overview of Non-medical Prescribing Practice Assessment Document video transcript

Hello, my name's Jill Gould. I'm the programme leader for non-medical prescribing at the University of Derby. The purpose of this video is to provide an overview of the practice assessment document. We're using the example of the document for nurses.

But the same structure will be found throughout the documents for pharmacists or allied health professionals. The only thing that's different through the documents is the terminology of the assessors. So, for example, for nurses, it's a practice assessor or practice supervisor.

Whereas for pharmacists, it's designated prescribing practitioner. There are a few other differences that I'll highlight throughout. The purpose of this document is to provide a structured way for you to evidence your judgements as to whether the practice of the prescribing student is safe and effective by the end of the course.

So the whole purpose, the whole structure is to lead you to being able to make those judgements and provide evidence for those judgements. Just to mention for any of the students, the DPP, DMP, whoever practice assessor in this case, the name will appear there for nurses.

They also must have a practice supervisor. However, for any of the professions, there can be additional supervisors that help with supplying some of the testimonies if needed or observed consultations or generally just helping to assess the competencies in practice.

Each of the students has got an academic assessor or a personal academic tutor, and that should that person should be named in their in their practice assessment document with contact details if it's a midwife. There is an expectation that the student and academic assessor, midwife, academic assessor has met within the first two weeks of the course start.

So that's just a separate requirement for midwives. This is a notation of some of the abbreviations used through out this document, as mentioned, academic assessor. In the other ones it will be practice educator or DPP designated prescribing practitioner and so on. This is common to all of the pad docs, the consultation, assessment and improvement instrument for nurses. The case based discussion, clinical examination reports and so on. There's a bit of an introduction and I won't go through that here.

But it is useful to mention that because this is a professional course and regulated by regulators who are protecting the public, it's important that if there are any problems, any significant failures or serious problems, then it can result in overall failure of the programme. And we would expect to be notified if there's any significant issues.

We also remind students that they cannot prescribe until they are registered as a prescriber on their professional register. The basic contents of this, it's structured with a an overview and information for the first few pages. And then there's part one, which is the practice competency sign off.

So the everything that's leading up to the sign off overall and then part two is actually some of the clinical skills which help you make that judgement, whether they can be signed off. There are some appendices as well. So some basic information includes the fact that it's 12 days or 90 hours. They have some expectations throughout the different stages of what to complete. It's at separate times for nurses.

This is an explanation of the difference between a practice supervisor and a practice assessor. Basically, a practice supervisor is providing some of the opportunities for the student. They are helping the practice assessor come to the judgement about whether the student to safe or effective. In contrast, the practice assessor or DMP is making that judgement by the end of the course and is accountable for that final decision for practice competence. The academic assessor is the practice of the academic tutor or or personal academic tutor.

There are some example responsibilities that go with these roles. And I always tried to identify that for the students, they should be able to identify some of their learning needs because they need to become familiar with the Royal Pharmaceutical Society competency framework for all prescribers.

So there's a there's an onus to a certain extent on them to recognise what they already know, but what they don't also what they don't know. Whereas for us as practice supervisors and practice assessors, it is also important for us to highlight areas which they might not realise they don't know.

So they aren't prescribers. So even though they may have a good grasp of what they require for their specialist area of practice, it is up to us to raise their awareness of areas that they might not realise they have knowledge deficits within. This is just an overview of four practice assessors, practice supervisors. An overview of the responsibilities. And you can read through that in the document.

It is worth mentioning that the student does not have to stay with the assessor for every hour of supervision. So there is such a thing as independent practice. And we'll talk about that in a minute. We do ask that respectfully, that if there are any concerns with regard to the student's ability to achieve or the practice, that they let us know as soon as possible. If there are significant issues, we would expect a certain amount of it to be dealt with internally in the practice arena.

But there's also a practice concerns, alert form in case that process needs to be put into place. And as notified of any issues, the intermediate report offers an opportunity as well to look at the progress of the student up to that point. And you can we will follow up any minor concerns at that point.

Placement visits can be undertaken and they might be needed if it's indicated in the practice assessment, pre admission or if it's requested by the practice assessor or practice supervisor or the student, or if it's in response to something that's in the intermediate report or others form of communication that triggers contact being needed.

