback should be sought from supervisors, patients and health care professionals to help improve and perfect skills and to provide confidence for the newly qualified pharmacist.

Form found on HEE LaSE OLE (Course Materials Section)

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Trainees will be exposed to new experiences during their pre-registration training that they may feel are challenging, as they have had to think outside the box. These situations provide lots of learning, as outlined in the learning in practice example below. Trainees should seek the learning from the experiences they have, especially those that are perceived as difficult or challenging, as they provide the most learning and therefore benefit for future practice.

Learning in practice example

A trainee is working at the pharmacy hatch (reception) when a healthcare assistant (HCA) appears requesting an urgent supply of an unfamiliar injection. The trainee decides to look up the medication in the BNF and once they have identified that it is a kind of insulin they check on the computer system and the item is showing as out of stock. On further review of the drug chart the trainee notices that the patient appears to be on a very specific insulin regime and the dose is now due as a meal is being served on the ward. The trainee decides that it is probably needed without delay. In the meantime, a queue is building up at the hatch. The trainee gets one of the other pre-registration pharmacists to attend the hatch and asks another colleague for advice on where to obtain the medication. They suggest that the trainee checks ward stock levels, but the trainee does not know how to do this yet. The trainee asks one of the pharmacy technicians to show them how to do this and they go and get a supply from an alternative location to issue to the HCA. The trainee writes this situation up as evidence to discuss with their educational supervisor and on review they ask the trainee to reflect on why they felt it was urgent to supply the insulin and what the implications would have been if a dose had been missed, what other options they could have considered (and the pros and cons of each), when it wouldn’t have been appropriate to make a supply and what their thought process would be next time they were asked for an urgent item. As this scenario is a common occurrence during a hospital pharmacist’s career, what can the trainee learn from this situation? Possible learning includes: Learning about a new medicine Learning what resources are available and how to effectively use these resources to find out about

the medication Learning the process of how to obtain the medication Learning how to delegate work to other members of the team Working as an effective member of the team

Pre-registration pharmacists who recognise this as learning may have: Asked for a witness to support their written evidence and therefore obtained feedback from

members of the team on their performance and team working Reflected on how this learning has/will benefit people using pharmacy services Identified some other personal learning or developmental needs and set themselves some further

learning as an action plan Used this contribution to care to demonstrate their competence

Reflection is important especially after the trainee has had an experience that has challenged them. Following this scenario, if the trainee deals with a similar request again, they may deal with it in a different way, taking into consideration what they have learnt from that initial experience. Every experience provides an opportunity to learn something.

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C.1 Workplace Based Assessments

Workplace Based Assessments (WPBAs), also known as Supervised Learning Events, are formative assessments which are used to highlight areas of good practice and to identify areas for further development. These assessments are primarily designed to improve practice and enable trainees to strive for excellence. They are used within Foundation Pharmacist training and as such the pre-registration year is the ideal platform for their use, in preparation for the foundation stage of a pharmacist’s career. WPBAs include the following tools:

• Mini-Clinical Evaluation Exercise (mini-CEX) • Case Based Discussion (CBD) • Medication Related Consultation Framework (MRCF)

All Health Education England (HEE) commissioned pre-registration pharmacists are expected to undertake the following types and numbers of WPBAs during their pre-registration year: Type of Workplace Based Assessment Minimum number to be completed during

the pre-registration year Mini-Clinical Evaluation Exercise (mini-CEX) 1 Case Based Discussion (CBD) 1 Medication Related Consultation Framework (MRCF) 1

C.1.1 Mini-Clinical Evaluation Exercise (mini-CEX)

What is a mini-CEX? Mini-CEX has been used as a formative assessment tool within medical training for many years and has been adapted for use within pharmacy. Within pre-registration training it should be used to observe a trainee providing real-life pharmaceutical care for a patient new to the trainee or a patient known to the trainee who has been prescribed new therapy. It should involve observing an interaction between a trainee and a patient or a trainee and a healthcare professional e.g. a doctor. The observer provides the trainee with immediate developmental feedback on this interaction, focussing on the trainee’s clinical skills, attitudes and behaviours. Mini-CEX are suitable for use in a variety of situations normally expected by a trainee such as medicine reconciliation, receiving a medicines information enquiry on a ward or carrying out medication counselling with a patient e.g. counselling a patient about their warfarin. See section E3 Medicines Management and E4 Clinical Pharmacy for examples of when the Mini-CEX tool could be used Why use a mini-CEX? Mini-CEX is a time efficient way of assessing trainees in real practice settings and it presents a realistic challenge to trainees. It allows trainees to receive immediate developmental feedback on their performance from an experienced pharmacy professional about a real patient, in real time. Who is involved in a mini-CEX? The trainee and the practice supervisor in the clinical rotation should arrange a date and time in advance for the assessment to take place. This should preferably be organised at the start of the rotation and ideally the mini-CEX should be timetabled into the rotation.

Mandatory Training

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Where does the mini-CEX take place? The mini-CEX must be conducted in a clinical setting. Feedback provided to the trainee should be undertaken somewhere quiet where there will be minimal disruption. How long does a mini-CEX take? The observation will take approximately 15 – 20 minutes, followed by immediate developmental feedback, which may take approximately 30 – 60 minutes in total to complete. How many mini-CEX need to be completed? Trainees are expected to complete a minimum of one mini-CEX in a clinical rotation during their pre-registration year that involves trainee/patient interaction. The assessment form should be uploaded into their e-portfolio for review by their educational supervisor. As the mini-CEX tool can be used to demonstrate trainee progression, undertaking a mini-CEX during the first half of the training year and another one in the second half of the year can be useful. What happens during a mini-CEX? Time and date arrangement: The trainee and the practice supervisor, or other suitable assessor in the clinical rotation, should have arranged a suitable date and time in advance for the assessment to take place.

Patient selection: The assessor should accompany the trainee to their ward where the trainee should identify a previously unseen patient, or a previously seen patient prescribed new therapy. It might be necessary for the assessor to identify an alternative patient in order to undertake the assessment, at the agreed time, recognising that the identified patient might for example be off the ward or asleep at the time of the assessment, and a realistic approach should be adopted.

Trainee-patient interaction: In situations where trainee/patient interaction is being assessed (e.g. taking of a drug history), the assessor should stand at a distance so that they can observe and hear the interaction (e.g. at the end of the patient’s bed). They should not interrupt the interaction with the patient unless they feel that the information being provided is detrimental to patient care. Normal ward procedures should be followed by the trainee being assessed. The assessor should observe the trainee’s ability to deliver pharmaceutical care to the patient in real time.

Trainee-healthcare professional interaction: In situations where the trainee’s interaction with other members of the multidisciplinary team is being observed and assessed, the assessor should observe and assess the trainee’s ability to interact with other healthcare professionals to deliver pharmaceutical care to a patient in real time. The assessor should stand at a distance so that they can observe and hear the interaction. They should not interrupt the interaction with the healthcare professional unless they feel that the information being provided is detrimental to patient care.

Trainee-assessor discussion: A discussion between the trainee and assessor should take place immediately after the trainee/patient/healthcare professional interaction. The trainee should briefly present the clinical scenario to the assessor, highlighting key pharmaceutical issues and suggesting an appropriate action plan. The discussion should be led by the trainee. The assessor should take a passive role in the discussion. The assessor should prompt the trainee using questions relevant to the clinical scenario, to assess the trainee’s understanding of it. However, the assessor should not dictate how the trainee should deliver the pharmaceutical care, unless their action is detrimental to patient care.

Completion of the mini-CEX form: A paper version of the mini-CEX form should be completed by the assessor during the observed assessment.

The assessment form should be completed based on the trainee’s performance within each area of competence, using the corresponding scales.

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Feedback to the trainee: Following the assessment, immediate developmental feedback should be provided to the trainee using the mini-CEX form as a basis for the discussion. Following this, the trainee should be provided with the form to upload into their e-portfolio, ready to share with their educational supervisor. The assessor should provide feedback on the skills essential to the provision of good pharmaceutical care, highlighting the trainee’s strengths and identified areas for development. This should lead to a shared set of actions required by the trainee in order to develop their practice. At the next meeting with their educational supervisor, the trainee should discuss any learning outcomes from the agreed list of actions and how these will be achieved. What areas of competence are assessed during a mini-CEX? The following areas of competence are assessed during a mini-CEX and the explanation for each area is as follows: Delivery of patient care 1. Patient consultation Gaining patient consent, conducting a patient-centred consultation,

exploring the medical/surgical condition with the patient, considering the patient’s own health beliefs, being aware of personal limitations and making appropriate referrals.

2. Need for drug Establishing the patient’s background, taking a drug history and gaining the necessary information from a range of sources in order to decide on the appropriateness of drug therapy.

3. Selection of the drug Appropriate consideration of evidence-based medicine and drug interactions (drug-drug, drug-disease, drug-patient).

4. Drug specific issues Checking that the drug is prescribed correctly (route, formulation, dose, frequency, course length) and considering available results and what effect they have on drug therapy e.g. U&Es, LFTs etc.

5. Provision of drug product

Implementing an effective system for the supply of medicines

6. Medicines information and patient education

Provision of medicines and health advice to patients, carers, other pharmacy staff, medical and nursing staff, and other healthcare professionals.

7. Professionalism Identification and prioritisation of medicines management issues, time management, patient confidentiality, appropriate application of guidelines such as the formulary, therapeutic switching policies etc.

Problem solving 8. Gathering information Accessing and summarising the information required and ensuring the

information used is up to date. 9. Knowledge Knowledge of pathophysiology of common medical/surgical conditions

encountered, pharmacology, side effects, and drug interactions. 10. Analysing information Demonstrating the ability to evaluate information gathered (reliability of

source, relevance to patient care), correctly identifying the problem, appraising options, making appropriate decisions and demonstrating a logical approach.

11. Overall Clinical Care An assessment that summarises all the above in terms of outcomes for the patient.

What rating scale should be used to assess the trainee’s performance? For each area of competence, the trainee’s performance should be rated according to the scale overleaf. The full range of options should be used by the assessor. Trainee’s whose performance falls below “meets expectations” should be provided with developmental feedback that prioritises the areas of competence they need to focus on, and assessors should ensure learning needs for the trainee are identified.

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Significantly below Performs poorly; very rarely meets the standard expected Below Performs poorly; meets the standard required occasionally Borderline Performs satisfactorily; with appropriate support and direction should

meet expectations Meets expectations Performs well and to the standard expected of a pre-registration

pharmacist at that stage in their training Above Performs to a standard higher than expected of a pre-registration

pharmacist at that stage in their training Significantly above Performs to an excellent standard; trainee is ahead of his/her peer

group Unable to comment Unable to comment as performance not observed whilst s/he was there

How can trainees and assessors learn to use the mini-CEX tool? Trainees and assessors can learn more about how to use the mini-CEX tool by viewing http://jpbsoutheast.org/assessment-tools/jpb-assessment-tools-dvd/index.html C.1.2 Case Based Discussion (CBD)

What is a CBD? CBD has been used as a formative assessment tool within medical training for many years and has been adapted for use within pharmacy. A CBD is a discussion between a trainee and a practice supervisor on a previous case, designed to retrospectively evaluate trainee input into patient care. The discussion should include a background understanding of the disease state, awareness of treatment goals and evidence-base and explanations of actual interventions made by the trainee and treatment management. Trainees are provided with developmental feedback on their clinical skills, problem solving skills and knowledge, in relation to a real-life situation. In contrast to a mini-CEX, a CBD is an assessment of a trainee in relation to a retrospective patient case which involves assessment in real time. A CBD is suitable for a wide range of cases for example discussing the pharmacokinetics or pharmacodynamics of a new drug for a patient, evidence based use of a drug in a particular patient or the legal or ethical issues around patient care. See section E4 Clinical Pharmacy for examples of when the CBD tool could be used Why use a CBD? A CBD allows trainees and their assessor to discuss a retrospective patient case in order to enhance learning. The assessor can observe how the trainee utilises their problem solving skills and advance their learning by encouraging reflection. It is not the assessor’s role to interrogate the trainee about the case, rather to ask questions related to the expected areas of competence and to assess the trainee’s strengths and areas for development. Who is involved in a CBD? The trainee and an appropriate practice supervisor should arrange a date and time in advance for the assessment to take place. Ideally the CBD should be timetabled into the pre-registration year. Where does a CBD take place? A CBD should be undertaken somewhere quiet where there will be minimal disruption. It is not necessary for a CBD to take place in a clinical setting. How long will a CBD take? Depending on the case being discussed, a CBD may take 30-60 minutes to complete.

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How many CBDs need to be completed? Trainees are expected to complete a minimum of one CBD during their pre-registration year. The assessment form should be uploaded into their e-portfolio for review by their educational supervisor. As the CBD tool can be used to demonstrate trainee progression, undertaking a CBD during the first half of the training year and another one in the second half of the year can be useful. What happens during a CBD? Time and date arrangement: The trainee and the practice supervisor should have arranged a suitable date and time in advance for the assessment to take place.

Patient selection: The trainee should choose a patient case and agree in advance with the assessor whether the case is suitable for a CBD. Once agreed, the trainee should prepare in advance of the assessment.

Completion of the CBD form: A paper version of the CBD form should be used by the assessor during the assessment to structure the discussion.

The assessment form should be completed after the assessment based on the trainee’s performance within each area of competence, using the corresponding scales. Trainee-assessor discussion: The trainee may bring patient notes, drug charts and other documents to help them to discuss their case. The trainee should start the discussion by outlining the key points of the case to the assessor. They should then highlight the key pharmaceutical care issues and the rationale for the treatment and care that they provided. Following this the assessor should take over the discussion and question the trainee to identify if they have fulfilled the assessment criteria, using the CBD form to assist with this. The assessor should provide verbal developmental feedback during the assessment and written feedback by way of the CBD form, after the discussion has taken place. Feedback to the trainee: The most important part of a CBD is the feedback provided to the trainee in order for them to further develop. The assessor should provide feedback on the skills essential to the provision of good pharmaceutical care, highlighting the trainee’s strengths and identified areas for development. This should lead to a shared set of actions required by the trainee in order to develop their practice. At the next meeting with their educational supervisor, the trainee should discuss any learning outcomes from the agreed list of actions and how these will be achieved. What areas of competence are assessed during a CBD? The following areas of competence are assessed during a CBD and the explanation for each area is as follows: Delivery of patient care 1. Pharmaceutical

Needs Assessment Has identified correctly the pharmaceutical care needs for the patient. The trainee is able to prioritise the pharmaceutical care problems appropriately.

