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PDA express concerns about the GPhC deregulation of independent prescriber training

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  • PDA express concerns about the GPhC deregulation of independent prescriber training

    The PDA has taken issue with the GPhC’s proposals for pharmacist independent prescriber training, which includes the removal of the two-year-experience safety net, the absence of a syllabus and seemingly the intention to allow pharmacy technicians to design and deliver training courses.

    Fri 8th June 2018 The PDA

    The PDA has taken issue with the GPhC’s proposals for pharmacist independent prescriber training, which includes the removal of the two-year-experience safety net, the absence of a syllabus and seemingly the intention to allow pharmacy technicians to design and deliver training courses. The PDA also took the view that “in some cases, the wording of the outcomes is unclear and/or the levels of outcome are inappropriate” and additional outcomes were needed.

    The GPhC said that the removal of the two-year experience requirement was supported by course providers, but the PDA pointed out the apparent issues with the GPhC’s reasoning and its seemingly heavy reliance upon those views to inform its approach. In PDA’s response they questioned why the GPhC had not sought to hold course providers to account for the apparent failure to uphold GPhC course entry standards (outlined in the consultation), and why it was now proposing to trust the same providers to admit candidates only on the appropriateness of the applicant’s experience – the requirement they said they had hitherto failed to uphold. The PDA feels it would not bestow confidence in the rigour of the process and suggests there is significant risk that prospective candidates will be permitted to train, who are not ready to do so.

    The PDA response asks the GPhC to explain under what circumstances it considers pharmacists not to be “in good standing” with it – a term used within the proposals.

    Responding to the GPhC’s proposals, the PDA said:
    To become a GP requires a 5-year medical degree, 2 years’ foundation training (during which time doctors can prescribe, but remain under clinical supervision and work in a highly clinical hospital environment) and then 3 years of training beyond that to become a GP (normally 18 months in an approved training practice and 18 months in approved hospital posts). This route ensures thorough training before a doctor could work as a GP assessing and diagnosing patients with varied conditions, many of which will require specialist referral.

    Though it would not need to be as rigorous, the PDA would like to see a similar development pathway which properly prepares pharmacists for a role in prescribing. This would start at undergraduate level and continue with appropriate post-graduate training, potentially involving a mandatory period of work in a hospital environment as part of the training.”

    It continued:
    “The GPhC’s proposals in this consultation would allow a newly-qualified pharmacist to become an independent generalist prescriber (supervised by another person who may only just have qualified as a generalist prescriber) and work in a GP practice.

    In our view this would deregulate standards, diminish professionalism and pose unnecessary risks to patients, if implemented. The proposal is antithetic to the approach we believe is necessary for the development of the profession. We are concerned that cost pressures in the NHS may be driving organisations such as the GPhC to deregulate and reduce standards; it is not the role of the pharmacy regulator to manage NHS budgets. Driven (we believe) by similar pressures, we have observed other policy approaches within pharmacy which appear to conflate the role of the pharmacist with that of the GP. This ultimately comes at the expense of patients and a safe and effective long-term healthcare strategy.”

    https://www.the-pda.org/pda-expresse...iber-training/

  • #2
    For those of you that are not are aware, the GPhC is thinking of removing the 2 years requirement and also the requirement that the DMP has to be a G.P,.Therefore assuming this consultation bears fruit, one could get an experienced IP pharmacist to supervise them during the IP course.

    Anyway, regarding this article, I have to say I diasgree with the PDA. I agree 1000000% with the view point of the PDA that we need a more structured and intense training program for pharmacist to become IPs so they can be competent in prescribing for more clinical conditions. But I don't think th PDA should be fighting this move by GPhC... because it's not like IP pharmacists are currently prescribing willy-nilly. All IP pharmacists that I have met are actually very careful in what they prescribe(much more so than most GPs I've seen!), and as an up and coming junior pharmacist, I will definitely not be more careless when prescribing just because I become an IP sooner than others. In the end, we all have to prescribe within our level of competence anyway.