The practice learning agreement is something that is signed by the practice assessor or the designated prescribing practitioner or the DMP at the first stages. We expect this to be completed in the first week or first two weeks of supervised practice. It doesn't need to be handed in or seen by us until the intermediate stage. But it's important to complete it early on. It's the contract between the learner and the practice assessor, and it is the commitments that you're making to help with their assessed practice.

So there's a list of things there. We do hope that you outline a brief plan for follow up meetings. So practice assessment plan in agreement. So the the date of the initial interview in this case, if there's if there is a practice supervisor because it's a nurse, then that should be included there when they're going to meet the practice supervisor. The date that you're going to meet for the intermediate report and the date that you plan to meet for the final report. It's also useful to highlight some preferred days or times for supervision.

The students agreed area of clinical competence that should have been completed pre admission on their pre admission portfolio. But it's just to confirm between you and the student that you are clear about what their specialist area is in relation to prescribing and practice. So, for example, it could be specialist cancer services, it could be NHS one one one if it's a pharmacist usually or integrated urgent care. It could be a general general practice. Now, sometimes it's better for the student and for you if you hone that down further.

So a lot of pharmacists, they are in the general practice area. But they hone it down to chronic disease management or hypertension, something a little bit more concise. Nurses also sometimes do that. But, for example, if it's community matron, you could say community matron, chronic diseases, or you could just say community matron. So it depends. It can be it depending on the situation. It can be so broad or it could be narrow.

The again, this is because it's a nursing practice assessment documents, so there is an area in this one for supervisors, but not in the other one.

And then the student also signs to agree to certain requirements.

There's a practice assessment flow chart, it charts the journey from pre admission through to finish.

So, for example, it's talking about the pre admission portfolio. The university programme updates session.

Or if you're watching this video. If if you're a new practice assessor, you must attend the session.

Although previous practice assessors are DMP, as can access this online and undertake the quiz.

So make sure you do the quiz after you've listened to this video.

The student begins the course and then within the first one to three weeks, the first learning contract, first interviews done and and that's the scene is set for further practice.

The intermediate report is usually after about 30 hours supervision. We ask for it to be handed in in approximately week twelve of twenty six. And that's so we can review it and provide some feedback at that point.

We do expect them to achieve level two or three, but if they only achieve level zero or one, we will make contact in order to see if there's any issues.

There's also the final report. And again, if it's a pass that everything's fine. But if not, we will find out what the action plan is.

There's also a practice communication flow chart. And the reason this is put in is because sometimes we hear concerns raised by the learner. It's not so often that we hear concerns by the supervisor. But it's important that that's included.

The main concern that we hear from learners is that they're due to sickness or absence or other issues. Sometimes their designated medical practitioner or other practice assessor becomes unavailable. Now, if that's minor, then we expect them to be able to deal with that.

You know, if it's a few weeks absence or if it's a temporary situation, then that's not a problem. However, if it's continued, the student can sometimes feel a little bit unsure about what's happening and they might want to raise that as a concern.

And then stage three, as if it can't be resolved, if there's no end in sight to win, that this problem can be resolved. Then we do expect the student to find another designated medical practitioner or another practice assessor to continue through the course.

And there's a process for changing the practice assessor.

And there's a form in Appendix one.

If the issue is raised by the supervisor or assessor, for example, absence, poor attendance, not progression or issues with competence.

Again, we would expect the appropriate person to be informed.

We would expect that to mainly be in practice. But if required, you can let us know.

And there is if it was minor issues, we wouldn't necessarily need to know.

But if it was continued or if the performance review issues, if it's unresolved, then there is a form at the end of this document, which is a concerns form that can be completed.

It could be that an illness or other work absence is a prop is is required.

And there are different processes for students to take for that.

So for example, they can have an authorised break from study if they're not too far into the course or if it's just to do with if they've had all the teaching.

But it's to do with not being able to get their assessments done, then it can be through exceptional extenuating circumstances processes.

I'm just going to skip through that one, just to mention that we do expect the supervised practice, even though it's 12 days.

We don't expect that to be all at the start or all at the end.

It should be as evenly distributed as possible. So, for example, the first six weeks, two days of supervision and then week seven to 12, three days leading up to the halfway report and then so on, four days and three days so that it's spread throughout the course. There's many different forms of supervision.

I think early on it would be expected that the learner observes their practice assessor role modelling is a very important way for them to learn. So we would expect that they are able to observe others in practice.

It could be direct supervision where you are directly observing them in practice. It may be indirect where there are other people involved or they are working independently. And you are finding out from other people or from them how that experience went.