2. Treatment Recommendations

Can discuss the treatment of the main medical problem – evidence-based treatment guidelines, drug therapy (mechanism of action of drugs, dosage range, key pharmacokinetic data, cautions, contra-indications, common side effects, major drug interactions, patient counselling points)

3. Follow-up /Monitoring

Can discuss the rationale for the monitoring of the patient’s pharmaceutical care. Can demonstrate practical on-going and appropriate monitoring of therapy (including end-of-bed charts as well as biochemistry, haematology) Can discuss and demonstrate how the care of this patient was managed in conjunction with the wider healthcare team

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4. Professionalism Demonstrates ability to prioritise; and was timely, and succinct. Can show an ethical approach, and awareness of any relevant legal frameworks. Has insight into own limitations. Considers interface issues.

5. Overall Clinical Judgement

Can discuss own judgment, synthesis, caring, effectiveness, for this patient

What rating scale should be used to assess the trainee’s performance? For each area of competence, the trainee’s performance should be rated according to the scale below. The full range of options should be used by the assessor. Trainee’s whose performance falls below “meets expectations” should be provided with developmental feedback that prioritises the areas of competence they need to focus on, and assessors should ensure learning needs for the trainee are identified. Significantly below Performs poorly; very rarely meets the standard expected Below Performs poorly; meets the standard required occasionally Borderline Performs satisfactorily; with appropriate support and direction should

meet expectations Meets expectations Performs well and to the standard expected of a pre-registration

pharmacist at that stage in their training Above Performs to a standard higher than expected from a pre-registration

pharmacist at this stage in their training Significantly above Performs to an excellent standard; trainee is ahead of his/her peer group Unable to comment Unable to comment as performance not observed whilst s/he was there

How can trainees and assessors learn to use the CBD tool? Trainees and assessors can learn more about how to use the CBD tool by viewing http://jpbsoutheast.org/assessment-tools/jpb-assessment-tools-dvd/index.html C.1.3 Medication Related Consultation Framework (MRCF)

What is the MRCF? The MRCF is an observation focussing on consultation skills with a patient. It is a reflective tool used to support the development of consultation skills and behaviours necessary for delivering pharmaceutical care to patients, by identifying the trainee’s strengths and learning needs in this area of practice. There are five key stages to the MRCF, four relate to the stages of consultation and the fifth lists the behaviours associated with effective consulting. See section E3 Medicines Management and E4 Clinical Pharmacy for examples of when the Mini-CEX tool could be used Why use the MRCF? The MRCF provides a clearly structured way of conducting a patient consultation and describes the key activities and behaviours associated with each stage of the consultation process. Patient consultation is a learned behaviour and using the MRCF tool can help trainees to learn the key stages involved, how to review a patient’s medicines and how to identify any problems they may have, including adherence to their treatment. It also provides the assessor with a method for evaluating trainee-patient consultations and to use their observations to provide feedback to the trainee on future learning needs. Who is involved in the MRCF? The trainee and the practice supervisor should arrange a date and time in advance for the assessment to take place. The MRCF should be timetabled and should take place before the regional OSCEs in February.

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Where does the MRCF take place? The MRCF can be conducted in various settings. Feedback provided to the trainee should be undertaken somewhere quiet where there will be minimal disruption. How long does the MRCF take? The observation will take approximately 10 – 30 minutes (depending on the patient), followed by immediate developmental feedback, which may take a further 30 – 60 minutes in total to complete. How many MRCFs need to be completed? Trainees are expected to complete a minimum of one MRCF during their pre-registration year, to take place before the regional OSCEs in February. The MRCF paperwork should be uploaded into the trainee’s e-portfolio for review by their educational supervisor. As the MRCF tool can be used to demonstrate trainee progression, undertaking the MRCF during the first half of the training year and another one in the second half of the year can be useful. What happens during the MRCF? Time and date arrangement: The trainee and the practice supervisor should have arranged a suitable date and time in advance for the assessment to take place.

Patient selection: The assessor and trainee should agree on a patient appropriate to conduct a trainee led consultation with, at the time arranged for the MRCF.

Trainee-patient interaction: The assessor should stand at a distance so that they can observe and hear the interaction (e.g. at the end of the patient’s bed). They should not interrupt the interaction with the patient unless they feel that the information being provided is detrimental to patient care. The assessor should observe the trainee’s ability to conduct a patient consultation.

Completion of the MRCF paperwork: The MRCF paperwork is in two parts, the MRCF tool which includes the stages of consultation and consultation behaviours, and the MRCF supplement which includes patient and assessor feedback. These should be completed by the assessor during and immediately after the observed assessment.

The paperwork should be completed based on the trainee’s performance within each area of competence.

For each section of the consultation there is a list of individual activities and a rating scale to show if the requirements have been met by the trainee. There is also a global rating scale for the assessor’s general impression of the consultation.

Assessing the trainee’s consultation: The 5 key sections and associated criteria to be assessed by the observer are: A = Introduction: Scene setting to build a therapeutic relationship with the patient A: Introduction A.1 Introduces self A.2 Confirms patient’s identity A.3 Discusses purpose and structure of the consultation A.4 Invites patient to discuss medication or health related issue A.5 Negotiates shared agenda

B = Data Collection and Problem Identification: To identify pharmaceutical care needs B: Data Collection and Problem Identification B.1 Documents full medication history B.2 Assesses patient’s understanding of the rationale for prescribed treatment

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B.3 Elicits patient’s (lay) understanding of his/her illness B.4 Elicits concerns about treatment B.5 Explores social history B.6 Asks how often patient misses dose(s) of treatment B.7 Reasons for missed dose(s) (unintentional or intentional) B.8 Identifies and prioritises patient’s pharmaceutical problems (summarising)

C = Actions and Solutions: To establish an acceptable management plan with the patient C: Actions & Solutions C.1 Relates information to patient’s illness & treatment beliefs (risk – benefit discussion) C.2 Involves patient in designing a management plan C.3 Gives advice on how & when to take medication, length of treatment & negotiates follow up C.4 Checks patient’s ability to follow plan (are any problems anticipated?) C.5 Checks patient’s understanding C.6 Refers appropriately to other healthcare professional(s)

D = Closing: To negotiate safety netting strategies with the patient D: Closing D.1 Explains what to do if patient has difficulties following plan and whom to contact D.2 Provides further appointment or contact point D.3 Offers opportunity to ask further questions

E = Consultation Behaviours: To be observed throughout the consultation E: Consultation Behaviours E.1 Listens actively & allows patient to complete statements E.2 Uses open & closed questions appropriately E.3 Demonstrates empathy & supports patient E.4 Avoids or explains jargon E.5 Accepts patient (i.e. respects patient, is not judgemental or patronising) E.6 Adopts a structured & logical approach to the consultation E.7 Summarises information at appropriate time points E.8 Manages time effectively (works well within the time available) E.9 Keeps interview “on track” or regains “control” when necessary

As part of the MRCF the assessor should receive feedback from the patient on the trainee’s performance during the consultation, by asking the following questions:

I knew this before the consultation

I am still unsure I now know more about this

Why you need to take or use your medicines

How to take or use your medicines When to take or use your medicines

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Additional questions to ask the patient:

Strongly Disagree

Disagree Uncertain Agree Strongly Agree

I was greeted in a way that made me feel comfortable

The reason for the consultation was explained to me

I was listened to I was encouraged to express my own

thoughts

I had the opportunity to discuss treatment options

I was given as much information as I wanted I was encouraged to ask questions

My concerns were responded to I understood everything

I was satisfied with the consultation Any other comments that the patient made on the consultation:

After receiving feedback from the patient, the assessor should award the trainee a global rating for the consultation using the scale below: Overall Impression Overall the trainee’s ability to consult was:

Poor Borderline Satisfactory Good Very good Not competent Not competent Competent Competent Competent

Trainee-assessor discussion: Following the assessment, immediate developmental feedback should be provided to the trainee using the MRCF paperwork as a basis for the discussion. Feedback should focus on how the trainee performed in each of the stages and individual criteria involved in the consultation process and the behaviours necessary for consulting. The trainee’s strengths should be highlighted plus areas for further development and improvement. The trainee should be provided with the paperwork to upload into their e-portfolio, ready to share with their educational supervisor. At the next meeting with their educational supervisor, the trainee should discuss any learning outcomes from the agreed list of actions and how these will be achieved. How can trainees and assessors learn to use the MRCF tool? Trainees and assessors can learn more about how to use the MRCF tool by viewing: http://educatorhub.e-lfh.org.uk/Component/Details/458481. Trainees should complete the CPPE consultation skills for pharmacy practice: taking a patient-centred approach learning pack before undertaking the MRCF. This can be found here: https://www.cppe.ac.uk/programmes/l/consult-p-02 Other useful resources can be found here: http://jpbsoutheast.builtbyfox.es/assessment-tools/medication-related-consultation-framework-mrcf/index.html References https://www.lasepharmacy.hee.nhs.uk/foundation-programme/kss-foundation-pharmacist-programme-details/building-the-foundation-pharmacist-portfolio/ https://www.rpharms.com/help/using-foundation-tools

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C.2. Competence Based Training

All pre-registration training is underpinned by the GPhC performance standards and the section 10 outcomes from the GPhC Future Pharmacists: standards for initial education and training of pharmacists. The GPhC Registration Assessment Framework is derived from the section 10 outcomes. The GPhC Pre-registration Manual provides further information on demonstrating knowledge and competence.

GPhC Performance Standards

To demonstrate competence against the different performance standards, trainees are required to build a portfolio of evidence, using an e-portfolio, to show how these have been met. There is also a considerable body of research which claims that the development of professionalism is best assessed through reflective writing. Trainees should reflect on their day-to-day practice and produce evidence which maps to the GPhC performance standards. One piece of evidence can demonstrate competence against several different standards, providing that the trainee themselves has shown competence at the level expected of a registered pharmacist. Trainees must meet the standards consistently in order to be assessed as competent in them.

In employer training plans and throughout this handbook, objectives and practice activities are included to provide trainees the opportunity to demonstrate all performance standards at various points during their training. All GPhC performance standards need to be achieved and “signed-off” by the named ES by the end of the pre-registration year. For each of the GPhC performance standards, the ES/PS and the trainee should discuss and plan how best they could be achieved during training, considering the following: What prior experience or formal recognition relevant to the area of practice has the trainee had to date

and what developmental needs have already been identified with respect to any particular standard? How much evidence will be needed to demonstrate competence and for those that need to be

demonstrated in a range of situations, what does the range look like? What is the best way for the standard to be evidenced? – e.g. reflective account, competency log,

written piece, certificate of completion, witness statement, assessment checklist etc. Who will be responsible for the training/assessment? If, when and how will an assessment take place? - is observation sufficient, is there a “pass mark” or

minimum requirement for a competency log? etc. What information will be required to support the evidence of the performance standard? (e.g.

prescription items with patient identifiable data removed, completed assessment log, course certificate, etc.)

The pre-registration pharmacist should log their evidence, using the e-portfolio, indicating which of the performance standards they feel have been demonstrated. Evidence should be submitted to the practice supervisor or expert witness to authenticate before submission to the educational supervisor for review ready for discussion at the next scheduled meeting in preparation for the mandatory GPhC quarterly progress reviews. The responsibility for producing evidence lies with the trainee.

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C.3. Evidence of Competence

A template record of evidence form is available on the OLE, in the e-portfolio File Library, or the trainee’s employer may have their own preferred version. Below illustrates the information that a trainee could include in a record of evidence. 1. Brief description summary

Sets the scene – e.g. area of work, describes the trainee’s role in the situation and what the overall

task/process/incident was etc.

Specific learning outcomes or SMART (Specific, Measurable, Achievable, Realistic, Timely) objectives.

2. Description of Evidence What happened / what was the outcome? What did the trainee, personally contribute to the outcome? What did not go as well on this occasion and why was this? What other options could the trainee have considered and what influenced their decisions? What skills or knowledge has the trainee identified for further development and how does the

trainee plan to address these (e.g. inclusion of a SMART action plan)? What has the trainee learnt and how has this benefited service users and how will they change

their practice as a result?

3. Map against the relevant performance standards

Identifies which performance standards have been demonstrated

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C.4. GPhC Performance Standards

Expanded details for each performance standard can be found at GPhC Performance Standards Unit A - Personal Effectiveness

A1 – Manage Self A1.1 Behave in a manner consistent with membership of the profession A1.2 Manage your time effectively A1.3 Recognise your personal and professional limitations and refer appropriately A1.4 Respond with willingness and flexibility to new situations and to change A1.5 Remain composed and personally effective in all situations A1.6 Make decisions which demonstrate clear and logical thought A1.7 Take responsibility for, and accept outcomes of, your own decisions

A1.8 Amend your behaviour, when necessary, based on evaluation of your performance by yourself or others

A2 – Manage Work A2.1 Carry out tasks effectively

A2.2 Approach tasks and situations in accordance with the law and with the GPhC standards for pharmacy professionals

A2.3 Follow work systems correctly A2.4 Use resources effectively

A3 – Manage Problems A3.1 Recognise and define actual or potential problems A3.2 Identify workable options to resolve the problem A3.3 Select the best solution, based on sound analysis and appropriate evidence A3.4 Suggest and, if appropriate, implement solutions to problems

A3.5 Evaluate the outcome of the solution after implementation, and if necessary, redefine the problem (see A3.1)

A4 – Demonstrate a Commitment to Quality

A4.1 Work to an acceptable standard* when preparing products and delivering services * As defined by GPhC standards for pharmacy professionals with a focus on providing safe and effective care.

A4.2 Check your own work effectively A4.3 Minimise error by others through effective supervision A4.4 Identify and rectify your own and others’ mistakes promptly and effectively A4.5 Minimise health and safety risks to yourself and others A4.6 Base your actions, advice and decisions on evidence A4.7 Obtain and process the evidence you need to meet A4.6

A4.8 Have successfully engaged in a quality improvement process. This could be achieved for example by carrying out a small, planned audit assignment or completing a PDSA cycle.

