Medicines optimisation in care homes training pathway for pharmacy professionals

Supporting care home pharmacy professionals of the future

CH/BROCHURE18July 2018

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We have developed this brochure for pharmacy professionals working with people living in care homes to let you know how we can support you to improve patient outcomes.

Health Education England (HEE), on behalf of NHS England, awarded CPPE the contract to deliver the Medicines optimisation in care homes training pathway for 600 pharmacy professionals from April 2018 to March 2021. This was based on an open procurement process.

Read on to find out more about the structure and support provided throughout the training pathway.

Welcome

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Pathway contentThe content of the Medicines optimisation in care homes training pathway is written and reviewed by pharmacy professionals who are nationally recognised for their expertise. We collaborate with national organisations to deliver high-quality training.

We have involved patient and public representatives to ensure the learning focuses on the perspectives of people living in care homes and their carers. We test all of our learning programmes with pharmacy professionals before we finalise them.

For further information, visit: www.cppe.ac.uk

About CPPEThe Centre for Pharmacy Postgraduate Education (CPPE) is part of the Division of Pharmacy and Optometry at the University of Manchester.

We provide educational solutions for the NHS pharmacy workforce across England to maximise its contribution to improving patient care.

We are funded by Health Education England to offer continuing professional development for all pharmacists and pharmacy technicians providing NHS services in England.

Total staff: 135(FTE 57.05)

CPPE team135 members of staff

Support approximately

67,000 pharmacy professionals

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“The Medicines Optimisation in Care Homes programme will see pharmacists and pharmacy technicians trained to support older frailer people and other people living in care homes, to get the best from medicines and by doing so, reduce risk of harm, improve quality and save NHS and care home resources”. Dr Wasim Baqir, Lead Pharmacist, Medicines Optimisation in Care Homes programme

“The Care Quality Commission (CQC) understands that having pharmacy professionals in care homes promotes better use of medicines and improves people’s outcomes. CQC therefore supports the implementation of the training pathway to support pharmacy professionals in their role.” The Care Quality Commission

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Medicines optimisation in care homes training pathway

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The NHS England Medicines Optimisation in Care Homes programme is being funded through the Pharmacy Integration Fund (PhIF), the purpose of which is to develop schemes to integrate pharmacists and pharmacy technicians into the wider primary care workforce. This will improve access for patients, relieve the pressure on GPs and accident and emergency departments, ensure best use of medicines, drive better value and improve patient outcomes.

The 18-month Medicines optimisation in care homes training pathway has been developed to equip pharmacists and pharmacy technicians with the knowledge and skills

necessary to meet the objectives of the NHS England Medicines Optimisation in Care Homes programme.

These objectives include:

n achieving medicines optimisation for care home residents through access to a clinical pharmacy team with the supporting infrastructure

n ensuring that residents and/or their families or carers are given the opportunity to be fully involved in decisions about their medicines

n improving health outcomes for care home residents.

Experts

Wazim Baqir Lead Pharmacist, Medicines Optimisation in Care

Homes programme, NHS England

Anne Child Pharmacy and Dementia Specialist Lead at the Royal Masonic Benevolent Institution Care Company, and Specialist Advisor with the Care Quality Commission

Graham Stretch Senior Practice Pharmacist and Director of Pharmacy

Care Solutions, Chair PCPA Care Homes Group

Nisha Desai Clinical Practice Pharmacist. Previously worked as

Senior Clinical Pharmacist for Frail Elderly Services

at Northumbria HCFT, and worked in the Health

Foundation Shine Project

Marianne Tucker-Martin Care Homes Lead Pharmacist, South West

Healthcare GP Federation, Droitwich Spa. PCPA

GP Pharmacist of the Year 2018

Nicola Shaw Practice Clinical Support Pharmacist. MSc in

Clinical medication review for residents with learning

disabilities living in care homes and supported living

environments

Louise Winstanley Clinical Practice Pharmacist, Extensive Care Home

Experience. Member of development group for

NICE social care guideline 1

Helen Pinney Lead Pharmacy Technician, Pharmacy Care Solutions

Technician Lead PCPA Care Homes Group

These are some of the experts who have contributed to the development of the pathway.

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Structure of the pathwayThe Medicines optimisation in care homes training pathway offers modules which will be delivered at multiple locations across England. All modules include study days, learning sets and online learning.

Module 1 also includes a residential study course, which intends to create the opportunity for pharmacy professionals to network with each other and build strong collegiality to achieve success as part of the NHS England programme.

There are full-day workshops and study days that focus on specific clinical or professional development topics.

