1. Possible career structure for MI consultant Dr Catherine Duggan Associate Director of Clinical Pharmacy London, South East and Eastern and Senior Clinical Lecturer, School of Pharmacy, University of London Chair of United Kingdom Clinical Pharmacy Association

2. Content –Drivers for change –The competency agenda –Pharmacist development strategy –General level practice –Development of higher level practice –Consultant Pharmacist- MI

3. Drivers for change

4. Self-care Disease management Patient safety Access to medicines Policy trends… Dislocation between education & practice Non-competency based approaches No clear practitioner development Recruitment and retention Fitness for purpose

5. Competency → Competence → Performance → Fit to practise? = safe, health improvement The real issue…patient outcome

6. The Words CompetencySingle item of knowledge, skill or professional value CompetenceFull repertoire of competencies PerformanceReference to observable behaviour What an individual actually does, as opposed to what they can do EffectivenessEffect of performance on a recipient

7. Miller’s pyramid Does Shows how Knows how Knows performance assessment in vivo performance assessment in vitro clinical context assessment factual assessment From UG to post-registration development

8. Why competency-based approach? –National health policies –Governance; Patient safety; service quality –Evidence –Accelerated and sustained performance –Operationalise “science into practice” –Sustainability –defines and makes explicit development needs

9. Pharmacist development strategy – principles: Recognise different level of practitioner Embraces all facets and sectors of practice Linked to two recognised competency frameworks to link to KSF Educational quality assurance structures to provide rigour

10. 10% 20% 30% 40% 50% 60% 70% 1996/971997/981998/992001/02 Pharm Care Competencies (OSCE) 60% 30% Graduation One year later McRobbie et al

11. Pharmacist Development Strategy Pharmacist Pre- registration Pharmacist Registered Pharmacist Specialist Pharmacist Advanced Consultant Pharmacist Qualified Practitioner Senior or Specialist Practitioner Advanced Practitioner Consultant Practitioner Healthcare Scientists Making the Change Consultant Advanced Practitioner Specialist Practitioner Practitioner Allied Health Professions Meeting the Challenge PAM(PTA)2/2001 Competency Framework General Level Competency Framework Advanced Level

12. Competency…a complex construct Skills Behaviours Knowledge Values attitudes Competency Skills Behaviours Knowledge Values attitudes Competency Skills Behaviours Knowledge Values attitudes Competency Skills Behaviours Knowledge Values attitudes Competency

13. Competencies have their critics… “Expert practice is beyond competency” –not a tenable stance post-Bristol Reflective practice (Schön 1983) –necessary quality of expertise - but cause or effect? –not a sufficient characteristic Novice-to-expert progression (Dreyfus & Dreyfus 1986) –no mechanism to identify ‘expert’ –insufficient account of competence

14. General Level Practice

15. Higher Level Development Phase General Level Development Phase Undergraduate & Pre- registration Phases General Level Practitioner Advanced Practitioner & PhwSI Higher Level Development Phase 2 1 Consultant Practitioner General Level Framework Higher Level Framework: Advanced & Consultant Pharmacist development strategy

16. McRobbie, Webb, Bates, Davies, Wright 2001 Whiddett and Hollyforde 1999

18. Logrank P = 0.0048 Intervention = GLF n = 30 hospitals Time - months 14121086420-2 Probability.7.6.5.4.3.2.1 0.0 -.1 Intervention Controlled trial GLF in junior pharmacists Non-intervention

19. Reasons to be cheerful… 1.It is straightforward and practitioners understand it 2.It manages performance independent of sector 3.It makes “CPD” a realistic and useful activity ! –It is being used by employers because it works

20. NHS Specialist Services Specialist groups Senior Managers Service Perspective HE Universities London Brighton Kings Medway Portsmouth UEA Reading Kingston Educational Quality Collaborative programmes PG Diploma in General Pharmacy Practice Statement of Completion General Training JOINT PROGRAMME BOARD (London, East and South East England)

