Independent Prescribing (Short Course) / Course details

The programme is accredited by the General Pharmaceutical Council (GPhC) and the Nursing & Midwifery Council (NMC). Those who complete the programme are able to apply to their regulator for annotation as an independent prescriber.

The programme provides opportunities for students to develop and demonstrate knowledge and understanding, skills and other attributes detailed by GPhC/NMC learning outcomes.

We have adopted A competency framework for all prescribers (RPS, 2021) as the programme learning outcomes in line with the NMC approach. This offers a logical approach for students who will continue to use the prescribing competency framework to guide the further development and expansion of their practice once qualified. We have also mapped the learning outcomes and assessment strategy to the GPhC’s Standards for the education and training of pharmacist independent prescribers (2019).

The programme is a single 30-credit module assessed at FHEQ level 7. Structured learning activities are delivered over four months with all assessments being completed within 17 weeks of the first study day. In the future, we may offer the option to complete the period of learning in practice over six months, which would necessitate a later portfolio deadline, but the other assessments completed within four months.

Students are required to complete 26 days of structured learning activities, including mandatory attendance at study days and the directed study via the programme virtual learning environment (VLE). All students must complete 90 hours of learning in practice under the supervision of a Designated Prescribing Practitioner (DPP, pharmacists) or a Practice Assessor (PA) and Practice Supervisor (PS, NMC registrants).

This programme aims to enable pharmacists and nurses to develop the knowledge, skills and behaviours required for safe and effective prescribing practice so that they may apply for registration as an independent prescriber with the General Pharmaceutical Council (GPhC) or the Nursing & Midwifery Council (NMC).

The programme aims to enable students to:

1. Develop a systematic, evidence-based and critically reflective approach to identifying and addressing development needs associated with independent prescribing.
2. Critically appraise the ability to meet and further develop the consultation competencies within A competency framework for all prescribers (RPS, 2021).
3. Critically appraise the ability to meet and further develop the governance competencies within A competency framework for all prescribers (RPS, 2021).
4. Meet the professional standards set out by the General Pharmaceutical Council (GPhC, pharmacists) or the Nursing & Midwifery Council (NMC, NMC registrants) to enable an application for registration as an independent prescriber.

This programme provides opportunities for students to develop and demonstrate knowledge and understanding, skills and other attributes in the following areas. The learning outcomes are derived from those set out by the GPhC (2022) and the NMC (2023).

We have adopted A competency framework for all prescribers (RPS, 2021) as the programme learning outcomes in line with the NMC approach. This offers a logical approach for students who will continue to use the prescribing competency framework to guide the further development and expansion of their practice once qualified. We have also mapped the learning outcomes and assessment strategy to the GPhC learning outcomes. 

The course meets the GPhC and NMC learning outcomes. Please refer to the URL for further information.

Directed learning

Directed learning materials on the programme VLE provide 20 days’ learning activities that students can study flexibly and at their own pace. This allows them to spend more time on new knowledge and skills and less time revising and contextualising transferable skills. The learning materials are presented in two ways:

• Course content is mapped to the prescribing competency framework domains to allow easy reference to particular topics
• The planner arranges materials into weekly sections, which ensure that pre-work is completed in advance of workshops, there is building from one topic to another and the learning is divided approximately equally between the weeks.

All learning materials are reviewed for accuracy and currency in advance of the cohort as well as web links being verified and dates corrected. Students receive an introduction to the functionality, content and links in VLE during the induction webinar, they have access to explore from at least a week before the first study day and we offer an optional workshop on the first study day to address any difficulties that students have in navigating the resources.

Face-to-face workshops

Six study days are delivered during the course. These address the practical skills and topics where discussion of concepts with a diverse range of perspectives is beneficial to guide application in practice. Students are allocated to different working groups in each study block to allow maximum interprofessional working and networking. All workshops have associated pre-workshop activities to ensure that students have a reasonable baseline knowledge and understanding to allow optimal use of the face-to-face workshop time.