A5 – Demonstrate Ongoing Learning and Development A5.1 Identify and prioritise your own learning and development needs A5.2 Develop your own plans to meet identified needs, using SMART learning objectives A5.3 Make full use of learning and development opportunities A5.4 Evaluate whether your learning objectives have been met A5.5 Identify your further learning needs A5.6 Record your own learning and development process and outcomes A5.7 Apply learning to practice

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Unit B – Interpersonal Skills

B1 – Communicate Effectively B1.1 Communicate effectively in English B1.2 Behave in a polite and helpful manner B1.3 Sensitively approach people who need or who may need assistance B1.4 Elicit all relevant information by the use of appropriate questions B1.5 Listen effectively to the whole message B1.6 Respect and observe confidentiality B1.7 Act appropriately in response to spoken and unspoken needs of others B1.8 Behave in a manner which instils confidence B1.9 Behave assertively B1.10 Use appropriate body language B1.11 Provide information and advice appropriate to the needs of the recipient(s) B1.12 Handle conflict appropriately B2 – Work Effectively with Others B2.1 Acknowledge the ideas and opinions of others and act on them when appropriate B2.2 Present your own ideas and opinions appropriately when speaking and in writing B2.3 Meet commitments made to others within agreed deadlines B2.4 Give constructive feedback to others based on accurate evaluation of their performance B2.5 Secure help from others when necessary in an appropriate manner B2.6 Assist others when necessary B2.7 Delegate tasks appropriately B2.8 Supervise others in an appropriate manner to ensure that agreed outcomes are achieved B2.9 Use your knowledge and skills effectively when helping others learn Unit C – Medicines and Health C1 – Manage the Dispensing Process C1.1 Correctly receive prescriptions into the pharmacy C1.2 Check the prescription is valid C1.3 Assess the prescription for safety and clinical appropriateness C1.4 Resolve any identified problems appropriately C1.5 Perform calculations correctly C1.6 Assemble the prescription correctly C1.7 Supply extemporaneously prepared products according to the correct formula

C1.8 Correctly issue dispensed item(s) to patient or representative, with appropriate information and advice

C1.9 Ensure stock is managed correctly C1.10 Respond appropriately to requests to dispense prescription-only items without a prescription C1.11 Correctly process necessary documentation C1.12 Effectively check prescriptions dispensed by others C2 - Provide Additional Clinical and Pharmaceutical Services C2.1 Provide considered and correct answers to queries, founded on research-based evidence C2.2 Pro-actively assist patients to obtain maximum benefit from their treatment C2.3 Identify and take action to minimise risk to patients from their treatment C2.4 Actively provide information and advice to healthcare professionals C2.5 Construct medication histories using a range of sources C2.6 Use medication histories correctly C2.7 Recognise possible adverse drug reactions, evaluate risks and take action accordingly C2.8 Provide appropriate information and advice on the management of minor and common ailments C2.9 Effectively use opportunities to promote and support healthy lifestyles and prevent disease C2.10 Demonstrate awareness of emergency first aid C2.11 Refer, or direct the person, to a more suitable source of help or information, when necessary

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D. Guidance for Workplace Rotational Training Programmes All NHS employers providing HEE commissioned pre-registration pharmacist training are responsible for ensuring that workplace training and experience described are made available to all trainees. Trainees who will rotate out of their employing organisation during their pre-registration year should have an external rotation agreement completed for each training rotation they are attending within another organisation (NHS or private). This agreement can be used for multiple trainees were appropriate. The purpose of the external rotation agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed. Below are mandatory areas that all pre-registration pharmacists within London, Kent, Surrey and Sussex are expected to have included within their training programme:

Mandatory Areas

Induction (corporate, pharmacy department and pre-registration training programme) Patient Services (i.e. dispensary services, procurement and drug distribution services and medicines management) See sections E1 to E3 Clinical Pharmacy See section E4 Community Pharmacy See section E5

Workplace Based Assessments See section C1

Audit Project (to meet performance standard A4.8 - Have successfully engaged in a quality improvement process)

Regional Courses

On-line Learning Environment (completion of relevant learning activities as agreed with the educational supervisor/educational programme director)

Completion of a Health Education England Exit Survey The areas listed below are considered optional, however it is encouraged that some or all of these are provided for pre-registration pharmacists where possible. It is recognised that with the wide variety of NHS organisations in London, Kent, Surrey and Sussex offering a range of specialist services and with differing resources, that exposure of trainees to these areas of practice will vary.

Optional Areas Aseptic Preparative Services (Quality Assurance if available) See section E6 Medicines Information Services See section E7

Form found on HEE LaSE OLE

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Mental Health See section E8 Out-patient Pharmacy See sections E1 to E3 Children & Young People See section E9 Primary Care e.g. General Practice and Clinical Commissioning Groups See section E10

Optional Areas continued Quality Improvement Projects See section E11

Assessment and Feedback See section E12

Other areas included in the training programme will depend on local specialisms available. Some local training programmes will be shorter in length than others due to the multi-sector nature of the programme and the training programme provided will need to reflect this by focusing on mandatory areas. Learning outcomes for each area should be set by the employer with the support of this handbook to prepare the trainee for their future role as a pharmacist. D.1. Further Guidance to Support Trainees during the Pre-registration Year

Ward-based clinical pharmacy exposure Employers are encouraged to expose trainees to ward-based clinical pharmacy early in the pre-registration year. Trainees should be supported to become integrated into the ward team. It is suggested that trainees are attached to a core ward or team, for a proportion of each day when they are on site, for the duration of their pre-registration year, following appropriate training. This will result in practice supervisors seeing progression of the requisite skills and competencies throughout the year and will support trainees to maintain and grow their clinical skills throughout the year.

o Training in medicines management functions should precede clinical training and where appropriate trainees should act as a pharmacist in shadow form for the last month of their training at least.

o Additional speciality rotations in addition to mandatory areas can enrich the learning experience for trainees however trainee progression should be monitored, and sufficient time spent focussing on the mandatory areas included within this handbook.

o EPDs should arrange for trainees to have sufficient time within clinical areas to ensure it is positive and beneficial to learning.

Achieving handbook learning outcomes Some of the learning outcomes in this handbook can be achieved across multiple areas of practice and do not necessarily need a specific timetabled rotation in order to achieve them. For example:

o Mental health learning outcomes can sometimes be achieved during a rotation across the admissions pathway.

o Medicines information learning outcomes can be met by answering a clinical enquiry from a healthcare professional during a rotation in the dispensary or ward environment.

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Dedicated time each week for development Trainees should be provided with dedicated time each week for development. Examples of this include, but are not restricted to, attendance at regional courses, local pharmacy teaching sessions, intra- and inter-professional learning, shadowing, e-learning and time for reflection. Out-of-hours rotas It is anticipated that trainees will join out of hours’ rotas (e.g. evening and/or during the day at weekends but not overnight/residency) to gain experience of working outside of office hours in preparation for practice. Trainees need to be appropriately trained for working out of hours during the week and at weekends (e.g. completion of dispensing logs) and must be appropriately supervised at all times. Rotations outside of the employing organisation Many local pre-registration programmes are enriched by the provision of rotations outside of the employing organisation. Trainees always need to be appropriately supervised during these rotations. The educational supervisor should arrange with the trainee as to how communication will be maintained during times when the trainee is absent from the employing organisation. An external rotation agreement should be in place for times when the trainee is off-site.

Form found on HEE LaSE OLE

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E. Learning Outcomes for Pre-registration Training For each area of work, a list of learning outcomes has been compiled. In order to achieve these, the recommended practice activities should be completed by the trainee. To prevent duplication, a number of these have been cross-referenced to other sections of the handbook, the below symbol will indicate this.

For each practice activity, a list is attached of associated GPhC performance standards taken from the GPhC Pre-registration Manual. This will help trainees to plan and identify any learning gaps as they progress through the year. Next to some learning outcomes and practice activities, opportunities have been identified that show examples of the following methods of learning:

1. Inter-professional Education (IPE) – learning from or with other healthcare

professionals

2. Patient Involvement.

Please refer to section 8 of the GPhC Pre-registration Manual for details of the performance standards and the associated required outcomes from the GPhC standards for the initial education and training of pharmacists which are included for each group of performance standards.

Inter-professional Education

Patient Involvement

Cross Reference to

XXX

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E1. Dispensary Services Dispensary services are at the core of the healthcare organisation and effective medicine supply is essential to support the delivery of optimal patient care and medicines optimisation. An external rotation agreement should be completed if the trainee will be undertaking a rotation into an outsourced out-patient dispensing service within the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

Dispensary Services Essential Learning Outcomes All trainees are encouraged to discuss with their supervisors where the learning outcomes can be achieved. For example, if outpatient pharmacy services are provided through another provider within the trust, it is important to be clear what the trainee will achieve on a rotation through an outsourced service and who will supervise them. These learning objectives can also be achieved during rotations outside of the dispensary for example a community pharmacy placement or aseptic services if available within the trust. 1.1. To describe the individual roles of each member of the dispensary

team and their contribution to the dispensary service. 1.2. To describe the role and responsibilities of a Responsible Pharmacist (RP) and when

this is applicable in a hospital setting. 1.3. To gain an appreciation of the differing prescribers and prescriptions used within the

hospital setting including in-patient prescriptions, private, NHS and prescriptions issued by non-medical prescribers.

1.4. To follow Standard Operating Procedures (SOP) for processing both in- and out-patient prescriptions. This includes: Receipt of prescriptions, including NHS charges and exemptions Screening and assessing the prescriptions. This is to include use of formularies. Dispensing. Providing appropriate information to the patient. Selling medicines to the general public.

What does this mean during the pre-registration year?

A pharmacist needs to know how a pharmacy is run to ensure that they are an efficient member of the pharmacy team and adopt the role of the Responsible Pharmacist (RP). Therefore, a trainee must be able to efficiently and safely dispense, check and screen medications for appropriate supply to a patient when validating therapeutic approaches and supplying prescribed and over-the-counter medicines.

The GPhC is aware of the importance of dispensary services and thus this is included within the performance standards and GPhC registration assessment framework. Section C1 of the performance standards is entitled “manage the dispensing process” and

within this section there are 12 individual standards relating to the dispensing process where trainees will need to demonstrate their competence.

Ensuring that safe and effective systems are in place to manage the risk inherent in the practice of pharmacy and the delivery of pharmaceutical services is vital.

Mandatory Training

Inter-professional Education

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Documentation kept and why. This includes prescriptions, drug charts, requisition sheets, discharge summary letter, controlled drug registers, private prescription register, clinical trials and unlicensed medicines.

1.5. To demonstrate skills associated with the dispensary process from receipt of a prescription or request to supply and issue to the patient, ward, department or clinic. To include (where applicable): Extemporaneous dispensing* High-cost drugs and Payment by Results tariff (PbR) exclusions Non-formulary items Unlicensed medication Controlled drugs Immunoglobulin Clinical trials Stock requests

1.6. To advise on the legal and procedural requirements for the receipt, dispensing, supply and destruction of all medicines, including controlled drugs.

1.7. To follow the procedures agreed for dealing with prescriptions that cannot be dispensed at the time that they are prescribed, with special emphasis on determining if urgent resolution is required or not (i.e. is an alternative required, bought in specially), communication with pharmacist, purchasing office, healthcare staff and patient where applicable.

1.8. To communicate effectively with the prescriber and ward nursing staff regarding queries which arise, relating to in-patient, out-patient and ward supplies including discharge medications. If unable to solve queries, know who to refer to and do so promptly.

1.9. To be aware of the policies of the hospital for managing patient own drugs, self-medicating schemes, dispensing for discharge, homecare, hospital doctors/non-medical prescribers and their families and private in/out patient prescriptions (including the maintenance of records and methods of payment).

1.10. To ensure continuity of medication supply once a patient is discharged including consideration of Medicines Compliance Aids (MCA). As part of this it may be appropriate to undertake an assessment of patient competency before advising on any type of compliance aid

1.11. To demonstrate the ability to prioritise workload according to local needs, including considerations required for staffing pressures.

1.12. To know the different alert status regarding bed pressures within the trust and how dispensary workflow adjusts accordingly.

1.13. To know the Standard Operating Procedures (SOPs) to deal with an exceptional circumstance in the dispensary (e.g. failure of the dispensary-based computer system, robot-dispensing system, major incident, telephone system failure etc.).

1.14. To know the policy followed for medication recall, including where these recalls originate from and their different priority levels (additional information can be found here

1.15. To demonstrate a knowledge of the policy for collecting and recording workload statistics and their use (i.e. audits and quality improvement)

Cross Reference to clinical learning

and community placement outcomes

Reading Resource

*Cross Reference to Aseptics, section 6.

Inter-professional Education Patient Involvement

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1.16. To know the error monitoring policy, including internal errors (i.e. ‘near misses’) and external errors (i.e. leave the pharmacy department) and know the feedback system and learning gained from this process.

1.17. To apply Control of Substances Hazardous to Health (COSHH) regulations within the dispensary.

1.18. To apply the concepts of quality assurance and quality standards to dispensary services.

1.19. If installed in the organisation, demonstrate awareness of robotic dispensing systems and the advantages and disadvantages that may impact on the pharmacy service.

1.20. If installed in the trust know the use, benefits and risks associated with the Emergency Drug Cupboard/Store and what medication types are kept there and why.

Mandatory Dispensary Practice Activities

These should be carried out according to local hospital policy. The guidelines provided are the minimum standard expected.

1. Design a personal self-checking procedure to minimise dispensing errors. Performance Standards: A2.1, A4.2, A4.4

2. Demonstrate an awareness of the handling and spillage requirements of cytotoxics and/or reconstitution of antibiotics/controlled drugs. Performance Standards: A2.2, A4.5

3.

Using the ‘Dispensary Numbers Log’, competently dispense a minimum of 200 items which must include the following:

• Discharge items • Controlled drug items • Items that require dose calculation e.g. liquids, low molecular weight heparins etc. • Items with variable dosing regimens e.g. steroids, amiodarone etc.

If possible: o Palliative care items for a syringe pump or anticipatory prescribing o An unlicensed item and/or indication o A private prescription o Specialist items e.g. paediatric, medicine compliance aid, extemporaneous

preparation or reconstitution, addicts, cancer services, clinical trials Performance Standards: A3.1, A3.2, A3.3, A3.4, A3.5, A4.1, A4.2, A4.4, C1.3 –C1.7, C1.11 As agreed by Pre-registration Pharmacist Educational Programme Directors (PRP EPDs) at the regional PRP EPD Network on 25th June 2019

Form found on HEE LaSE OLE (Course Materials Section)

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Mandatory Dispensary Practice Activities

4.