    I am curious to read the opinion of others here on this topic

    Comment


    • #3
      There is no substitute for experience. I support the two year requirement. I learnt to drive so that I could hire a car on our honeymoon. I was not allowed to hire a car until I had held a licence for a year. As there was no car in the family, this meant I had no experience apart from the test when I hired a car a year or so later. I took a wrong turning going into Ventnor IOW and did not feel able to do a three point turn in the main road which was narrow. Then came a bus and it clipped my wing. Fortunately the car we hired was prewar and a touch of paint was sufficient.
      I qualified during National Service and it could have been that I had no experience after qualifying for two years. However, I was lucky in that my locums were at very quiet pharmacies.
      johnep

      Comment


      • #4
        Totally with the PDA on this one. In order to try and protect patients a more not less rigorous system should be in place. As stated by the PDA the medics have undergone many more years of training. I know that the medics should diagnose and then someone suitably trained can carry on the treatment but let’s not dumb down the system so that people do not have confidence in IP prescribers. My pharmacist friend was seeing her GP re severe cold sores. The pharmacist IP trainee with the GP did not even know what the virus was! GP was not impressed , neither was my mate. If this is the level of people training to be IPs then count me out I’m sorry to say.

        Comment


        • #5
          IMHO the proposed system will rely on the fact that most of those who attend a GPs surgery have worries about their health, rather than serious health issues, and that whatever they are given will sort them out after a few days, which is the time the body will take to heal itself.

          Those few who attend the GPs with serious issues will usually be referred for tests, so it is quite possible that a triage screening which requires little additional training for a pharmacist under supervision will be fine.

          Of course the system will betray some unfortunate souls who will be overlooked, misdiagnosed and ignored. That is the price of economy.
          ....just my opinion

          Comment


          • #6
            The course isn’t about clinical training. It is about being able to make difficult decisions and standing by it. This can only come with experience.

            There would have been no way that I would have had the confidence nor the aptitude to have become a prescriber in the first two years of my qualification. Those two years were about trying to ground myself in the basics.

            But ... that was me and I am sure that there are others out there who could benefit. However, it was those two years that built me.

            Comment


            • #7
              A lot of people talk about going into IP and worries about it being saturated. I'm cynical that the PDA are just wanting to keep things cushy and wages high and stop the floodgates.

              There should be a syllabus, but the GP DMP requirement merely prevents many pharmacists even attempting this course. It's corporate pharmacy written all over it, don't complete your training unless the local lord gives you permission to leave the village i.e. dispensary and pursue something else.

              Comment


              • #8
                In fairness I do think the 2 year requirement is fair. Most newly qualified pharmacists are like rabbits in headlights.

                I take no issue with a pre-reg in GP classifying that year as one years experience though so there's room in the regulations for movement.

                It only makes sense for pharmacists to train pharmacists. They'll have more focus on the pharmacology and regulatory side which is the unique offering we bring into general practice. As people have said the majority of diagnostics are in the hands of the GP and pharmacists take care of the maintenance side.
                I remember when a blog was an individual boot.

                Comment


                • #9
                  A competence assessment before starting the training would be a sufficient gateway.
                  It would also let candidates know the standards required.
                  Dealing with people as patients is slightly different from dealing with them as customers too.
                  47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
                  2018 AD : Modern Man : I shopped, I clicked, I collected.
                  How times change.

                  If you find you have read something that has upset or offended you an anyway please unread it at once.

                  Comment


                  • #10
                    Originally posted by Pharmanaut View Post
                    A competence assessment before starting the training would be a sufficient gateway.
                    It would also let candidates know the standards required.
                    Dealing with people as patients is slightly different from dealing with them as customers too.
                    Half the issue with competency assessments is that if we do them to death we just end up with pharmacists who are good at competency assessments. There's no substitute for experience. All pre-reg's are competency assessed and still frequently look in a state of shock for their first couple of months while holding onto the BNF with a death grip.

                    A standardised curriculum would allow potential candidates the areas in which to study and I completely agree about consultation skills being related to, but not the same as, customer relations skills.
                    I remember when a blog was an individual boot.