Key topics delivered during the study days are:

• History-taking, consultation skills and complex consultations
• Basic observations and physical examination
• Clinical reasoning
• Critical reflection
• Evidence-informed practice
• Law and ethics
• Documentation, including case notes and prescription-writing
• Monitoring and follow-up
• Public health, including antimicrobial stewardship

Period of learning in practice

All students must complete at least 90 hours of learning in practice. This affords the opportunity to develop specific skills, explore the application of knowledge and skills in context and bring together the different aspects of the prescribing process into complete episodes of increasingly autonomous care. It also provides experiences on which to reflect with the feedback of the DPP or PA/PS and peers as well as considering the service user’s feedback. A learning contract developed at the start of the course guides the efficient use of this time and identifies the necessary resources to ensure that development needs are addressed.

Students should be able to:

• Develop a comprehensive understanding of the responsibility of an independent prescriber, be aware of their own limitations and work within their professional competence
• Demonstrate an ability to recognise and analyse the signs and symptoms of conditions relevant to their area of practice
• Develop and apply advanced clinical assessment skills in order to inform a working diagnosis and formulate a treatment plan
• Develop and apply advanced clinical assessment skills in order to monitor response to therapy and evaluate the use of a clinical management plan in practice
• Demonstrate a thorough understanding of the principles of pharmacology and apply these principles to their own practice
• Analyse the impact of individual patient variation on drug handling
• Demonstrate the ability to perform advanced drug calculations

Students should be able to:

• Recognise and demonstrate the attributes and behaviours essential to build and maintain effective relationships with patients and carers
• Critically evaluate a range of patient-centred consultation models and apply effective patient-centred consultation to practice
• Critically review and appraise a shared approach to decision making by assessing the patients’ need for medicines, taking into account their needs, wishes and values
• Recognise internal and external factors that influence prescribing decisions and consider management strategies for these.

Students should be able to:

• Select and use diagnostic aids relevant to the conditions for which the practitioner intends to prescribe, including monitoring response to therapy
• Demonstrate advanced skills in conducting a consultation, including taking an  accurate history (including a medication history) in a systematic and responsive manner
• Maintain accurate, effective and timely records to ensure other prescribers and health care staff are appropriately informed.

Students should be able to:

• Identify and evaluate a range of reflective models and analyse their effectiveness in supporting their learning needs
• Identify learning opportunities to fulfil CPD needs and maintain a critical and reflective record of CPD activity
• Develop advanced communication and relationship building skills to consult appropriately with patients and their carers.

Open book online examination

The exam lasts two hours and is completed online in a computer cluster through the course VLE. Access to the NICE BNF (https://bnf.nice.org.uk/) is provided and students may use a non-programmable calculator in line with university regulations.

The structure of the exam is:

• Part one: law and ethics (80 % pass mark)
  • 10 multiple choice questions (MCQs) with one mark per question
  • three short answers questions (SAQs) with five marks per question
• Part two: pharmacology (80 % pass mark)
  • 10 MCQs with one mark per questio
  • three SAQs with five marks per question)
• Part three: calculations (100 % pass mark)
• ten questions, which are all pass/fail

A question bank grouped into topic areas ensures that the full syllabus is assessed and there is a sufficient rotation of questions. Questions are reviewed for currency before use and for performance after the assessment.

Students must pass all three parts of the exam independently; there is no compensation between assessments.

Objective structured clinical examination (OSCE)

The three-station OSCE has been developed using the model adopted by Manchester Medical School. Each OSCE marking scheme contains two parts:

• An analytical checklist of technical elements (Ebel and Frisbie, 1991)
• A global assessment of the person-centredness of the approach.

Students must pass all three stations to pass this assessment:

1. Clinical assessment/diagnostic aid, ie, basic observations (NEWS2)
2. History taking and record-keeping, ie, documented history
3. Professional accountability and communication, ie, prescription-writing and providing medicines-related information.

There is also a short numeracy assessment that caries a 100% pass mark within the OSCE assessment.