Using the ‘Dispensary Numbers Log’, competently check a minimum of 200 items which must include:

• Discharge items • Controlled drug items • Items that require dose calculation e.g. liquids, low molecular weight heparins etc. • Items with variable dosing regimens e.g. steroids, amiodarone etc.

If possible: o Palliative care items for a syringe pump or anticipatory prescribing o An unlicensed item and/or indication o A private prescription o Specialist items e.g. paediatric, medicine compliance aid, extemporaneous

preparation or reconstitution, addicts, cancer services, clinical trials

This should be reflective of the standards for the National Framework for Accredited Checking Performance Standards: A1.1, A1.7, A2.1, A2.2, A2.3, A3.1, A4.1, A4.2, A4.3, A4.4, B2.4, C1.12, C1.2, C1.3 As agreed by Pre-registration Pharmacist Educational Programme Directors (PRP EPDs) at the regional PRP EPDs Network on 25th June 2019

Guidance on errors: Each pre-registration pharmacist is to gather evidence of a minimum of 200 correctly

dispensed items and 200 correctly checked items. Error severity is listed on the regional ‘Dispensary Number Log’. If a minor error is made, the trainee should reflect on the error. Up to a maximum of 3

minor errors are allowed. If a fourth is made, then the trainee must restart the process and gather evidence of an additional 200 dispensed items and an additional 200 checked items.

If a major error occurs, the trainee must reflect on the error and restart the process and gather evidence of an additional 200 dispensed items and an additional 200 checked items.

If a second major error occurs, the trainee must reflect on the error and restart the process with evidence of a new total of 400 dispensed items and 400 checked items.

If process restart is required, it is recommended that the pre-registration pharmacist takes a break from recording before restarting the process.

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E2. Procurement and Drug Distribution Services An external rotation agreement should be completed if the trainee will be undertaking a rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

Procurement and Drug Distribution Services Essential Learning Outcomes 2.1 To describe the principles, practices and purpose of stock control including:

Re-ordering depleted stock from a variety of suppliers Re-ordering items out of hours and obtaining them without delay Stock rotation and stock checks How to receive incoming stock Communication of issues relating to the stock to the supplier of the product Documentation of delivery notes, invoices

and credit notes Safe use of controlled drugs

2.2 To gain an understanding of NHS supplies and contracts 2.3 To identify appropriate storage conditions for medicines and be aware of the medicine cold

chain. 2.4 To describe the different procedures and methods for the supply of stock items to wards,

departments and clinics when e.g. topping up medicines, using patient’s own drugs, for signed orders, verbal orders and to-follow-items.

2.5 To describe the procedures for handling a drug alert/product recall.

What does this mean during the pre-registration year? All pharmacy staff may find that they need to develop an understanding of the key drug procurement processes and the medicines supply chain in the NHS. With current budgetary pressures in mind, pharmacists are now more frequently asked questions about medicines supply and drug costs. Queries about the comparative costs of medicines, cost pressures (i.e. volume change multiplied by price change), dates of patent expiries of branded medicines, changes in product selection and annual use are becoming common. It is important, for pre-registration pharmacists to appreciate and understand how the flow of medicines works in hospital from purchasing to receipt to dispensing/supply. This will give them a solid baseline understanding for the rest of the pre-registration year and beyond, especially when it comes to performing on-call/emergency/residency duties out of hours once qualified.

Mandatory Training

Cross Reference to 1.14 (Dispensary)

Cross Reference to 1.6 (Dispensary)

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2.6 To comply with legislation and local policy surrounding the dispensing and prescribing of medicines that do not have a product licence, are being used off-label or are used according to protocol if part of a clinical trial.

2.7 To comply with the policy and procedures for ensuring the accountability and security of drugs in transit and the functions and responsibilities of messengers/porters/drivers who transport medicines including controlled drugs.

2.8 To appreciate the legislation around waste management. Suggested Procurement and Distribution Practice Activities

1. Perform competently two stock top-ups including the issue and preparation of stock delivery. Performance Standard: C1.9

2.

Dispose competently of unwanted medicines on two occasions, to include destruction of controlled drugs under supervision. Performance Standards: A1.1, A2.1, A2.2, A2.3, C1.9, C1.11

3. Competently order two items of stock outside the normal top-up system. Performance Standard: C1.9

4. Competently receive and put away two wholesale orders including a fridge item and controlled drug. Performance Standards: A2.1, A2.3, C1.9

5. Follow one drug from purchasing, receipt and to dispensing. Performance Standards: A2.4, C1.9

6.

Deal competently with a minimum of two out-of-stock items from different areas (e.g. ward stock item, patient item). Performance Standards: A1.1, A3.1, A3.2

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E3. Medicines Management Medicines management (MM) is an evidence-based approach to prescribing which balances the safety, tolerability, effectiveness, cost and simplicity of treatments. Medicines management includes optimising medicines through medication review and medicines reconciliation to ensure that patients get the greatest possible benefit out of their medicines in a safe and effective way. Medicines Management consists of:

• Providing cost-savings. • Providing unbiased information about medicines and treatments. • Supporting practitioners and patients to make the best use of their medicines. • Minimising the harm caused by medicines (including reasons for admission). • Developing relevant guidelines to medicines management. • Improving communication between sectors and different institutions to ensure the safe, appropriate

and efficient transfer of care. Shadowing pharmacists or other healthcare staff at the beginning of the year is common, allowing trainees to become familiar with the role. However, trainees will quickly find that they are required to become gradually more involved, carrying out MM roles under supervision or independently if signed off in MM by their practice supervisor. The pre-registration pharmacist will work closely with key pharmacy staff such as clinical pharmacists, pharmacy technicians and pharmacy assistants. .

Medicines Management Essential Learning Outcomes The following MM learning outcomes should be covered during the pre-registration year. Some learning outcomes will specifically apply to time spent on an MM rotation, although it is expected that there will be an overlap with other rotations, for example the dispensary. Tools such as mini-Clinical Exercise (mini-CEX) and Medication Related Consultation Framework (MRCF) can support supervised learning events, patient involvement and generate valuable, valid feedback and evidence of trainee progression.

3.1. To demonstrate a knowledge and understanding of the systems used to deliver medicines to in-patients.

3.2. To perform and document accurate patient medication histories.

What does this mean during the pre-registration year? MM links with the ‘Clinical Pharmacy’ learning (section 4); the following aspects will be covered in this section: Medicines reconciliation.

o Obtaining an up-to-date and accurate medication list, ensuring accurate documentation of source of information and identifying and resolving any discrepancies.

Use of Patient’s Own Drugs (PODs) to support compliance. Supply of medicines. Counselling patients about their medicines. Consulting effectively with patients, carers and the multidisciplinary team.

Mandatory Training

Tools found on HEE LaSE OLE (Course Materials Section)

Cross Reference to

Clinical Pharmacy, Section 4

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3.3. To perform and accurately document medicines reconciliation, including assessment of Patients Own Drugs (PODs) for use

3.4. To communicate effectively with and refer to colleagues and fellow health care professionals to ensure the safe and effective management of patients.

3.5. To provide counselling to patients on newly initiated medicines or those who are unable to administer their medication appropriately.

3.6. To promote evidence-based practice ensuring consideration is given to cost effectiveness and compliance with local formulary requirements, without compromising patient safety.

3.7. To demonstrate how to efficiently prioritise different medicines management related tasks, whilst ensuring patient care is not compromised.

3.8. To communicate with patients and other healthcare staff across the primary/secondary care interface, to ensure the pharmaceutical needs of the patient are appropriately planned for prior to discharge.

Mandatory Medicines Management Practice Activities

1.

Medicines Reconciliation: i. Observe a set number of medicines reconciliations (number determined locally). ii. Undertake and document a set number of medicines reconciliations – these are to be

observed by an appropriately trained pharmacy professional and must be completed on different patients using a variety of sources (number determined locally).

Performance Standards: C2.5, C2.6, B1.1-B1.11 A ‘Standard Process for a Medication Reconciliation’ and a ‘Medicines Reconciliation Record Form’ are available for on the OLE.

2.

POD Assessment: i. Observe a set number of POD assessments (number determined

locally). ii. Undertake and document a set number of POD assessments – these are to be

observed by an appropriately trained pharmacy professional and must be completed on different patients (number determined locally).

Performance Standards: A1.6, A2.1, A2.3, A2.4, A5.7, B1.1, C2.6 A ‘POD and Transcribing for Supply Record Form’ is available on the OLE.

3.

Transcribing for Supply (TfS): i. Observe a set number of TfS orders (number determined locally). ii. Undertake and document a set number of TfS orders – these are to be observed by

an appropriately trained pharmacy professional and must be completed on different patients (number determined locally).

Performance Standards: A1.6, A2.1, A2.3, A2.4, A5.7, B1.1, C2.6 A ‘POD and Transcribing for Supply Record Form’ is available on the OLE.

Form found on HEE LaSE OLE (Course Materials Section)

Form found on HEE LaSE OLE (Course Materials Section)

Form found on HEE LaSE OLE (Course Materials Section)

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Suggested Medicines Management Practice Activities

4. Complete medicines reconciliation quizzes available on the OLE (Course and Programme Support Materials section).

5. Undertake practice OSCE stations (facilitated by the trust) – resources will be supplied directly to trust educational programme directors by HEE LaSE Pharmacy.

6.

Gain experience in counselling patients involving examples of the following devices, dosage forms and/or medications: The number of consultations will be decided between the EPD, ES and Practice Supervisor as part of the training programme. Due to the importance of these areas in hospital pharmacy and in the GPhC registration assessment framework, a working knowledge of all of the above is recommended. This learning could be facilitated using the mini-CEX or MRCF tools. Performance Standards: A1.1, A2.1, A2.2, A2.4, A4.1, B1.1-11, C2.2, C2.9, C2.11.

Complex drugs e.g. warfarin, amiodarone, steroids Creams and ointments Drops; ear, eye and nasal Inhalers Medicines compliance aids e.g. blister packs Oral syringes Pen devices Pessaries Sprays Suppositories

Guidance on errors: No errors are to be observed within these activities. If an error occurs trainees must reflect on the error and restart the activity the error occurred

within.

HEE LaSE OLE

Cross Reference to

Clinical Pharmacy, Section 4

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E4. Clinical Pharmacy Clinical pharmacy has been defined as “promoting rational use of drugs competently and responsibly to patients, taking into account their social, socio-economic, psychological and biological aspects in order to make positive change in their daily lives” (PJ, 2016) and is of great importance in the patient healthcare pathway. In line with the NHS Long Term Plan launched In January 2019, clinical pharmacy services need to evolve beyond institutionalised services into the realm of preventative medicine. Thus, important for both trainees and all involved in their journey to becoming a qualified pharmacist to address this. Shadowing by trainees at the beginning of the year is common, allowing them to become familiar with the role. However, as the year progresses, trainees are required to become more involved, carrying out clinical roles under supervision. Trainees will work closely with pharmacy staff such as clinical pharmacists, pharmacy technicians, pharmacy assistants and pharmacy apprentices (staff of all grades and different specialist knowledge).

An external rotation agreement should be completed if the trainee will be undertaking a clinical rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

What does this mean to a trainee during the pre-registration year? Appropriate, cost-effective medicines management and treatment optimisation are key drivers within the NHS and pharmacists have been identified as a key workforce to enable this in both primary and secondary care and so excellent clinical pharmacy skills are crucial. The clinical pharmacist role is an opportunity to experience learning from inter-professional education. This could include multi-professional simulation exercises and joint teaching with FY1 doctors, nurses and other allied healthcare professionals. The GPhC registration assessment has evolved into a knowledge-application exam rather than a knowledge-recall exam and so clinical pharmacy knowledge and its application is essential.

Mandatory Training

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Clinical Pharmacy Essential Learning Outcomes

The following clinical pharmacy learning outcomes should be achieved during the pre-registration year. Some learning outcomes will specifically apply to time spent on clinical rotations, although it is expected that there will be an overlap with other rotations, for example the dispensary. Tools such as mini-Clinical Exercise (mini-CEX), Case-Based Discussions (CBD) and Medication Related Consultation Framework (MRCF) can support supervised learning events, patient involvement and generate valuable and valid evidence of trainee progression.

4.1. To have a working knowledge of the trust’s clinical pharmacy standards/policy and be able to apply them to clinical practice.

4.2. To have a working knowledge of the BNF, summary of product characteristics (SPC) and hospital clinical resources. Examples of hospital clinical resources include: Medicines Management policy Prescribing guidelines, including local and national (e.g. NICE) Local formulary including process for request / one off supply of non-formulary and

unlicensed drugs Antibiotic guidelines / policies including IV to oral switch policy Relevant clinical protocols Therapeutic Drug Monitoring policies and procedures Renal impairment adjustment guidelines (e.g. Renal Drug Database) Use of named patient & unlicensed drugs Administration of IV drugs (Medusa guidelines) Enteral administration e.g. nasogastric (Drug Administration via Enteral Feeding Tubes) High Cost Drugs (PBR Ex) Safe and secure handling of medicines Ward stock locations Home IV procedures, where available (e.g. OPAT) Self-administration policies, where available (e.g. self-administration of insulin)

4.3. To utilise ward resources and the communication network that exists at ward level to ensure high quality patient care.

4.4. To demonstrate prioritisation of workflow including that of patient medicines management problems (both clinical and non-clinical issues e.g. supply).

4.5. To accurately take and document patient medication histories and reconciliations and communicate/resolve issues identified.

4.6. To identify patients with medication related problems that require the clinical input of a pharmacy team member.

4.7. To safely and effectively screen prescription charts or electronic prescribing to ensure appropriate treatment, including doses, interactions, monitoring and legality and resolve arising issues. Consider the use of an appropriate clinical checklist

4.8. To demonstrate how to utilise supplementary charts or electronic systems (e.g. observation charts, blood glucose monitoring).

4.9. To apply and identify issues with patients’ blood and monitored parameters (e.g. blood pressure, heart rate, temperature, full blood count, blood glucose, renal and hepatic function) to ensure safe and effective treatment.

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Patient Involvement

Patient Involvement

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4.10. To prioritise and resolve any issues arising from screening prescriptions through communication with the multi-disciplinary team

4.11. To communicate effectively (and negotiate as required) with and refer to colleagues and fellow health care professionals to ensure optimal patient management.