They can also have insight visits, spend time with other people. So, for example, if they want to know about the whole prescribing process, they might spend time with a pharmacist if they're a nurse or if their pharmacist, they might want to know more about certain types of clinical assessments so they could spend some time with a nurse or a advance practitioner for independent practice.

The student can actually spend some hours in their usual place of practice and then it can count in their hours. If they then talk about that, have a critical discussion or a case based discussion with the assessor afterwards. So, for example, they might spend two hours in a clinic with patients and then half an hour with their practice assessor. So the two hours can count as two hours with it, as two hours of practice. But the half hour is a half hour with their practice assessor.

And they would be expected to be meeting some of the learning outcomes in tandem or coinciding with those forms of observation. And for there are different types of evidence. So direct observation, there isn't really any evidence as such except that the practice assessor or DMP will be signing certain things off in the practice assessment.

Had a document as they observe them. There can be an observer report or statements if they're spending time with other people, discussion, critical discussion, other and also an important way. And there are some formal case based discussion reports that can be used as evidence of having this critical discussion.

There's a minimum of three expected from the students by the end of the course. There's also standardised assessment forms. So, for example, a consultation observation form. And again, there's a minimum of three expected, but there can be you can do more than that.

They can have more than three observed consultations. If it's going to help their practice, question and answer and reflections, you can actually ask them to do a written piece of work if you feel that that would meet the competency more effectively.

The other thing that we ask for within this document is a testimony by an expert, by experience or a patient, somebody in their care. And there's a formal form for that. Further through this document.

So this is the kind of timeline, again, there's an initial interview and then there's the halfway report and then the final assessment. And that's just outlining who can do that. This is the minimum that's required.

We've also already mentioned the observed consultations in the case-based discussions.

There's also a clinical skills assessment. Any action plans that are required and a final sign off of that.

There's a clinical management plan, although the pharmacists don't need to do that.

A learning log which keeps track of the hours because it's 90 hours that's required.

There's a some mock prescriptions that are handed in as part of the power doc, as well as professional values and attitudes assessment and the expert by experience testimony.

So part one of the part starts now, and that's starts with the initial interview.

That's just the broad overview of the identified areas for development and the action plan to achieve them.

So the student themselves can write that up as long as it's signed by the practice assessor as agreed.

And that's just the broad brush strokes. Now, this competency framework, it says 2016. That's because it's not officially published yet. At the time of this. But I've seen it and there's not too many additional competencies at the moment. There's 68. I think it rises to something like 74 and the new one. So they've added a few more competencies. So this will all change, but it's too early to make it public yet.

So this still is the same in the new competency framework for all prescribers. It's still the one to six is the consultation and prescribing governance is seven to 10. And these headings are still the same. Some of these individual competencies will change, but most of them have stayed the same. There's just some additional ones.

How this is structured is the intention is that the student at the start there, they become familiar with the competency statements. They have a think about how they think they will achieve it, but then that can change by the end. They may have achieved it in a different way than they first thought they would.

The other thing to say about these is there's 68 competencies, which seems like a lot. But actually it might be the case that a single observed consultation captures all of them. So you can group them together. You don't have to, as the practice assessors supervisor do these individual ones.

That's up to the student. It might be helpful to agree them, but you don't have to sign it there. The only place this is signed is at the last page where at the end you're signing to say that they've all been achieved.

And the halfway report is the next form in this. This gets handed in approximately 13 weeks, sorry, 12 weeks into the course. And we use the same structure throughout. Clear fail or fail, pass or clear pass. So that is in all of the assessment documents within this document.

We do need to highlight that at the intermediate stage. We we don't expect them to fail at this stage. But that's not saying that they have fully met the competency.

What it's saying is that you have seen enough from the student at this stage that you feel that they're showing sufficient progress, that they are likely to achieve the competence at the final stage. OK, so sorry. I'm just going to skip down to where you sign that off.

So these are the competencies zero to one, two to three, saying that they you feel that they are heading in the right direction. The other thing that's completed here is the learning log hours of professional values form, which is we'll go back to you in a second. And the Clinical Skills Action Plan. So that's what the intermediate report looks like for allied health professionals and nurses, for pharmacists.

There's an additional requirement that they need to submit a audio file of a case based discussion.

So we expect one audio case based discussion for the pharmacists at this point.