Online learning includes the tutor-supported Care homes: medicines optimisation essentials for pharmacy professionals e-course, self-directed study, enquiry-based learning and interactive webinars.

Modules also include learning sets, which consist of small groups of pharmacy professionals, usually in the same area, coming together to discuss agreed learning topics.

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Modules Length of module

Module 1: Essentials for medicines optimisation 13 weeks in care homes

Module 2: Clinical pharmacy knowledge and its 26 weeks application to people living in care homes

Module 3: Clinical assessment skills 13 weeks

Module 4: Leadership and management 13 weeks

Module 5: Choice of units for advanced 13 weeks skills development

Clinical pharmacists who are not independent prescribers will also complete an independent prescribing course towards the end of the training programme.

Overview of the pathway

The Medicines optimisation in care homes training pathway has a range of modules linked to learning outcomes. The pathway has been designed to meet the learning needs and experiences of both pharmacists and pharmacy technicians, while also recognising existing capabilities and offering learners a continuous, relevant learning experience.

The pathway consists of five modules. All modules are compulsory, and the final module offers a choice to the learner based on their learning and development needs, as well as their scope of practice.

The pathway includes a range of study methods to suit different learning styles and also includes three stages of assessment.

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* Independent prescribing (if required) will be studied towards or at the end of pathway

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Statement of assessment and progression (SoAP)

There will be a process at the end of the pathway to allow the learner to receive a statement of assessment and progression which will measure their progression in their role and their progression with the learning and assessments.

Assessment stage 3

n Case-based discussion (CbD)

n MSF and reflective essay

n Consultation skills direct observation of practice using the medication-related consultation assessment tool (MR-CAT)

There are three stages of assessment during the Medicines optimisation in care homes training pathway.

Assessment stages

Assessment stage 1

n Safeguarding children and vulnerable adults Level 2 e-assessment

n Care homes: medicines optimisation essentials for pharmacy professionals e-assessment

n Consultation skills e-assessment

n e-Learning for Healthcare (eLfH) Equality, Diversity and Human Rights e-assessment

n Completion of work-based learning workbook

Assessment stage 2

n Case-based discussion (CbD)

n Multisource feedback (MSF)

n Clinical examination and procedural skills assessment record (CEPSAR)

n Patient satisfaction questionnaire (PSQ) and reflective essay

Mix, meet and motivate – learn togetherAs well as taking part in online learning, pharmacy professionals on the Medicines optimisation in care homes training pathway will participate in a number of study days and learning sets, which are part of the core pathway learning. They will have the opportunity to hear about, and learn from, a wide variety of peers in a local group facilitated by a CPPE education supervisor.

Each module will have a number of study days and learning sets covering many different aspects of medicine optimisation

in care homes. These days will introduce the concept of frailty, polypharmacy and deprescribing and cover clinical conditions such as type 2 diabetes and end-of-life care. The days will also cover concepts such as leadership to equip the pharmacy professionals with strong leadership skills to ensure that safe, effective and outcome-focused care is implemented. Our study days will also offer pharmacy professionals practical training to help support care home staff to give the best possible person-centred care.

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AssessmentCase-based discussions

The case-based discussion (CbD) assessments have been designed to assess pharmacy professionals undertaking the patient-facing clinical role described in the Medicines Optimisation in Care Homes programme.1 The CbD is a retrospective structured discussion, designed to assess the pharmacy professional’s input into patient care. Clinical mentors assess the CbDs in the learning sets and have completed CbD assessor training through CPPE.

The CbD encourages pharmacy professionals to reflect on practice and allows peers and the clinical mentor to ask questions

around different areas, such as professional judgement, clinical decision-making and the application of pharmaceutical knowledge in patient care.

Multisource feedback

The CPPE multisource feedback (MSF) tool will collect pharmacy professionals’ colleagues’ opinions on their overall professionalism and (where appropriate) clinical performance to identify areas of development. Pharmacy professionals will receive a report of their collated feedback and will reflect on it with their education supervisors. They will then identify actions to address development areas and include these in their personal development plan (PDP).

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Clinical examination and procedural skills record (CEPSAR)

The clinical examination and procedural skills assessment record provides a framework for pharmacy professionals to demonstrate and reflect on their clinical examination and procedural skills. Once deemed competent to perform these assessments skills, pharmacy professionals will reflect on their practice and describe the steps that they have taken to improve their skills and how they have applied their learning to practice, providing an action plan for further development.