4.12. To identify and provide counselling to patients who require help with the administration of their medicines or who have been prescribed new medicines, supported by the MRCF tool - including special formulations, the use of devices, and patient information leaflets.

4.13. To provide both active and passive medicines information, advice and prescription queries to other healthcare professionals (i.e. part of the multidisciplinary team (MDT)) e.g. adverse effects, medication and patient/disease interactions, contra-indications, mechanisms of action, optimum drug formulation, appropriate route of administration, nil-by-mouth patients, and patient’s blood considerations.

4.14. To apply the principles of pharmacokinetics to individualise patient therapy, including formulation changes e.g. changes in bioavailability

4.15. To monitor the outcomes of medication therapy for effectiveness, adverse reactions and interactions.

4.16. To endorse the patient’s inpatient chart (including electronic prescribing if used at trust) as per trust policy.

4.17. To know the process of how to document clinical contributions to care, including recommendations accurately and clearly in the patient’s notes.

4.18. To understand the importance of data protection & confidentiality within daily practice and has received trust/local training.

4.19. To demonstrate awareness of local clinical governance / risk structures, including how to report errors/incidents/poor practice at a local level.

4.20. To be aware of ward-based audits that pharmacy is involved with e.g. medication safety, medication/CD storage, pharmacy interventions.

4.21. To demonstrate awareness of the Drugs & Therapeutics Committee (or equivalent) at the trust and the processes to approve clinical guidelines and medication approval.

4.22. To understand how medications can be supplied to patients without the need for a prescription e.g. Patient Group Directions and emergency supplies

4.23. To demonstrate awareness of local polices relating to safety alerts including: Clozapine administration and monitoring High dose morphine/diamorphine Intrathecal policy IV potassium policy and guidelines Methotrexate administration Use of oral syringes Wrong route chemotherapy

4.24. To demonstrate awareness of high-risk drugs (including total parenteral nutrition, as per safety alerts (4.23) and the GPhC registration assessment framework) and the policies and procedures that are associated with the prescribing, screening, dispensing, checking and administration of them.

4.25. To apply clinical pharmacy skills to different patient groups.

Patient Involvement

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Suggested Clinical Pharmacy Practice Activities for Trainees

These are directly linked to and should provide evidence that clinical objectives have been met.

1.

Have a working knowledge of the Medicines Learning Portal 36Thttp://www.medicineslearningportal.org 36T This on-line resource contains information, scenarios and quizzes on: Clinical Topics Specialist Topics Professional Skills Administration Alternative medicine Calculations Adverse reactions Antibiotics Communication Interactions Excipients Critical evaluation Drug handling Inherited disorders Decision making Children Mental health Managing medicines Renal Palliative care Research Liver Injection compatibility Pregancy Breastfeeding

Performance Standards: A2.1, A2.3, A2.4, A5.1, A5.2, A5.3, A5.4, A5.5

2.

Show involvement of inter-professional education. Suggested methods for this are: a. Shadow one or more of the following healthcare professionals: Dietician Ward Nurse Specialist Nurse e.g. Diabetic Nurse/Macmillan Nurse

Physiotherapist

Learning Disability Link Nurse Practitioner

FY1/FY2 doctor

Non-medical prescriber Occupational Therapist and/or b. Attend multi-professional ward rounds or relevant outpatient clinics involving pharmacy input Performance Standard: A5.3

Inter-professional Education

Cross Reference to Medicines

Information, section 7

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Suggested Clinical Pharmacy Practice Activities for Trainees

3.

To review patients’ therapy/management with reference to national guidance (e.g. NICE, etc.) showing how these link to local trust policy.

The key aim of the task is to ensure: • identification of pharmaceutical problems • prioritisation of pharmaceutical problems • development of an action plan to address or prevent problems • outcome and monitoring (including observations and bloods)

The number of patient reviews should be decided between the trainee and the educational supervisor. These reviews could include: i. a patient in which Therapeutic Drug Monitoring (TDM) is required ii. a patient whose therapy includes parental therapy and its associated pharmaceutical input iii. a patient relating to the therapeutic areas of the GPhC registration assessment framework, the below table provides some examples, not an exhaustive list:

Acute Kidney Injury Gastrointestinal Ulceration Alzheimer’s Hypertension Anaemia Critical Care & High Dependency Angina Infections Antibiotic Stewardship Ischaemic Heart Disease Asthma Learning Difficulties Atrial Fibrillation Chronic Kidney Disease Cardiac Failure Paediatrics (link with section 9) Care of the Frail Pain Control C.O.P.D Palliative Dementia Parkinson's Disease Depression Pre- & Post-Operative Care Diabetes Swallowing Issues / Feeding Tube Epilepsy Thromboembolic Disorders Fluid/Nutrition Thyroid Disorders

Due to the importance of these areas in hospital pharmacy and the GPhC registration assessment framework, a working knowledge of all of the above is recommended. This learning could be facilitated using the mini-CEX, CBD or MRCF tools. Performance Standards: A1.1, A1.3, A1.6, A1.7, A2.1, A2.2, A2.4, A3.1-5, A4.6, A4.7, B1.1, B1.6, C1.2, C1.3, C1.4, C1.5, C2.1, C2.3, C2.6, C2.7, C2.11

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Suggested Clinical Pharmacy Practice Activities for Trainees

4.

Gain experience in counselling patients involving examples of the following devices, dosage forms and/or medications:

Complex drugs e.g. warfarin, DOACs, amiodarone, digoxin, steroids

Oral syringes

Creams and ointments Variety insulin devices Drops; ear, eye and nasal Pessaries Inhalers, spacer devices/volumatics, peak flow meter Sprays Medicines compliance aids e.g. dosette box, blister packs Suppositories

The amount of patient counselling sessions is to be decided between the trainee and the educational supervisor.

Due to the importance of these areas in hospital pharmacy and the GPhC registration assessment framework, a working knowledge of all of the above is recommended. This learning could be facilitated using the mini-CEX or MRCF tools. Performance Standards: A1.1, A2.1, A2.2, A2.4, A4.1, B1.1-11, C2.2, C2.9, C2.11.

5.

Clinically screen (under supervision) a minimum of 100 items for legality and clinical safety. The items must be taken from prescriptions which represent a variety of formats (e.g. inpatient charts, TTOs, outpatient/A&E scripts etc.) and clinical backgrounds. This learning could be facilitated using the mini-CEX, CBD or MRCF tools. Performance Standards: A1.3, A1.6, A1.7, A2.1-4, A3.1-3, A4.1, A4.2, C1.2-5, C1.11, C2.7

6.

Act as a clinical ward pharmacist and provide pharmaceutical patient care (under supervision) in preparation for practice, to consolidate knowledge and skills. This learning could be facilitated using the mini-CEX, CBD or MRCF tools. Performance Standards: A1.1, A1.3, A1.6, A2.4, A3.1, A4.6, C1.2-4, C2.3, C2.6, C2.7

Cross Reference to Medicines

Management, section 3.

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References/Further reading

1.

Hassalin, M.A., Hashmi, F.K. and Al-Tamimi, S.K. (2016) Defining clinical pharmacy: a new paradigm. The Pharmaceutical Journal [Online], 297(7894). Available from: https://www.pharmaceutical-journal.com/opinion/comment/defining-clinical-pharmacy-a-new-paradigm/20201798.article [Accessed 19 February 2019]

2. https://www.nicpld.org/courses/fp/assets/RPS_ClinicalCheckQuickReferenceGuide.pdf

3. NHS Improvements: Patient Safety Alerts https://improvement.nhs.uk/resources/patient-safety-alerts/

4. NHS Improvements: Never Events list2018 https://improvement.nhs.uk/documents/2266/Never_Events_list_2018_FINAL_v5.pdf

Reading Resource

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E5. Community Pharmacy The shared ambition for the community pharmacy sector is to radically enhance and expand the personalised care, support and wellbeing services that they provide by focussing on three key roles for the futureP

1P

as a facilitator of personalised care for people with long-term conditions as a trusted, convenient first port of call for episodic healthcare advice and treatment as a neighbourhood health and wellbeing hub.

P

1 The Community Pharmacy Forward View (2016) The ideal way to achieve the required learning outcomes is through a set, specific external placement in community pharmacy. Some outcomes may be able to be covered through use of an outsourced outpatient pharmacy within a trust. An external placement or rotation can take place at any time during the pre-registration year however in order to actively contribute to clinical care of patients (rather than observing others), consideration should be given to a placement taking place in the latter half of the pre-registration year. An external rotation agreement should be completed before the trainee undertakes their community pharmacy placement. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

Please note, not all community pharmacies provide the same services. This is reflected in the essential versus desirable learning outcomes. The learning outcomes and suggested practice activities should be used to help plan and structure learning and can be tailored to the individual pharmacy environment and trainee. Individualised training plans that are developed and agreed in advance of the placement are recommended.

Additional learning activities 1 and 2 included within this section of the handbook should be undertaken prior to an arranged placement or rotation. Evidence in this area of practice can support demonstration of competence against the following GPhC performance standards: A1.1, A1.2, A1.3, A2.1, A2.2, A2.3, A2.4, A5.1, A5.2, A5.3, A5.4, A5.5, A5.6, A5.7, B1.2, B1.4, B1.5, B1.6, B1.7, B1.8, B1.10, B1.11, B2.5, C1.1, C1.2, C1.3, C1.6, C1.8, C1.10, C1.11, C2.1, C2.2, C2.5, C2.8, C2.9 and C2.11

Community Pharmacy Essential Learning Outcomes

5.1. To identify compliance with the role of the Responsible Pharmacist regulations Performance Standards: A2.2, A2.3, A5.5, A5.6

External e-Learning

Mandatory Training

Cross Reference to 1.2 (Dispensary)

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Community Pharmacy Essential Learning Outcomes 5.2. To describe the process of endorsement, pricing and sorting/submission of prescriptions

according to the NHS Business Services Authority Prescriptions Services department. This may include: Medicinal products Appliances (medical devices) Unlicensed Specials and Imports Special containers i.e. oral liquid antibiotics requiring reconstitution Split pack dispensing Veterinary products

Performance Standards: A2.2, A2.3, A2.4, C1.11, A5.5, A5.6 5.3. To demonstrate ability to receive (including validity and eligibility check) and dispense

prescriptions commonly presented in primary care. To include: Prescriptions issued by a GP or non-medical prescriber Private prescriptions (including payment of) Prescriptions for Schedule 1, 2 or 3 controlled drugs, to include methadone Prescriptions for supply by instalments Prescriptions issued by a dentist Prescriptions issued by a vet

Performance Standards: A1.1, A1.2, A2.1, A2.2, A2.3, A2.4, A5.5, A5.6, B1.2, B1.4, B1.6, B1.8, B1.10, B1.11, C1.1, C1.2, C1.3, C1.6, C1.8, C1.11

5.4. To describe the process involved in dealing with requests for urgent/emergency supply of a Prescription Only Medicine (POM): At the request of a prescriber At the request of a patient or a patient’s representative

Performance Standards: A2.1, A2.2, A2.3, A2.4, B1.2, B1.4, B1.5, B1.6, B1.8, B1.11, C1.10, C1.11

5.5. To describe the process of assessing the suitability of compliance aids i.e. dosette boxes Performance Standards: A2.1, A2.3, B1.4, B1.5, B1.11, C2.2

5.6. To apply consultation skills to all patient encounters in the community pharmacy setting. To include: Issue of medication to patients Gaining an accurate history of medication or health to inform over the counter (OTC) sales Ad-hoc and planned conversations with patients about their health concerns and

medicines Opportunities for health promotion

Performance Standards: A1.1, A1.2, B1.2, B1.4, B1.5, B1.6, B1.7, B1.8, B1.10, B1.11, C2.1, C2.2, C2.5, C2.8, C2.9, C2.11

5.7. To relate the selection of OTC and treatments for minor ailments to treatment guidelines, drug properties and the patient Performance Standards: A2.2, A2.4, A5.5, A5.6, B1.4, B1.5, B1.6, B1.7, B1.8, B1.11, C2.1, C2.2, C2.8, C2.11

5.8. To create and utilise opportunities to promote health and wellbeing to patients e.g. ‘making every contact count’ (MECC), organising or participating in a healthy living pharmacy campaign Performance Standards: A1.1, A1.2, A5.1, A5.2, A5.3, A5.4, A5.5, A5.6, A5.7, B1.2, B1.4, B1.5, B1.6, B1.7, B1.8, B1.10, B1.11, B2.5, C2.2, C2.8, C2.11

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Community Pharmacy Essential Learning Outcomes 5.9. To identify current referral pathways for patients and describe when and how these should be

applied. To include: Referral into community pharmacy service/s e.g. direct to pharmacy referrals from NHS

111 Referral from community pharmacy service/s to another healthcare professional or into

other healthcare services Performance Standards: A1.3, A2.4, B1.4, B1.5, B1.6, B1.7, B1.8, B1.11, B2.5, C2.2, C2.11

5.10. To recognise the role of the community pharmacy within the wider NHS and describe the different services provided by community pharmacies including the placement pharmacy: Essential services Advanced services Enhanced services (locally commissioned services) in response to the needs of the local

population Performance Standards: A2.4, A5.5, A5.6, B2.5

5.11. To describe the roles of different members of the community pharmacy team and how each may contribute to patient care Performance Standards: A1.3, A2.4, B2.5, C2.11

5.12. To explain the legal and professional requirements associated with supplying emergency hormonal contraception Performance Standards: A1.3, A2.2, A2.4, C2.9, C1.10, C2.11

5.13. To explain the principles behind Medicines Use Reviews (MUR), (including Prescription Intervention MUR) and the New Medicines Service (NMS) and be able to promote these services to patients encountered in any health settings Performance Standards: A1.1, A1.2, A2.1, A2.4, A5.5, A5.6, A5.7, B1.4, B1.5, B1.6, B1.8, B1.10, B1.11, C2.2, C2.9, C1.11, C2.11

Community Pharmacy Desirable Learning Outcomes

5.14. To identify the stages involved in successful completion of the New Medicines Service (NMS) Performance Standards: A2.2, A5.7, B1.11, C2.2, C2.11

5.15. To explain the legal and professional requirements associated with supplying medicine by patient group direction Performance Standards: A2.2, A2.3, A2.4

5.16. To explain the concept of Healthy Living Pharmacies (HLP) and the criteria for achieving and maintaining HLP status and quality criteria Performance Standards: C2.2, C2.8, C2.9, C2.11

5.17. To describe the functions of the GPhC Inspectorate Performance Standards: A2.2, C1.11

5.18. To describe the process for managing disposal of unwanted medications in the community setting. To include: Hazardous substances Controlled drugs

Performance Standards: A1.1, A2.1, A2.2, A2.3, C1.11 5.19. To discuss the ways in which community pharmacy can work with other service providers such

as acute trusts and GP practices to minimise the potential for patient safety incidents for example by the use of digital technologies and summary care records Performance Standards: A1.3, A2.4, B1.7, B2.5, B1.11, C2.2, C2.11

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5.20. To examine the roles and contributions of the multidisciplinary health and social care team to community pharmacy services and discuss opportunities for multi-professional working in primary care Performance Standards: A1.3, A2.4, A5.3, B2.5, C2.11

Suggested additional reading/learning activities to support achievement of learning outcomes

1.