So the Professional Values and Attitudes Forum that is completed at the intermediate stage as well as the final stage.

And it's basically saying for each of the professions that they are working within their professional code.

So that's kind of straightforward. But it's just to reaffirm that they are that there's nothing that you're concerned

about in terms of professional practice for the values and attitudes part of it.

The idea is that the students self assesses where they are, whether they strongly agree or disagree with the various statements.

And then the practice assessor or DMP also ticks a box to say where they think the student is.

Now, the purpose of this is to raise those difficult conversations.

If you have a student say, for example, you have a student in terms of self-awareness, where they seem to not be self-aware, that they have learning needs, so shows an awareness of the effect of their own behaviour or awareness of limitations and development needs.

So they might already they might come across as overconfident and that they know everything already.

Well, it might be difficult to have that conversation, but you would think that perhaps they rate themselves quite highly.

You can rate them a little bit lower.

And then the purpose is that it then STRs, that discussion about some of the things that they might need to know, in addition that they don't know about it can work conversely as well.

If the student perhaps seems to be lacking a bit of confidence and it might be helpful to know that actually they are doing quite well.

Yes, they they they are aware of their limitations and development needs.

And so it might be that you rate them higher than they rate themselves.

And again, that can stir up a conversation. So there's several different categories for that.

Are we? This gets handed in at the intermediate stage and the academic assessor or ordering tutor signs it off at that at that stage.

The next one here, the next few pages are the final report.

And that's where the individual competencies for the RPS competency framework and any additional ones for the GPHC, are scored as pass or fail.

So they're highlighted as pass fail all the way down, all 70 for whatever number we're at at the moment.

There's the second professional values and attitudes form to complete.

There's the record of practice experience, the learning log. And that's where the students normally write out the date that they've had the practice, a supervised practice, what their key learning experience was.

They can link it to specific competencies if they want. But that's optional. The length of time and then the supervisor and supervisors initials.

And if it was somebody other than the practice assessor, you'd want the initials there.

But otherwise, the the practice assessor can sign it off at the bottom.

Now, this is where I see a practice supervisor can help the nurses because they can sign it here.

And it's not until the final cumulative page where the practice assessor must sign it off to say that they've met all 90 hours.

This is the expert by experience feedback where the student is working with vulnerable patients or if it's not suitable for the patient to write it themselves.

The practice assessor or practice supervisor or other observer can write it on behalf of the patient.

We ask the patients are anonymized and they don't sign it.

But we can't fail a student for the patients signing it because we do know we are aware that sometimes patients want to to sign it themselves to kind of give that feedback in that sense of ownership for it.

There's a final interview form where the student makes comments and the practice assessor or DMP makes comments and then an action plan if needed.

Now, the intention of that is if the student doesn't pass. But we have seen them filled in before whereby the practice assessor wants to say

something about after the student finishes the course and and make some recommendations.

So it can be used for that as well. The final signoff or declaration of suitability is very important.

It's signing to say that they've completed the ninth and basically have achieved everything

that they needed to in practice in order to be considered for registration as a prescriber.

So this is what's it states for the nurses. It states something slightly different for allied health professionals and for pharmacists.

And then just that other reminder about students not being able to prescribe until they're annotated on the register.

And then this is for us, because we actually, as the academic assessor, we have to make that final judgement as to whether they've passed or not.

And so that it can be annotated on the register. This is part two of the pad.

And this is all concerned with clinical skills. So just an overview of some of the responsibilities meetings.

Again, an outline of that scale that we use zero, one, two and three.

And some of the some of the upcoming clinical skills records that we use.

So this one is about basic clinical skills.

The student is supposed to self assess whether they have a low level of current knowledge and skills in a particular clinical skill.

And if they have a low level and it's mandatory or you deem it to be useful or necessary for prescribing practice, then it becomes a high priority.

If they're already have significant levels of knowledge and skills in that area, then they.

It is not a high priority. They don't have to do an action plan for it.

So the essential skills, the ones that every student needs to be able to do as a prescriber are these first eight skills.

We would expect most nurses to have all of them to to already be significantly experienced in these.

It might be that you don't know their level of skill and that you want to see them do this.

So then it becomes a high priority for pharmacists in particular.

They tend to need to do this the the manual blood pressure, temperature, respiratory.

They also do it in the university setting. They're assessed in all this, but it needs to be done in practice as well.

So they tend to have a low level of experience with that.