21. –Government funding – national model ? –PG Diploma in General Pharmacy Practice -Core - MI, Technical, Patient & Clinical Services Common Validation by HEIs in collaborative Currently 350 junior practitioner-students School Pharmacy Univ Brighton Univ East Anglia Univ Portsmouth Medway School King’s London Univ Reading Kingston Univ NHS Early implementation – Joint Programme Board Generalist Training (3 years)

22. Defined Area of Practice I (20 Credits) Summed credits (60) = PG Cert GPP Summed credits (120) = PG Dip GPP 6 months 12 months 6 months Defined Area of Practice III (20 Credits) 6 months Assessment 2 (20 credits) Assessment 3 (20 credits) Assessment 4 (20 credits) Portfolio review – AfC gateway Assessment 1 (60 credits) Defined Area of Practice II (20 Credits) Module 1 (M1) (60 Credits) Principles of Practice Technical / MI / Pt Services/Clinical

23. The bigger picture… –Growing higher level practice –Recognising advanced to consultant practitioners –…an evidence-based approach In other words, a practitioner development strategy from junior to Consultant

24. Higher level practice

25. Higher Level Development Phase General Level Development Phase Undergraduate & Pre- registration Phases General Level Practitioner Advanced Practitioner & PhwSI Higher Level Development Phase 2 1 Consultant Practitioner General Level Framework Higher Level Framework: Advanced & Consultant Pharmacist development strategy

26. Attributes of higher level practice? –Expert in clinical practice –Able to work in multidisciplinary teams –Dissemination and contribution to evidence –Training, support and mentorship of staff –Managing a team and a caseload –Leadership skills

27. Expert professional practiceExpert skills and knowledge Patient care responsibilities Reasoning and judgement Professional autonomy Building working relationshipsCommunication Teamwork and consultation LeadershipVision, motivation, governance Strategy, innovation Service development ManagementPlanning, performance, change Priorities, resources, standards, risk Education, training, developmentMentorship role model delivery CPD Research and evaluationPractice linkage, policy Critical evaluation, protocol review Evidence creation, development Supervision, partnerships ADVANCED LEVEL

29. Applying ACLF to different practice groups –Self assessment of practice level –specialist-in- training –experienced practitioner –leading-edge practitioner –Evidence –to substantiate assessment –Sample (n=390) Cancer69 Mental health69 Critical care36 Primary care84 Paediatrics53 MI43 Other36

30. Percentage of respondents located per cluster N=390 8.9 6.0 43.416.332.1 42.120.830.4 10.652.0 7.752.6 11.753.5 36.620.828.2

31. -2012 -2 0 2 4 6 F E M F E M F E M F E M F E M Expert PP Leadership Management E & T R & E Practice level HOMALS Quantification Specialist in training Experienced practitioner Leading-edge practitioner Advanced level practitioners n = 390

32. Current level of practice 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Mean cluster score Expert Practice Working relationships Leadership Management E&T and Development Research & Evaluation Specialists in training Experienced practitioners Leading-edge practitioners

33. Competency profiles –Consultant profile –EPP, BR and Leadership at Mastery –Management, ETD and RE at Excellence –Advanced level profile –5 clusters at Excellence –RE at Foundation –Applying consultant profile to sample –50 pharmacists satisfy competency criteria (12.8%) –21 (+/- 7) years post qualification (mean +/- SD) –34% diploma, 40% MSc, 18% PhD

34. Consultant Pharmacist- MI

35. 3 clusters at Mastery 3 clusters at Excellence

36. Expert professional practiceExpert skills and knowledge Patient care responsibilities Reasoning and judgement Professional autonomy Building working relationshipsCommunication Teamwork and consultation LeadershipVision, motivation, governance Strategy, innovation Service development ManagementPlanning, performance, change Priorities, resources, standards, risk Education, training, developmentMentorship role model delivery CPD Research and evaluationPractice linkage, policy Critical evaluation, protocol review Evidence creation, development Supervision, partnerships ADVANCED LEVEL