Complete relevant sections of the CPPE distance learning programme Effective management of over the counter medications36T NB this learning programme has been developed and provided by NHS Education for Scotland. Users should recognise that this programme will refer to Scottish policies and organisations.

2. Complete relevant sections of the CPPE e-learning course 36TCommon clinical conditions and minor ailments36T

3.

Listen to a pharmacist interview a patient or patient’s representative in response to a request to dispense prescription-only items without a prescription (with the patient’s consent). If the pharmacist decides to supply, dispense the product and make the entry in the register (under supervision of the pharmacist).

4.

Learn how to endorse prescriptions presented to a community pharmacy, how prescriptions are filed and the process by which prescriptions are submitted to the relevant authority for payment.

5. Complete the controlled drug record and the prescription register, under the supervision of a pharmacist

6.

Explore the Consultation Skills (foundation) learning resources on the CPPE gateway page 36Thttps://www.cppe.ac.uk/gateway/consultfound36T and undertake activities relevant to learning needs. As a minimum:

Familiarise yourself with the MRCF (see ‘Test Yourself’) and use the tool for self-assessment and gaining feedback from others on your consultation approach and structure.

7. Complete the 36Tindividual and team skills assessment tool36T from the Implementation guide and Toolkit for 36TMaking Every Contact Count36T

8. Explore the information and resources available on the 36TPSNC website36T. To include: 36TDispensing and Supply36T 36TServices and Commissioning36T

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E6. Aseptic Preparative Services Aseptic Preparative Services or Technical Services prepare and distribute a sterile product that is free from bacteria or other micro-organisms that may cause harm to the patient.

If an aseptic unit is not available at the trust, an understanding of aseptic processes can be achieved by trainees completing practice activities 1 to 3 overleaf. Practice activity 1 may also be of use to those who have an aseptic unit but want to supplement their learning. An external rotation agreement should be completed if the trainee will be undertaking a technical services/aseptic preparative services rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

Aseptic Preparative Services Essential Learning Outcomes

6.1. To understand: i. The outcomes of the Farwell report ii. Quality Assurance of Aseptic Preparation Services standards handbook (5P

thP

edition), also known as the Yellow Guide iii. Rules and Guidance for Pharmaceutical Manufacturers and Distributors iv. MHRA/NPSA Rapid Response Alerts

6.2. To describe the differences between licensed and unlicensed units, including the importance of a Responsible Pharmacist (exemption 10 of the Medicines Act 1968).

6.3. To describe what an external audit is and its applications/plan of action. 6.4. To describe what aseptic technique is and how it is achieved. 6.5. To describe the differences between positive and negative pressure isolators, describe what

products are made within each type of isolator and how this links to the patient. 6.6. To be aware of safe handling of drugs, chemicals and pharmaceutical products aseptically

prepared within the unit, with special emphasis on cytotoxic preparations and ensuring staff safety.

6.7. To be aware of the formulation/types of products compounded within an aseptic unit. 6.8. To state the sources of microbiological contamination, and how these can be controlled.

What does this mean to me during my pre-registration year? Aseptic Preparative Services is an excellent opportunity to gain experience in the handling and use of unfamiliar and hazardous medications. Providing an insight into the different licensing laws and how that affects the pharmacist role and medication production, along with practical experience and improvement of calculation and accuracy skills. Clinical skills will also be developed with increased knowledge of chemotherapy, Centralised Intravenous Additive Services (CIVAS) and/or Total Parenteral Nutrition (TPN). Trainees can use these skills to enable them to describe the clinical application and administration of products prepared and their associated risks when administered to patients, which is useful for future pharmacy careers and for the GPhC registration assessment as the assessment framework lists malignant disease as medium weighting.

Optional Training

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Aseptic Preparative Services Essential Learning Outcomes

6.9. To have knowledge of the environmental monitoring and standards which are required for aseptic manipulation, the methods and equipment used to monitor the clean rooms and the workstations (i.e. laminar flow cabinets, isolators, unit benches etc.)

6.10. To know the importance of documentation in aseptic production, to gain experience in document production and know the consequences of product(s)/drug(s) recall, errors in production, defects and procedure deviations. To include what actions would need to be taken.

6.11. To describe the clinical application and administration of products prepared within the unit and their associated risks when administered to the patient.

Aseptic Preparative Services Desirable Learning Outcomes

6.12. To identify the role and responsibilities of all members of staff working within the unit and work alongside them.

6.13. To observe and/or use equipment in the unit correctly and safely, depending upon the unit’s protocols.

6.14. To understand how to interpret environmental monitoring results and the consequences of any deviations.

6.15. To undertake aseptic manipulations, under supervision (could include bench work, broth tests, ‘dummy’ products).

6.16. To have an understanding of and gain experience in checking products and screening prescriptions

Aseptic Preparative Services Mandatory Practice Activities

1.

Review and complete the relevant sections of the TSET Aseptic Processing Programme It is necessary to register with TSET in order to access this programme.

2.

Review of the NPSA Rapid Response Safety Alert on the administration of vinka alkaloids. https://www.sps.nhs.uk/articles/npsa-alert-vinca-alkaloid-minibags-adult-adolescent-units-2008/

3.

Watch the Department of Health Safe Administration of Intrathecal Chemotherapy; Just an Ordinary Day video. 36Thttps://www.youtube.com/watch?v=oNCObzqSMa0 36T

Aseptic Preparative Services Suggested Practice Activities

Some of the aseptic practice activities can be linked to the GPhC performance standards and identify where aseptic dispensing is particularly well placed to provide good quality evidence of competence. Additional performance standards can be demonstrated as experience allows.

Cross Reference to Section 6b Quality

Assurance and Quality Control

External e-Learning

Reading Resource

Video Resource

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4.

Under supervision, undertake aseptic manipulation, which can include bench work, broth tests and dummy products depending on local procedures. Performance Standards: A2.1, A2.3, A2.4, A4.1, A4.2, A4.5, C1.5, C1.6**, C1.7, C1.11*** **If assembles item themselves. ***If does own documentation.

5.

Assist with the daily and weekly environmental and/or microbiological monitoring that occurs within the aseptic unit. Performance Standards: A2.1, A2.3, A2.4, A4.1, A4.2, A4.5, if competently completes environmental monitoring.

6. Contribute to documentation of aseptically dispensed products Performance Standards: A2.1, A2.3, A2.4, A4.1, A4.2, C1.5, C1.11.

Methods of assessing pre-registration pharmacists in Aseptic Preparative Services Several methods can be used to assess the pre-registration pharmacist in Aseptic Preparative Services, including: Trust specific technical services workbook and associated exercises Discussion with trainee Observation/shadowing Observed practice (and double checked by accredited staff member) Practical activities (including documentation, bench work, etc.)

Table Highlighting the Performance Standards applicable to Aseptic Preparative Services GPhC performance standard Example learning outcomes Assessment of trainee

by practice supervisor A2.1 Carry out tasks effectively

Undertaking aseptic manipulation (under supervision)

Assisting with environmental and/or microbiological monitoring in the aseptic unit

Completion of documentation A2.3 Follow work systems correctly

Undertaking aseptic manipulation (under supervision)

Assisting with environmental and/or microbiological monitoring in the aseptic unit

Completion of documentation A2.4 Use resources effectively

Undertaking aseptic manipulation (under supervision)

Assisting with environmental and/or microbiological monitoring in the aseptic unit

Completion of documentation A4.1 Work to an acceptable standard when preparing products and delivering services

Undertaking aseptic manipulation (under supervision)

Assisting with environmental and/or microbiological monitoring in the aseptic unit

Completion of documentation A4.2 Check your own work effectively

Undertaking aseptic manipulation (under supervision)

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GPhC performance standard Example learning outcomes Assessment of trainee

by practice supervisor Assisting with environmental and/or microbiological monitoring in the aseptic unit

Completion of documentation A4.5 Minimise health and safety risks to yourself and others

Undertaking aseptic manipulation (under supervision)

Assisting with environmental and/or microbiological monitoring in the aseptic unit

C1.5 Perform calculations correctly

Undertaking aseptic manipulation (under supervision)

Completion of documentation C1.6 Assemble the prescription correctly^

Undertaking aseptic manipulation (under supervision) ^If does assemble item themselves.

C1.7 Supply extemporaneously prepared products according to the correct formula

Undertaking aseptic manipulation (under supervision)

C1.11 Correctly process necessary documentation†

Undertaking aseptic manipulation (under supervision) †If does assemble item themselves.

Completion of documentation

Further Aseptic Preparative Services Activities

6.A Large Scale Hospital Pharmaceutical Manufacturing

These learning outcomes may only be covered by spending time at a large-scale hospital pharmaceutical manufacturing unit.

Large Scale Hospital Pharmaceutical Manufacturing Learning Outcomes

To list and describe the differences between the various types of regulatory licences for medicinal products.

6.A.1. To explain the theory and application of the various methods used for terminal sterilisation of pharmaceuticals prepared in the unit, with particular reference to methods of validation, in process monitoring and maintenance of records.

6.A.2. To define the standards required for the environment. 6.A.3. To complete the relevant documentation associated with large-scale pharmaceutical

manufacture and assembly.

Large Scale Hospital Pharmaceutical Manufacturing Practice Activities

1. Witness all administrative procedures associated with the ordering and receipt of raw materials, the preparation of worksheets/labels and the bonding, stock rotation and release of containers, raw materials and finished products.

2. Demonstrate the correct selection equipment used within the unit.

Optional Training

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Performance Standards: A2.1, A2.3, A2.4, A4.1, A4.5 3. Participate in the production/assembly of all product types prepared within the unit.

Performance Standards: A2.1, A2.3, A2.4, A4.1, A4.5, C1.5, C1.11 6.B Quality Control and Quality Assurance

These learning outcomes may only be covered by spending time at a Quality Control and/or Quality Assurance unit.

Quality Control and Quality Assurance Learning Outcomes

6.B.1. To discuss the concept of quality assurance. 6.B.2. To demonstrate the application of the principles of EU Good Manufacturing Practice (GMP)

and of Good Laboratory Practice. 6.B.3. To demonstrate an awareness of safety in the laboratory and pharmacy in general with

knowledge of local and national rules, guidance and legislation. 6.B.4. To demonstrate an application of quality systems e.g. British and International Standards,

Controls Assurance Standards and Health Technical Memorandums. 6.B.5. To demonstrate an awareness of professional standards. 6.B.6. To discuss the role of the Medicines Inspectorate, Office of the Chief Pharmacist, and

Department of Health in hospital pharmacy manufacturing, aseptic dispensing, wholesale dealing and licensing.

6.B.7. To demonstrate knowledge of the local organisation, policies and procedures to ensure a quality service.

6.B.8. To be assessed competent in following all necessary Quality Assurance procedures during the testing of unlicensed medicines and their raw materials.

6.B.9. To identify and discuss factors which affect stability of various formulations. 6.B.10. To state the importance of environmental monitoring and the interpretation of results. 6.B.11. To demonstrate knowledge of the principles of quality control of medical gases (in

accordance with HTM 2022). 6.B.12. To demonstrate an awareness of the Quality Assurance requirements for the management of

unlicensed medicinal products

6.B.13. To discuss the drug alert, complaint and recall procedures. 6.B.14. To demonstrate knowledge of the methods and importance of instrument, method and

process validation. 6.C Radiopharmacy

The radiopharmacy learning outcomes may be covered by spending time at one of the radio pharmacy/nuclear medicine departments within the region. Radiopharmacy Learning Outcomes 6.C.1. To be aware of the principles and procedures of a radiopharmaceutical preparative service.

6.C.2. To identify the role of a pharmacist in nuclear medicine and career opportunities for radiopharmacists in the UK.

Cross Reference to Clinical, section 4.

Optional Training

Optional Training

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6.C.3. To appreciate the professional responsibilities of a radiopharmacist/nuclear medicine scientist.

6.C.4. To discuss the roles of other disciplines in nuclear medicine and their working relationship with the radiopharmacist/nuclear medicine scientist.

Radiopharmacy Practice Activity

1. Spend time observing practice in a nuclear medicine department. Performance Standards: A2.4, A5.1, A5.3

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E7. Medicines Information Services Medicines information (MI) is a clinical service which is aimed at giving up-to-date, accurate, independent, practical advice to healthcare professionals and patients about medicines. All pre-registration pharmacists should have an MI rotation if their trust has an MI centre or if possible, an external placement should be arranged with a neighbouring trust. If no MI rotation is provided, then the MI learning outcomes outlined below can be met in other areas (e.g. clinical, dispensary).

An external rotation agreement should be completed if the trainee will be undertaking a medicines information rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

Medicines Information Services Essential Learning Outcomes

These learning outcomes, derived from the GPhC performance standards, identify where MI is well placed to provide good quality evidence of competence. Pre-registration pharmacists should tackle a range of enquiries whilst in MI including those that are urgent and/or higher risk and participate in other MI activities as appropriate (e.g. publications, formulary). It is recommended trainees answer at least twelve enquiries of at least five distinctly different types.

Trainees should be encouraged to complete self-assessment against the learning outcomes throughout the training, by providing evidence of attainment. They should also work with their practice supervisor to identify outcomes that have not yet been met. Practice supervisors should comment constructively on achievements and ensure that evidence and assessment methods are documented. Both trainee and practice supervisor should sign the final assessment and the trainee be given a copy, as well as the educational supervisor.

