EDUCATION
WITH A PROJECTED SHORTFALL OF GPS IN SCOTLAND OF 740 BY 2020, THERE’S A NEED TO LOOK CREATIVELY AT HOW OTHER PROFESSIONAL GROUPS CAN OFFER MORE SUPPORT IN PRIMARY CARE1
. FIONA REID
FFRPS, PRINCIPAL LEAD (PRESCRIBING & CLINICAL SKILLS) AT NES SCOTLAND LOOKS AT THE CHALLENGES BEING FACED…
PHARMACY IN GENERAL PRACTICE
The NHS Education for Scotland (NES) National Learning Pathway is one of the ways in which pharmacy staff are being supported to take advantage of the opportunities this presents for them, and their careers.
THE CHALLENGE The Scottish Government provided £16.2million for 140 clinical pharmacists to be employed within General Practices from 2015-18. The vision is that these pharmacists will be Independent Prescribers (IP) with advanced clinical skills and will work directly with practices to support the care of patients with long-term conditions; freeing GP time to spend with other patients.2
In practice, some Health Boards have used the funding to employ pharmacy technicians and only about 30 per cent of the new pharmacists employed in the roles are IPs, most with limited clinical skills training and little experience of patient-facing work in this setting. Roles and responsibilities also vary between different Health Boards.
It was important that these new practitioners could access consistent but flexible training to meet their learning needs.
THE LEARNING PATHWAY DEVELOPMENT NES Pharmacy, worked with various partners including Directors of Pharmacy, the Royal Pharmaceutical Society (RPS) and the Royal College of General Practitioners (RCGP) to support development of the Pathway. Two experienced clinical pharmacists working in general practice and a GP were commissioned by NES who also
linked with educational colleagues in other parts of the UK to share expertise and resources.
The learning pathway consists of four areas:
• Fundamentals of GP practice (thirteen-module e-learning programme)
• Therapeutic Modules (cardiovascular, diabetes, pain, respiratory)
• A series of national bootcamps (totalling four days and based on training needs)
• A competency and capability framework for Advanced Practice Pharmacists (available on the new NES e-portfolio).
FUNDAMENTALS OF GP PRACTICE These e-learning modules are available for any pharmacy practitioners working in general practice and are completed according to agreed identified learning needs. At the time of writing, 450 practitioners have registered for this training, where a discussion forum is supported by an experienced GP pharmacist.
THERAPEUTIC MODULES E-learning modules covering common chronic conditions have been made available to the pharmacists. This requirement was identified since many of these practitioners do not have postgraduate clinical pharmacy qualifications.
BOOTCAMPS
Learning pathway for pharmacists animation (
https://vimeo.com/235550382)
8 - SCOTTISH PHARMACIST
Each cohort of pharmacists and pharmacy technicians attend a series of three national bootcamps. The first is a residential event with two follow-up days at six and 18 months. The bootcamp purpose is to share learning and experiences across Scotland, to encourage national networking and to deliver non-
Small group discussion at a bootcamp experiential education and training.
The tutors are multi-professional and include GPs, practice managers, advanced nurse practitioners and experienced GP pharmacists and pharmacy technicians. Content, delivered in small groups, includes telephone consultations, polypharmacy and medication review, Practice Based Small Group Learning and interpretation of blood tests. Delegate interaction is facilitated via requirements to bring pre-prepared material for discussion in small groups. Presentations are given by the Chief Pharmaceutical Officer, representatives from the RCGP and RPS and patient representation via the ALLIANCE.
ADVANCED COMPETENCY & CAPABILITY FRAMEWORK A competency and capability framework has been developed based on the RPS Advanced Practice Framework in collaboration with leading GP pharmacists, GPs, RPS and RCGP. The framework was launched in September 2016 and is being piloted with the initial three cohorts of pharmacists. An e-portfolio has been developed to facilitate this.
A competency framework will be launched for pharmacy technicians working in general practice in early 2018.
NES COMPETENCY AND CAPABILITY FRAMEWORK
Other Aspects
It was identified that those pharmacists who were currently not IPs required training in core clinical assessment and patient-centred consultation skills. Bespoke courses have been commissioned from the award-winning NES Pharmacy collaborative of Medical, Nursing and Pharmacy Schools. This included bespoke training for pharmacists working in Shetland, Orkney and the Western Isles. Pharmacists are also fast-tracked onto NES-commissioned IP courses.
Implementation Three residential bootcamps have run since September 2016 with a total of
134 pharmacists and 27 pharmacy technicians attending. Follow-up days have also been held for two cohorts and more events are planned for early 2018. Evaluation from these events has been extremely positive and the educational delivery of these, together with the other elements of the pathway, are being formally evaluated.
All the pharmacists have accessed the competency framework through the e-portfolio and NES is working closely with all Health Boards to support practitioner progress through the framework.
ONGOING CHALLENGES AND FUTURE PLANS
One of the issues with this development from an educational viewpoint is the lack of resource for both clinical and educational supervision (tutoring) for the pharmacists. Some Health Boards have built the requirement for some clinical supervision into negotiations with the General Practices where the pharmacists have been sited however this is extremely variable. Some pharmacists do have educational supervision in place however again this varies greatly.
NES Pharmacy are currently exploring training requirements for educational/ clinical supervision with colleagues within NES Medicine, aligned to that for GP training. We are also looking to develop a virtual network for the practitioners progressing through the pathway so that the national conversation and sharing of developments in practice can continue. •
REFERENCES
1. Royal College of General Practitioners. A blueprint for Scottish general practice - A strategy for a safe, secure and strong general practice in Scotland (2015) http://
www.rcgp.org.uk/policy/workforce. aspx
2.
http://www.sehd.scot.nhs.uk/pca/ PCA2015(P)16.pdf
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