37. Knowledge and Skills Personal attributes Management skills Technical skills Interpretive skills Conceptual skills Interpersonal skills Pragmatic, ownership, individual working Humility, initiative, communication Confidence, flexibility, iteration Pro-activity, concentration Managing people, team working, influencing others Motivational skills, organisational skills, time management Organisational skills, task prioritisation Writing, meetings, identifying knowledge gaps Literature searching, presentation skills, protocol writing, administrative skills Writing, form filling, computer literacy, scientific language, obtaining funds, Data collection, data management, audit and research Charting progress, task prioritisation, writing (iteration), Critical appraisal, identifying knowledge gaps Reading literature, selection of research methods, statistics and interpreting data: analysis, credibility issues Big picture: concepts into practice, identifying research questions Thinking: critical, conceptual, teaching Selecting approach, implementation of research in practice Mentoring, Role model, teaching Communication, negotiation, team working

38. Cluster Foundation F-E Excellence E-M Mastery Expert Practice Building Relationships Leadership Management E&T and Development Research and Evaluation ACLF Second cycle Third cycle MSc(Adv) DClinSci/PhD/MRes

39. Expert professional practiceExpert skills and knowledge Patient care responsibilities Reasoning and judgement Professional autonomy Building working relationships Communication Teamwork and consultation LeadershipVision, motivation, governance Strategy, innovation Service development ManagementPlanning, performance, change Priorities, resources, standards, risk Education, training, development Mentorship role model delivery CPD Research and evaluationPractice linkage, policy Critical evaluation, protocol review Evidence creation, development Supervision, partnerships ACLF

40. Higher Level Development Phase General Level Development Phase Undergraduate & Pre- registration Phases General Level Practitioner Advanced Practitioner & PhwSI Higher Level Development Phase 2 1 Consultant Practitioner General Level Framework Higher Level Framework: Advanced & Consultant Pharmacist development strategy Not just clinical Aspirational for all specialties Leadership and Mentors essential Higher levels – M and D programmes We need to think big

41. Awarded Master in Adv Practice (University / JPB accredited- RC recognised ?) PG DipGPP Award (or equivalent) New D Clin Sci [or mod map to professional D] (Specialism) & critical adjacencies MSc Adv Pract EPP / BWR Statement of completion of Practice (University / JPB accredited- RC recognised ?) L / M / E&D / R&E

42. Challenges…? –Equivalence between specialist and generalist –Practicalities of rotations & placements –Maintenance of the service –Curriculum & assessments –Supply and demand

43. EPP / BWR L & M Assessment? Eg: Experience, Portfolios, learning Evidence E&D R&E Learning sets All linked to the assignments & learning outcomes- academically robust Syllabus & curriculum determined by and set by expert practitioners- Recognised (accredited) training centres Assessment? Eg: Change management assignment Assessment? Eg: Teaching portfolio Assessment? Eg: Ethics submission/ audit work Awarded Master in Adv Practice (University / JPB accredited- RC recognised ?) Statement of completion of Practice Element (University / JPB accredited- RC recognised ?)

44. “Royal College” All sectors specialism JPBs (locality based) Accreditation infrastructure, assessment, QA, evidence Practitioners who need registering at Foundation, Advanced, PwSI

45. Practitioner in training Key skills & Knowledge Cognitive skills Consultation skills Problem solving Professionalism Competence Medicines expert Intellectual practitioner Decision maker CONTEXT Practitioner Skills Applied Pharmaceutical Sciences Applied Therapeutics Clinical Governance & Risk

46. JPB and CoDEG websites www.postgraduatepharmacy.org www.codeg.org Where to find information

47. Possible career structure for MI consultant Dr Catherine Duggan Associate Director of Clinical Pharmacy London, South East and Eastern and Senior Clinical Lecturer, School of Pharmacy, University of London Chair of United Kingdom Clinical Pharmacy Association