                    Comment


                    • #11
                      Originally posted by Nimrec View Post

                      Half the issue with competency assessments is that if we do them to death we just end up with pharmacists who are good at competency assessments. There's no substitute for experience. All pre-reg's are competency assessed and still frequently look in a state of shock for their first couple of months while holding onto the BNF with a death grip.

                      A standardised curriculum would allow potential candidates the areas in which to study and I completely agree about consultation skills being related to, but not the same as, customer relations skills.
                      Good point.
                      I've only succeeded at interviews being the only candidate...
                      47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
                      2018 AD : Modern Man : I shopped, I clicked, I collected.
                      How times change.

                      If you find you have read something that has upset or offended you an anyway please unread it at once.

                      Comment


                      • #12
                        Originally posted by Nimrec View Post

                        Half the issue with competency assessments is that if we do them to death we just end up with pharmacists who are good at competency assessments. There's no substitute for experience. All pre-reg's are competency assessed and still frequently look in a state of shock for their first couple of months while holding onto the BNF with a death grip.

                        A standardised curriculum would allow potential candidates the areas in which to study and I completely agree about consultation skills being related to, but not the same as, customer relations skills.
                        Competency assessments are just a corporate dream. I just don't see why anyone would believe in them so strongly.

                        Comment


                        • #13
                          Originally posted by mcitr View Post

                          Competency assessments are just a corporate dream. I just don't see why anyone would believe in them so strongly.
                          I think they have their place. At least they ensure pre-reg pharmacists have to evidence a range of experiences. It mitigates at least some of the potential for them to be used as a free MDS robot for a year.
                          I remember when a blog was an individual boot.

                          Comment


                          • #14
                            Does anyone know what became of this GPhC consultation? I know they consulted on this issue regarding the change in regulation for IP but nothing is said regarding whether they're going through with it or not.

                            Comment


                            • #15
                              I must admit that I think it’s a stupid idea to let newly qualified pharmacists prescribe under any circumstances. They simply don’t have the experience, knowledge or skills to do. I base that on having worked with numerous pre reg students and newly qualified pharmacists. They are like rabbits in the headlights, many of them can’t even dispense to any kind of standard, they walk away from work if they don’t know how to complete it, and some of them are too precious to ask questions of those they work with including dispensers and techs, and too frightened of displaying a lack of knowledge to the pharmacists.

                              The only way that I could see it work would be to compress the theoretical knowledge of the degree into a continuous three year course, without the three months vacation, then use the final two years on practical experience spent between hospital and community. There should be at least nine months in placements during year four and six months in year five. If you want to train them as IPs then it should be through a national standard of training supported through their universities and mentored through a combination of medical and pharmacy tutors.

                              With regard to being trained by others, including technicians, I don’t have any problem with it. My job includes training pre reg pharmacists to dispense and check and I feel that I do a better job of it than a pharmacist who might rarely dispense. After all, who would you rather be trained by? Someone who does the job rarely, or someone who does that job for eight hours a hours a day and who knows it upside down and back to front?

                              Do I think that it’s a good idea to even have IPs or Nurse Consultants? Hmm... my recent experiences suggests not. My mother has had five reminders to go for a blood test, even though she went to the first one. As there are discrepancies on the blood test, she is just being called in for another test repeatedly rather than being referred to a doctor, who could decide is this a real problem, or can we just let it go?

                              The more annoying incidence was when grandad was required to go to an appointment. Despite informing reception that he must see a doctor he was given an appointment with an IP/nurse consultant. I don’t which as they don’t bother to tell us who these people are. It could be the gardener for all we know. Anyway, whatever this person was the first thing they said to grandad was that he was too complicated and should see a doctor. Having pointed out that he was supposed to be seeing a doctor they asked him to wait until the doctor was available to see him. He sat for 45 minutes waiting for that appointment. Is that anyway to treat a nearly 90 year old man? They were told that he had to see the doctor, and totally ignored that information, and then made him sit for nearly an hour before he saw the doctor. It’s madness.

                              Comment

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