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Pharmacy inspections

Inspection reports and learning from inspections

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Using peer review processes to help support the learning and continual professional development of Pharmacist Independent Prescribers

Pharmacy type

Community

Pharmacy context

Thisis a village pharmacy in a rural area. It delivers the usual range of NHSservices, including Pharmacy First Plus. Pharmacy First Plus is an NHS Scotlandservice which includes prescribing for common clinical conditions by PharmacistIndependent Prescribers. The pharmacist in this pharmacy has several years’experience as an independent prescriber.

Relevant standards

  • 2.2 - Staff have the appropriate skills, qualifications and competence for their role and the tasks they carry out, or are working under the supervision of another person while they are in training
  • 2.4 - There is a culture of openness, honesty and learning

Why this is notable practice

The pharmacist independent prescriber (PIP) is actively using communication channels with PIP colleagues to share practice, to learn from each other and develop further. This broadens the scope of their practice, therefore increasing access to safe and effective treatment for a growing range of symptoms and conditions, for people in different locations.

How the pharmacy did this

The experienced PIP had previously worked between community pharmacy and in a GP practice where colleagues were always available to share ideas with and ask for advice. The PIP had identified that since changing her role to work solely in community pharmacy it was easy to feel isolated regarding prescribing. When speaking to less experienced PIPs working in pharmacies in the same company, and providing the Pharmacy First Plus service, she became aware that they felt the same. And they had never benefited from working alongside colleagues from other disciplines.

This led to the formation of a peer review group. The group included a small group of PIPs from within the company and working in the same health board area. Due to the coronavirus pandemic, the group met virtually using video conferencing. They intended to hold some meetings in person, when safe to do so. As well as regular meetings, they set up an encrypted instant messaging group to enable them to address issues and ask for others’ opinions as the need arose. Sometimes the less experienced PIPs asked challenging questions about complex issues. The experienced PIP supported them, reminding them that the service was called ‘Pharmacy First’, and included prescribing for common clinical conditions. So, referring to other practitioners was sometimes the correct course of action.

As pharmacies continued to be the ‘first stop’ during the pandemic, the PIPs were seeing a wide range of symptoms and conditions. And sharing experiences with colleagues was helping increase confidence and supported their competence as practitioners. The training for delivering the Pharmacy First Plus service included record keeping, so all PIPs had a way of recording the consultation. But the experienced PIP had a standard format that she used for recording consultations and sharing information with GPs. So, she had shared this with the group to support good record keeping.

The peer review group was in its infancy and was a ‘safe space’ for the PIPs to talk about their practice. Each PIP had a memorandum of understanding (MOU) with the health board and their own personal formulary. It defined their scope of practice and only included medicines in the local NHS formulary. As the service was relatively new , the PIPs planned to review and update it in line with local changes, ensuring they always supplied the currently recommended medicines for the condition. NHS Education for Scotland (NES) provided webinars for PIPs which they all attended when possible. Recently topics had included skin conditions and GI conditions. Specialists from other disciplines were being invited to present at these sessions.

To help keep her own knowledge up to date the experienced PIP also engaged in practice based small group learning. This involved being part of a local multidisciplinary group. Its members included GPs, PIPs, advanced nurse practitioners and a few community pharmacists. It met monthly and had a structured format. The group reviewed cases, discussed treatment options and offered opinions. The PIP found these sessions invaluable, enjoyable and informative. There was also a social aspect which helped develop relationships across the disciplines. This made it easier to contact colleagues from other professions for advice or opinions as the need arose.

What difference this made to patients

People accessing this Pharmacy-led service benefit from access to timely, safe and effective treatment for a range of common clinical conditions. And can feel assured that they are receiving quality care from pharmacists who keep their knowledge and skills up to date.

Highlighted standards

We have identified the standards most likely and least likely to be met in inspections, and highlighted examples of notable practice for each of these standards; to help everyone learn from others and to support continuous improvement:

  1. 1.1 Risk management
  2. 1.2 Reviewing and monitoring the safety of services
  3. 4.2 Safe and effective service delivery
  4. 4.3 Sourcing and safe, secure management of medicines and devices
  5. 2.2 Staff skills and qualifications