So it's a high priority and an action plan is needed. The other one that's a common one is the mental health assessment.

It says use of appropriate tools and an interpretation. But for most of the students, that is actually just the consenting capacity.

So do they know how to assess for mental capacity, for gaining consent for the patient?

So it depends, as a lot of them might have experience with that already.

Now, these are just some examples of other clinical skills that might need to be assessed

throughout their practice and their space if there's others that also are required.

So specific and review specific and broad review of blood tests might be one that's they have a current low level and need higher levels.

So that would be a high level as very high priority for their future practice.

So this is the action plan. So it corresponds to the numbers in the previous page, the actions required the date for review and whether it's passed.

And then finally, whether even if they haven't had any in the action plan, they do need to have their clinical skills signed off at the end of these essential ones.

Definitely. But if they didn't have an action plan for any just the essential ones and then that's where the DMP signs it off.

We're getting there. This is the next section is three case based discussion reports.

It starts with an overview of what's meant by a case based discussion, what we're expecting and the scale again.

The first part is just a brief overview of the presenting problem.

Everything needs to be anonymous ised, but an overview of the problem.

And then if you did observe the assessment itself, you can make these judgements.

If you haven't observed it, you might have to quiz the student as to, you know, how they listen to the patient.

What was their what what was the history? How did they gather? You know, you might have to ask them about that.

If it didn't coincide with an observed consultation. So it goes through the different categories.

There's room for notes and then there's a whole page for a summary.

Now the student can listen to your feedback and write that up themselves, or you can write it for them so it doesn't matter how that's done.

But the important thing is that it's signed at the end. So there's three of those.

And where the practice assessor isn't a medical practitioner,

we expect at least one of these case based discussions to be undertaken by a medical practitioner.

So that's why this last one here. That's just in case the practice the they don't have a designated medical practitioner assessing them.

The next one is an observed consultation, and that is based on some well recognised tools that are used by the GMC.

You can use an alternative to like the cane tool that's not included in this document, but it can be used if it's preferred.

It uses the same type of scale. And again, one must be biomedical practitioner, one by the practice assessor, if that's not a medical practitioner and then one by a supervisor where this the nurse,

if it is a nurse and there they have a designated medical practitioner, the they can do all three.

If they don't have a separate supervisor, that's no problem.

So that's what this one looks like. Again, it's the an overview of the presenting problem and then how the actual consultation went.

So history taking diagnosis, Redflex, polypharmacy and so on.

Safety net. OK. And again, same thing with the feedback.

The student can write it based on feedback, verbal feedback, or you can write it if you want.

The observer can write it. This is they do need to complete some learning logs and these go along with the mock prescriptions that they do.

And that's just to think about it a little bit more detail some of the decisions they're going to be making as a prescriber.

There's some mock prescriptions and there is we do expect at least one reflection on experience.

They can do more than one, but one is a minimum for the pharmacists.

They must do this based on the there's three learning outcomes are standards sorry, learning outcomes that aren't covered by the competency framework for all prescribers.

So they they must do a piece of reflection that meets those three learning outcomes.

And finally, we get to the appendices, appendix one is just in the case where the DMP or practice assessor needs to change.

There's a form for that for changing the DMP. Appendix two is the practice concerns alert form where we were mentioning back at the top if there's any problems in practice that aren't resolved and need to be communicated to the team.

This is a form by which to do it.

And the expectation is that we respond to this within five days and provide some feedback and a summary of the next steps.

And then the last part, the last appendix is a practice learning evaluation.

We expect the student to share this with you.

It's good practice for them to evaluate the practice that experience that they've had, and it's good practice for them to share that with you.

Now, there can be times when the student hasn't been hasn't found the practice to be favourable.

And so we have had to put in some extra comments for if they don't want to share this directly with you.

If there's any concerns raised, again, we need to address those concerns and there's ways in which we can do that.

So this is the practice evaluation that the complete.

And it also includes a section where they rate their confidence as a prescriber at near the start of the course and at the end of the course.

So we hope to see progression in that way. And then the last page of the practice assessment document is just lines of communication.

So how the students get a hold of certain areas in case they forget it and can't log on or something.

But also how they get hold of you and how you guys can get a hold of us if need be.

OK. I hope you have found that somewhat useful. That concludes an overview of the practice assessment document.

We're more than happy to discuss any individual issues with you or answer any questions.

Thank you very much.