Case presentation
While the other assessments test individual competencies, the case study presentation assesses the ability to complete several parts of the prescribing process together. Students are allocated 15 minutes to present their case to up to three peers and an assessor, and this is followed by five minutes of questions from the audience. The assessment is conducted online and recorded for second marking purposes.

A template is provided guiding the content and flow of the case presentation and covers the following points:

• present the patient and outline why you chose the case and your involvement in it
• outline your management and prescribing decisions
• explain your rationale, which should include a critical appraisal of the evidence, including primary sources
• reflect on your approach
• explain how you will apply your learning to practice
• pseudonymised case note entry and prescription using practice systems.

Students are advised to choose a case that they have managed autonomously and that represents their typical practice within their identified scope. The case should demonstrate the transition from their background role to a prescribing role so it’s likely that the case should focus on the competencies they identified in their learning contract as being development needs.

Reflective practice portfolio

The reflective practice portfolio is a means for students to plan, record and evidence their development during the period of learning in practice.

The completed reflective practice portfolio must contain (and templates/guidance are provided for):

• DPP/Practice Assessor sign-off (see below)
  a written record of three two progress meetings with the DPP or PA/PS
• learning contract
• reflective practice log
• personal formulary of three detailed monographs with a 1,000-word critique of the guidelines/evidence explaining the rationale for further choices
• three practice-based history-taking assessments and a 1,000-word reflection on feedback
• three practice-based assessments for at least one clinical skill relevant to the student’s scope of practice.
• 1,000-word reflection on the development of consultation skills, including service user feedback and feedback from the DPP/PA on history-taking and clinical skills.

Formative assessments

Formative assessments afford the opportunity to experience the assessment, understand the format and gain feedback to inform further development. There are several formative assessments in all aspects of the course that will help to guide development and offer ideas for ongoing assurance of competence after qualification.

Academic assignments are submitted during the course for formative feedback and are then further developed to form part of the reflective practice portfolio.

• Learning contract
• Reflective practice log
• Personal formulary

A mock exam presents an opportunity to experience the format of the exam and questions and to gain feedback on their approach to answering these context-specific questions.

The mock OSCE on the final study day allows students to experience the environment and format of the final assessment. This is a peer-assessed exam that enables benchmarking of practice against sample marking schemes, but students also experience the patient’s perspective and gain a working knowledge of what the examiners are looking for.

Development of the reflective practice portfolio is guided by a series of directed activities designed to support the exploration of key concepts in practice. These are initially formative with feedback from the DPP or PA/PS and other colleagues. They ultimately provide evidence of competence in the application of knowledge and skills within the student’s scope of practice.

Students are provided with details of assessment criteria before completing assessments along with guidance on how to approach the assessments and examples from former students.

Formative assignments are scheduled at intervals to allow students time to create these pieces of work at a logical point during the course and gain feedback from their Academic Assessor. Scheduling the assignments allows the programme team the opportunity to provide feedback much faster than the university standard of 15 working days; it is commonly eight working days in recognition of the course being only four months long. All formative feedback is marked in line with the summative marking schemes and is balanced and constructive.

Students may also request ad hoc feedback from their Academic Assessor. We encourage students to negotiate this in advance to increase the chance of the feedback being swifter than the university standard. They are also advised that Academic Assessors will not comment on more than one piece of work at once or on the same piece of work more than twice.

Students receive personalised formative feedback following the summative assessments after they have been independently second-marked, moderated where necessary and ratified by the Exam Board.

An up-to-date list is provided via Reading Lists Online on Blackboard. Most resources are either provided as electronic resources through the University library or publicly accessible online resources.

Further to the recommended reading, students may find the following publicly accessible websites useful:

• RPS, A competency framework for all prescribers: www.rpharms.com/resources/frameworks/prescribers-competency-framework
• CPPE Prescribing gateway pages: www.cppe.ac.uk/gateway/prescribing
• NICE BNF: https://bnf.nice.org.uk/
• NICE: www.NICE.org.uk
• MHRA: www.mhra.gov.uk
• Nursing & Midwifery Council: www.nmc-uk.org
• General Pharmaceutical Council: www.gphc.org