Medicines Information Services Mandatory Practice Activity

As part of the training year, trainees will be expected to utilise The Medicines Learning Portal. 36Thttp://www.medicineslearningportal.org 36T A ‘track your progress’ document which outlines the topics trainees should complete as a pre-registration pharmacist is available to use. Trainees should show their MI practice supervisor and educational supervisor their learning progress: 36Thttp://www.medicineslearningportal.org/2016/04/how-to-use-site.html36T

What does this mean to a trainee during the pre-registration year?

All pharmacists involved with patient care need clinical problem-solving skills to deliver medicines optimisation. Medicines information training should follow these key central objectives:

Being able to ask the right questions when problem solving. Using a range of sources about medicines to seek relevant information. Applying professional judgement - being able to collate, synthesise and evaluate information found. Adapting communication techniques to deliver expert advice.

Optional Training

External e-Learning

Form found on HEE LaSE OLE

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GPhC Performance Standard Example Learning Outcomes Trainee Self-assessment Assessment by MI Practice Supervisor

Process A1.6 Makes decisions which demonstrate clear and logical thought

7.1. To demonstrate a systematic and organised approach to information retrieval and problem-solving when completing a range of real clinical enquiries

7.2. To document the enquiry process accurately

Resources A2.4 Uses resources effectively (includes other healthcare workers, workspace, equipment, material and both text-based and electronic references)

7.3. To demonstrate an understanding of the resources available in Medicines Information; to select and use them appropriately, appreciating their strengths and weaknesses

7.4. To listen to and seek advice from MI team

members 7.5. To obtain information from sources outside the MI

centre (e.g. expert colleagues, libraries, pharmaceutical manufacturers)

Problem Identification A3.1 Recognises and defines actual or potential problems (problems include difficulties, minor and serious, needing resolution)

7.6. To undertake enquiries in the MI centre and: a) Interpret the enquirer’s needs suitably when

searching for information and processing it. b) To identify the potential impact on the eventual

answer or other relevant issues.

Evaluating Options A3.2 Identifies workable options to resolve the problem

7.7. To collate the information gathered, and use it to consider the potential answers that might be given

7.8. To evaluate the potential answers by assessing

the evidence, and considering the risks and benefits of each approach

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GPhC Performance Standard Example Learning Outcomes Trainee Self-assessment Assessment by MI Practice Supervisor

Formulating Answer

A3.3 Selects the best solution, based on sound analysis and appropriate evidence Sound analysis will include:

• exploring the strengths and weaknesses of options

• considering barriers to resolving the problem

• discussion with others.

A4.6 Base your actions, advice and decisions on evidence (rather than assumption, anecdote or hearsay)

A4.7 Obtain and process the evidence you need to meet A4.6 (by effectively gathering, reviewing, evaluating and applying research evidence)

C2.1 Provides considered and correct answers to queries, founded on research-based evidence (evidence sources will include clinical textbooks, journals and pharmaceutical company information (paper based or electronic)).

7.9. To compose answers to MI enquiries that demonstrate an understanding of the quality of evidence.

7.10. To demonstrate that the answer supplied is the

best option for the specific scenario by being able to defend it.

7.11. To complete a basic literature evaluation of a

published paper. 7.12. To cite literature references correctly.

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GPhC Performance Standard Example Learning Outcomes Trainee Self-assessment Assessment by MI Practice Supervisor

Communicating Advice

B1.1 Communicate effectively in English (‘effectively’ here means that you are competent enough in English to understand and be understood in writing, on the phone and in person)

7.13. To demonstrate effective telephone skills in gathering and delivering information.

7.14. To compose clear, concise and professional

written communications (email or letter) with good grammar, spelling and punctuation and language appropriate to the enquirer.

Questioning Skills B1.4 Elicit all relevant information by the use of appropriate questions

7.15. To identify all of the information required from an enquirer before starting to answer their question.

7.16. To actively seek more information or clarification

from enquirers when it is not spontaneously forthcoming.

Tailored Approach

B1.11 Provide information and advice appropriate to the needs of the recipient(s) (include individuals, groups and people with particular needs, for example people with diabetes, asthma and so on)

7.17. To translate information into practical advice that is relevant to the clinical situation presented by the enquirer.

7.18. To use and adapt suitable language depending

on the enquirer, and identify the most appropriate communication method (i.e. oral/written/in person)

7.19. To anticipate enquirers’ future needs and identify

additional issues which were not part of the original question, but which will impact on the answer (e.g. interactions as part of adverse drug reaction enquiry).

7.20. To understand the purpose of user satisfaction

surveys in MI.

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GPhC Performance Standard Example Learning Outcomes Trainee Self-assessment Assessment by MI Practice Supervisor

Proactive Information

C2.4 Actively provides information and advice to healthcare professionals

7.21. To provide or contribute to information that anticipates healthcare professionals’ needs about medicines

Representing Own Opinions

B2.2 Present your own ideas and opinions appropriately when speaking and in writing

7.22. To defend a professional opinion when answering an enquiry, whilst demonstrating an appropriate awareness of personal limitations.

Meeting Deadlines

B2.3 Meets commitments made to others within agreed deadlines (this will include giving a clear explanation if you cannot meet a commitment)

7.23. To answer enquiries within the agreed timeframe set by MI practice supervisor and/or enquirer.

7.24. To demonstrate negotiation of deadlines with

enquirers taking into account clinical urgency, departmental workload and enquiry complexity.

7.25. To describe, if appropriate, examples of

communication with enquirers where answers to enquiries couldn’t be done within the agreed timeline, with justification.

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GPhC Performance Standard Example Learning Outcomes Trainee Self-assessment Assessment by MI Practice Supervisor

Adverse Reactions

C2.7 Recognises possible adverse-drug reactions, evaluates risk and takes action* accordingly (* this may include advising and informing the patient or their representative, discussions with colleagues and reporting in line with local and national protocols)

7.26. To receive enquiries which may involve adverse reactions and to ask appropriate questions (e.g. timing of medication and relevant medical history).

7.27. To identify actual or potential adverse drug

reactions and analyse the likelihood, severity, and remedial actions to take.

7.28. To identify when MHRA yellow card reporting is

required and demonstrate reporting process.

Signposting

C2.11 Refer, or direct the person, to a more suitable source of help or information when necessary (e.g. support groups, GP, hospital A&E department)

7.29. To demonstrate appropriate referral of patients or healthcare professionals when a request for advice is outside the competence of the MI team and be able to justify why this was an appropriate course of action.

General Comments: Trainee General Comments: Supervisor

Signed and dated (Trainee): Signed and dated (MI Practice Supervisor):

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E8. Mental Health The ambition of NHS England is that by 2020, mental health is on an equal footing with physical health

(1)P and services are being transformed in support of this.

P

(1)P The Five Year Forward View for Mental Health (2016)

Inevitably trainees will encounter patients with a mental health disorder in any patient setting as one in four adults and one in 10 children experience mental illness. The majority of the learning outcomes in this section could therefore be met as opportunities arise during the training year. However, the ideal way to achieve these is through a set, specific rotation in mental health. This may be within a local mental health trust, with a specialist service linked to the training organisation or within core clinical rotations. Rotation or placement can take place at any time during the pre-registration year and is a local decision. To put trainees in the best position to achieve the given learning outcomes and take advantage of opportunities to apply their clinical knowledge and skills in this environment, practice activities 1 and 2 should be undertaken prior to an arranged placement or rotation. The learning outcomes and suggested practice activities should be used to help plan and structure their learning and can be tailored to the individual placement. Individualised training plans are recommended to be developed and agreed in advance of the placement and resources to enable this are provided.

An external rotation agreement should be completed if the trainee will be undertaking a mental health rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

What does this mean during the pre-registration year? Within the GPhC registration assessment framework, in the context of mental health, trainees can focus on aspects of validating therapeutic approaches and supplying prescribed and over-the-counter medicines, in particular: clinically evaluating the appropriateness of prescribed medicines consulting with patients on the safe and effective use of their medicines and devices providing, monitoring and modifying prescribed treatments to maximize health outcomes supplying medicines safely, efficiently and consistently within legal requirements and best

professional practice

All elements of working with patients and the public will also be applicable within this setting with regards to diagnostic and physiological testing, referral to another healthcare professional and non-prescription treatments. Evidence in this area of practice can support demonstration of competence against most of the GPhC performance standards.

Optional Training

Form found on HEE LaSE OLE

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Mental Health Essential Learning Outcomes

8.1. To describe common psychiatric conditions with respect to diagnosis and symptoms and the potential stigma associated with these conditions

8.2. To discuss medicines commonly used to treat psychiatric conditions, including their indications, side-effects, interactions, monitoring parameters and key counselling points. To include as a minimum: 2 x antidepressants, from different classes 3 x antipsychotics, including clozapine and a depot-preparation Lithium (including required monitoring) Valproate (including use in women of child-bearing potential) 1 x benzodiazepine (including prescribing guidelines) 1 x ‘Z-drug’ 1 x anti-dementia medication 1 x medication used in the treatment of alcohol or substance misuse

8.3. To describe the mental health services provided in the locality of your trust, the therapeutic areas and patient groups covered by them and roles of the different health care professionals that work within them, for example:

adult services child and adolescent services forensic services learning disability services older adult services substance misuse services alcohol eating disorders

8.4. To describe the use and initiation of clozapine, the dedicated patient monitoring system, the implications of not maintaining continuity of treatment and the importance of communication with the prescribing team and supplying pharmacy when moving between healthcare services.

8.5. To describe the risks associated with transfer of care between services for mental health patients and the role of pharmacy professionals in contributing to seamless care.

8.6. To gain an awareness of your obligation as a healthcare professional in the safeguarding of vulnerable adults and children.

8.7. To understand the implementation of the Mental Capacity Act (2005), when it might be applicable to decisions around medicines, the best interest principles and the right of people with capacity to withdraw their consent.

8.8. To describe key areas of the Mental Health Act (MHA 1983), e.g. the difference between patients detained under the Mental Health Act and informal patients and the consent to treatment requirements with regard to prescribing medicines

8.9. To access and discuss local (and national) resources for managing acutely disturbed behaviour e.g. Rapid Tranquilisation Protocols, NICE Guidance on Managing Violence and Aggression, protocols for the management of Behavioural and Psychological Symptoms of Dementia (BPSD).

8.10. To have an awareness of common challenges in relation to medications taken by patients with dementia and associated challenges for their carers.

Mental Health Desirable Learning Outcomes:

8.11. To safely dispense clozapine 8.12. To discuss key medicines management procedures e.g. use of the drug chart, discharge

prescriptions and related procedures, outpatient prescribing etc. 8.13. To discuss the basic principles of community mental health care

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Mental Health Desirable Learning Outcomes: 8.14. To identify patients and to discuss commonly used medicines along with key counselling and

adherence issues, interactions, side effects and monitoring parameters for drugs used in: obsessive compulsive disorders eating disorders trauma-related conditions, such as post-traumatic stress disorder perinatal mental health conditions, including postpartum psychosis childrens’ mental health conditions ADHD and autism spectrum condition substance misuse alcohol use disorders

8.15. To list tools or resources used locally to support the individual needs of patients with dementia and/or learning disabilities to optimise their care i.e. individualised care plans, positive behaviour support, patient-centred care plans, STOMP

The following practice activities link to the learning outcomes listed in this section of the handbook. Mental Health Practice Activities

1.

Complete relevant sections of the following CPPE learning programmes (you may find it helpful to discuss your personal knowledge gaps with your educational supervisor):

a. 36TMental Health Cards 36T, in particular: Card 4 (Mental and Physical Health); Card 7 (Legislation and Safeguarding); Card 8 (Risks and Benefits of Treatment); Card 11 (Transfer of Care) and Card 12 (Consultation Skills)

b. 36TConsulting with People with Mental Health Problems36T and reflect on consultations that you have undertaken in patients with mental health conditions.

Learning Outcomes: 8.1; 8.5; 8.6; 8.7; 8.8; 8.10

2. Explore the Choice and Medication website for the host Mental Health Trust (or Central site)

Learning Outcomes: 8.2; 8.14

3.

Present a Case Based Discussion on a patient with a mental health condition (to the local mental health pharmacy team if on placement). This may be a case study, a profile of a new drug, an interesting paper or any other topical clinical issue e.g. patient profile. Guidance can be given however the pre-registration pharmacist will need to: Prepare, practice and deliver the presentation Respond appropriately to questions Respond to feedback from the team.

Learning Outcomes: 8.1; 8.2 Performance Standards: A.3.1, A.3.2, A.3.3, A.5.1, B.1.1, B.1.10, B.2.2

Cross Reference to

Clinical Pharmacy, Section 4.

External e-Learning

Tools found on HEE LaSE OLE (Course Materials Section)

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Mental Health Practice Activities

4.

Attend a multi-disciplinary team meeting, (where possible accompanying a clinical pharmacist).

Learning Outcomes: 8.3; 8.12

5.

Discuss the medication of at least five patients that have a mental health condition, with a clinical pharmacist. Discussion must include the current treatment and its aims, together with any identified potential problems and suggested solutions.

Learning Outcomes:8.1; 8.2 Performance standards: A.1.6, A.3.1-5, A.4.6, C.1.2-5, C.2.3, C.2.6, C.2.7, C.2.11

6.

Through hands-on experience, monitoring or discussion, fully understand the clozapine dispensing process. To include: checking the prescription accessing the manufacturer’s on-line monitoring system ensuring blood test results are up to date and within accepted clinical parameters

Learning Outcomes: 8.4; 8.5; 8.11 Performance standards: C.1.2-6, C.1.11, C.2.7

7.

Accompany a clinical pharmacist or specialist pharmacy technician when undertaking direct patient counselling and be given the opportunity to directly counsel the patient or directly contribute to the session/s.

Learning Outcomes: 8.1; 8.2;

Performance standards: A1.1, B1.1, B1.4, B1.5, B1.6, B1.7, B1.8, B1.9, B1.10, B1.11, B2.4

8.

Accompany a clinical pharmacist on a teaching or educational visit to a ward or community team (where possible with at least two different care groups) and be given opportunity to directly contribute to the session. Learning Outcomes: 8.3; 8.4; 8.14

Performance standards: A1.1, A2.1, A5.3, B1.1, B1.4, B1.5, B1.6, B1.8, B1.9, B1.10, B1.11, B2.2, B2.4, C2.4

9.

Spend a session/s with specialist pharmacists or other health professionals involved in different areas of mental health care. For example: Community Mental Health Team Crisis Response Team Outpatient Clinic Memory Clinic Electroconvulsive Therapy (ECT) Clinic Specialist Medicines Information Perinatal Mental Health Service

Learning Outcomes: 8.3; 8.4; 8.14

Inter-professional Education

Patient Involvement

Interprofessional Education

Interprofessional Education

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Useful additional reading

1.

Introduction to Mental Health and Therapeutics produced by Midlands Mental Health Clinical Pharmacists Network https://www.cppe.ac.uk/gateway/mentheal

2. Progress in Neurology and Psychiatry, College of Mental Health Pharmacy (CMHP). 36TArticle series on the major psychiatric medication groups36T (free to sign up)

3. Choice and Medication Website (accessed via local Mental Health Trust)

4. Manufacturer’s information on clozapine

5. 36TSafeguarding36T

6. Relevant NICE & British Association of Psychopharmacology (BAP) guidelines e.g. treatment of depression etc.

7. Local Medicine Policies/Guidelines/Procedures e.g. Rapid Tranquilisation policy etc.

8. Journal articles e.g. Clinical Pharmacist and Pharmaceutical Journal CPD articles on Mental Health

9. The Maudsley Prescribing Guidelines in Psychiatry - David Taylor, Carol Paton, Shitij Kapur

10. Psychotropic Drug Directory – Stephen Bazire

11. 36TMental Health Act 36T 36TMental Capacity Act 36T

12. National ‘36TDementia Friends 36T’ Initiative

13. 36TNHS England (STOMP) 36T

14. Recent host-Trust POMH-UK Audit Reports and 36TPrescribing Observatory for Mental Health UK36T charts i.e. antipsychotic dose ready-reckoner

Reading Resource

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E9. Children and Young People In England, Northern Ireland and Wales, a child is someone who has not yet reached their 18th birthday. Once they turn 18, they are legally an adult. Where available, a rotation through a paediatric speciality is encouraged. However, experience in paediatrics can be gained from non-specialist areas such as an outpatient dispensary, community pharmacy and medicines information.

An external rotation agreement should be completed if the trainee will be undertaking a rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

Children and Young People Essential Learning Outcomes 9.1. Explain the differences in drug handling and effect between children and adults. 9.2. Describe the age classifications of children and young people. 9.3. Perform calculations pertaining to children and young people’s medicines. 9.4. Calculate corrected gestational age of neonates, mean weight, body surface area and renal

function for children and young people. 9.5. Discuss the licensing issues pertaining to children and young people’s medicines. 9.6. Explain the increased risk of adverse drug reactions (ADRs) in children and young people

and describe the actions you should take if you suspect an ADR in a child or young person. 9.7. List useful information sources to assist with dealing with enquiries about children and

young people’s medicines. 9.8. Know the most appropriate dose for patients of different ages when recommending common

non-prescription medicines. 9.9. Demonstrate awareness of the principles and practice of safeguarding children and young

people. Children and Young People Desirable Learning Outcomes

9.10. Observe a pharmacist undertaking clinical pharmacy activities within the paediatric and/or neonatal setting.

9.11. Participate in the screening of paediatric and/or neonatal prescriptions. 9.12. Communicate effectively with children and their parents or carers.

Successful completion of the above objectives will provide evidence of the following performance standards: A1.1, A1.3, A2.1, A2.2, A2.4, A3.1-3.5, A5.1-5.7, B1.1-1.12, B2.5, C1.4, C1.5, C2.1-2.8

What does this mean during the pre-registration year? Approximately 20% of the UK population are under the age of 16 so pharmacists will encounter this patient group during their practice. Paediatric patients account for approximately 20% of questions asked in the GPhC registration assessment (including paediatric calculations).

Optional Training

Form found on HEE LaSE OLE

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Children and Young People Practice Activities

Self-directed e-learning courses are available, and it is advisable that all pre-registration pharmacists complete these at some point during the pre-registration year. Assessments within these courses are reflective of the standard required for the GPhC registration assessment.

1.

Desirable Paediatric prescribing principles – online learning (1.5 hours) Royal College of Paediatrics and Child Health https://www.rcpch.ac.uk/resources/paediatric-prescribing-principles-online-learning

2. Desirable Consulting with children and young people (2.5 hours). 36Thttps://www.cppe.ac.uk/programmes/l/consultcyp-e-0136T

3.

Desirable The ‘Me First’ Communication Tool developed in partnership with children, young people (CYP) and healthcare professionals. It highlights the key steps to guide shared decision making and encourage CYP centred communication. https://www.mefirst.org.uk/the-model/

4.

Desirable Child Health https://www.cppe.ac.uk/programmes/l/childhlth-e-03 36T This resource contains 50 hours of online learning however there is no requirement to complete the assessments or all modules. Paediatric rotation practice supervisors or pharmacists with an interest in paediatrics will be able to advise on the most appropriate sections to complete for individual trainees.

5.

Desirable Foundation Paediatric Workbook produced by the Neonatal & Paediatric Pharmacists Group (NPPG) This workbook can be accessed by practice supervisors who are members of the NPPG http://nppg.org.uk/home/education-and-training/

External e-Learning

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E10. NHS Commissioning This type of rotation is designed to provide an insight into medicines optimisation in NHS Clinical Commissioning Groups (CCG) or Commissioning Support Organisations/Units (CSO/U) across the health economy.

An external rotation agreement should be completed if the trainee will be undertaking a rotation outside of the employing organisation. The purpose of this agreement is to ensure that HEE commissioned pre-registration pharmacists within London, Kent, Surrey and Sussex receive the highest possible quality of training and experience, during a rotation within another organisation with which they are not employed.

NHS Commissioning Learning Outcomes

10.1. To identify and describe the different roles, responsibilities and current commissioning priorities of local medicines management teams.

10.2. To understand the role of a practice pharmacist working in primary care and how they work together in a multidisciplinary team.

10.3. To describe the function of the medicines management team in the CCG/CSO as a whole and the reporting structure.

10.4. To describe the structure and function of the NHS and how healthcare is both commissioned and provided.

10.5. To understand the differences between commissioning, commissioning support and provider organisations.

10.6. To identify how the medicines management team influences prescribing decisions and promotes evidence-based practice.

10.7. To understand the use of ePACT2 prescribing data in a local context considering cost, quality, safety, and patient factors.

NHS Commissioning Practice Activities

The list of practice activities given below are suggestions and may be modified locally by the practice supervisor providing that the learning outcomes are met.

What does this mean during the pre-registration year? In terms of the learning experience, it is not intended to be exhaustive but should provide a short insight into the role of primary care pharmacists and other individuals in CSOs or CCGs. Trainees should actively be engaged in tasks during their experience, rather than just observing pharmacists or reading information. The rotation should ideally be completed after the trainee has undertaken their medicines information training (if offered). A suggested duration for the rotation is over a two-week period. Pre-registration pharmacists should contact their rotation practice supervisor prior to starting this rotation to discuss logistics, pre-reading and the rotation itself.

Optional Training

Form found on HEE LaSE OLE

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NHS Commissioning Practice Activities

1.

Prescribing data analysis Analyse ePACT2 prescribing data and interpret the data, taking into account both national and local guidance and consider local demographics in establishing why a variation may exist between local and national prescribing data. Guidance should be provided on the task and findings communicated to the team in either verbal or written form. Suggested examples could include antibiotic prescribing, NSAIDs etc. Performance standards: A2.1, A2.3, A2.4, A3.3, B1.1, B2.2, B2.3, B2.5

2.

Medicines queries Draft a response to a request for medicines related advice e.g. to an individual prescriber, practice nurse or a community pharmacist reflecting on the difference in process and outcome given from the perspective of a medicines information service. Frequently occurring enquiries that have previously been received could be provided to trainees to respond to. Performance standards: A2.1, A2.3, A2.4, A3.3, B1.1, B2.2, B2.3, B2.5

3.

Multidisciplinary team working Observe pharmacists working with other healthcare professionals in primary care, intermediate care and within the CSO/CCG. Examples include: GP Practice nurse Finance staff Non-medical prescriber Reception staff in a GP practice Other allied healthcare professionals

Trainees should also understand the roles played by the above members of the multidisciplinary team. Performance Standards: A1.1, A1.4, A1.5, B1.2

4.

Local decision making Review a case in which local decision making is required to approve funding of a particular medicine. This could be a formulary decision that needs to be agreed or an individual request for a specialist drug. Ideally it would be beneficial if this was a current case under review to give an insight into the approval process. If this is not feasible a past case can be used as a practice example. Trainees should be provided with the case being presented, given time to study it and undertake further investigation to come to a decision of whether this drug would be approved for funding and explain the rationale for their decision. Performance standards: A2.1, A2.3, A2.4, A3.3, B1.1, B2.2, B2.3, B2.5

5.

Deprescribing and managing polypharmacy Accompany a medicines optimisation or practice pharmacist to review a polypharmacy/frail patient and present recommendations as a case study. Performance standards: C2.3, C2.4, C2.7

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E11. Quality Improvement Projects What is quality improvement (QI)? QI describes a commitment to continuously improving the quality of healthcare, focusing on the preferences and needs of the people who use services. It encompasses: A set of values (which include a commitment to self-reflection, shared learning, the use of theory,

partnership working, leadership and an understanding of context) A set of methods (which include measurement, understanding variation, cyclical change,

benchmarking and a set of tools and techniques) (1) P

The provision of recommendation(s). QI differs from an audit in that audits are often more clinically orientated whilst QI on the other hand can focus on more holistic issues as well as have shorter time spans allowing improvements to be incorporated quicker.

Quality Improvement Projects Learning Objectives

11.1. To explore the different strategy options that can be utilised to drive quality improvement and to select a suitable process to achieve this in the respective field of practice.

11.2. To contribute to the quality of care provided to patients within the employing organisation.

11.3. To review a topic of relevance to the employing organisation’s local priorities and objectives.

11.4. To contribute to the pool of quality improvement projects conducted within the employing organisation and within the region.

11.5. To gain an understanding of the local trust agreement processes required before embarking on an audit or other quality improvement process and identify the specialist resources and support available outside the pharmacy department to support with these projects.

11.6. To explore opportunities for inter-professional working by considering working on joint projects with e.g. Foundation Doctors

What does this mean during the pre-registration year? All trainees must “Have successfully engaged in a quality improvement process. This could be achieved for example by carrying out a small, planned audit assignment or completing a PDSA cycle” (GPhC Performance Standard A4.8). The PDSA cycle is shorthand for testing a change by: developing a plan to test the change (Plan) carrying out the test (Do) observing and learning from the consequences (Study) and determining what modifications should be made to the test (Act). (2)

Within the GPhC registration assessment framework, in the context of maintaining and improving professional performance, trainees should consider how pharmacists participate in audit and in implementing recommendations as well as understanding the purpose of audit and principles of both audit procedures and change management. In line with the NHS constitution and values, it is recommended that trainees particularly focus on projects that involve patient engagement.

Optional Training

Inter-professional Education

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Quality Improvement Projects Learning Objectives

11.7. To develop a culture for publication and sharing of best practice by scoping opportunities to present findings to a wider audience to allow the profile of pharmacy to be raised within the employing organisation and to develop skills such as how to submit an abstract or poster for presentation to an appropriate forum.

11.8. To develop skills in methodologies relative to the process chosen such as process mapping, evaluation of an evidence base, project planning, time management, data collection tool design, data collection, data analysis and interpretation, report writing, etc.

Suggested Project Time Plan

By September

Trainees should arrange to meet with the Trust Audit Lead or a member of their team to discuss and confirm the wider trust processes for completing quality improvement projects including: o identifying support available, o any internal submission opportunities, o proposal submission processes, o ethics requirements o write up format o current trust-wide or local pharmacy priorities for review

Agree a topic/Quality Improvement question and required outcomes. Undertake pre-rotation background work to ensure that the QI project is completed in

good time (this may / could extend beyond the actual rotation and should be planned accordingly)

Confirm the name of the project supervisor and schedule meetings for the duration of the project.

Engage with others within the trust working on the same or similar Quality Improvement question. It may sometimes be necessary to liaise with colleagues working across different sites within the same trust and the onus is on the trainee to ensure this is done

Complete a literature search to confirm if similar projects have been completed and determine lessons learnt from these.

By October

Chase up any trust approval if this is still pending and make any changes to the proposal/plan.

If collecting data, develop a data collection tool and pilot this before official data collection to ensure it is fit for purpose.

By January

Identify any external submission opportunities, respective deadlines and submission requirements – this could be in the form of a poster, abstract or presentation. Attention should be paid to word count, formatting etc. as these vary between different organisations. Examples of pharmacy specific opportunities include UKCPA, Clinical Pharmacy Congress, RPS, Pharmacy Management Academy events as well as a whole host of specialist groups and other healthcare conferences etc.

By March Aim to have all the project work completed ready for write up

By April Aim to have completed the write up ensuring trust guidelines are followed Communicate findings within the trust

Quality Improvement Projects Practice Activity

Further resources relating to quality improvement projects are available on the On-line Learning Environment HEE LaSE OLE

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References

1. Quality Improvement for General Practice - 0TA guide for GPs and the whole practice team - 07 September 2015 - Publisher: Royal College of General Practitioners (RCGP)

2. Institute for healthcare improvement (http://www.ihi.org)

3. NHS Improvement Resources (http://improvement.nhs.uk/resources/)

4. Collaborations for Leadership in Applied Health Research and Care (http://clahrcprojects.co.uk)

Reading Resource

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E12. Assessment and Feedback Everyone in the pharmacy team plays a key role in providing safe and effective care. Supporting the development of the pharmacy team is a key role of the pharmacist to achieve this. The learning outcomes within the GPhC standards for the initial education and training of pharmacists state that a pre-registration pharmacist must: contribute to the education and training of other members of the team, including peer review and

assessment. show how to contribute to the development of other members of the team through coaching and

feedback. work effectively within teams to ensure that safe and effective systems are being followed. supervise others involved in service delivery. identify, report and prevent errors and unsafe practice contribute to identifying the learning and development needs of team members. contribute to the development and support of individuals and teams.

Assessment and Feedback Practice Activity

Read the section on Assessment and Feedback on the on-line learning environment to assist with skills development.

Optional Training

What does this mean during the pre-registration year? Trainees will need to demonstrate competence in the following GPhC performance standards: B2.8 Supervise others in an appropriate manner to ensure that agreed outcomes are

achieved B2.9 Use your knowledge and skills effectively when helping others learn

HEE LaSE OLE