Consultation skills direct observation of practice (MR-CAT)

Good consultation skills are essential to delivering medicines optimisation in care homes. Pharmacy professional’s consultation skills will be assessed using the medication-related consultation assessment tool. Completing this assessment on two separate occasions will help pharmacy professionals to check their progress and ability to meet the Consultation skills for pharmacy practice: practice standards for England.2

Passing the assessment will provide assurance to individual pharmacy professionals delivering the service, people who live in care homes, colleagues and

other healthcare professionals within the wider multidisciplinary team that pharmacy professionals are able to recognise both good practice and practice that could be improved. This assessment will provide pharmacy professionals with detailed feedback on how they structure a consultation, areas of commendation and areas to develop.

Patient satisfaction questionnaire (PSQ)

The PSQ will provide pharmacy professionals with feedback from people who live in care homes and their relatives or carers on key consultation skills. The PSQ consists of ten statements about key consultation skills and behaviours, including how empathy is demonstrated, relationship-building and to what degree the pharmacy professional takes a person-centred approach. Residents, carers and family members are asked to rate these skills and behaviours using a seven-point scale from ‘poor’ to ‘outstanding’.

The PSQ is based on the Royal College of General Practitioners (RCGP) patient satisfaction questionnaire (PSQ).3 We have adapted the RCGP PSQ questionnaire for pharmacy to provide a unique and valuable perspective on how to improve practice in the care home setting.

“Some of my strongest feedback said I made people feel at ease, would really listen to them, and explained things clearly. This feedback has given me confidence and I’m very pleased as I think using a good bedside manner and simple language to give people the opportunity to make informed decisions on their health are my strengths. Some of the comments said that I help people to understand things they haven’t previously, make changes where they had problems and even that I listened when somebody said they didn’t want an intervention that I thought was beneficial made me appreciate how positive my role could be for people who live in care homes.” Clinical pharmacist working in a care home

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“My lightbulb moment was that I need to put the resident at the heart of everything we do.”Pharmacy professional at residential days 1 and 2

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A strong support structure underpins the learning pathway. Pharmacy professionals will benefit from clinical and educational support during their pathway. Support will be provided by a CPPE education supervisor, clinical mentor provided by CPPE and a clinical supervisor provided by the pharmacy professional’s employer.

Support structureCPPE

education supervisor

Clinical mentor

Clinical supervisor

Pharmacyprofessional

Education supervisorThe CPPE national team of education supervisors will ensure the pharmacists and pharmacy technicians have an effective learning experience throughout the pathway. The education supervisors will provide support to the pharmacy professional to develop their initial and ongoing education plan. Regular meetings take place with the education supervisor to review the pharmacy professional’s progress with the learning pathway, assessments and role progression. Education supervisors conduct professional discussions to support learning and reflection from the assessment process.

Clinical mentorClinical mentors are senior pharmacy professionals who will either have experience in working in a care home setting or relevant clinical responsibilities in a primary care position. Clinical mentors will provide group mentoring at the start of the pathway

to support pharmacy professionals to understand the safeguarding requirements in the care home environment and they will also assess case-based discussions during learning sets. The clinical mentor will provide support for role progression for pharmacy professionals on referral from the education supervisor.

Clinical supervisorEach pharmacy professional will have a named clinical supervisor provided by the employer, who will supervise them in the workplace, providing a rapid response to issues as they arise. The clinical supervisor will support role development and integration into the care home, and work with the pharmacy professional to ensure safe patient services and management of workload. They may act as an assessor when required and will provide feedback on progress to the education supervisor.

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“Thank you for the incredible content of the e-learning course and of the residential days. It’s a privilege to be part of this course. I have learnt more in the last eight weeks than I have in years!“

Pharmacy professional on the Medicines optimisation in care homes training pathway

It is intended that pharmacy professionals working as part of the NHS England Medicines Optimisation in Care Homes programme will be integrated into the wider health and social care system and they should be aligned to the Enhanced health in care homes framework.4

They must engage with the GP practices that are responsible for the primary healthcare of the patients and they should work alongside the clinical pharmacists working in general practice. They should be allowed access to the care home residents’ GP care records and

independent prescribing pharmacists should have access to prescribing capability with a supporting prescribing budget.

Pharmacy professionals working in care homes should work closely with local community pharmacies as well as other healthcare professionals providing care in care homes and local social care providers and commissioners.

Pharmacy professionals will also work closely with the wider health and social care teams to support people living in care homes to optimise their medicines fully.

Integration with the wider healthcare team

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1. NHS England. Medicines Optimisation in Care Homes programme overview. March 2018. www.england.nhs.uk/wp-content/uploads/2018/03/medicines-optimisation-in-care-homes-programme-overview.pdf

2. Consultation Skills for Pharmacy Practice. www.consultationskillsforpharmacy.com

3. Royal College of General Practitioners. PSQ for Workplace Based Assessment. www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba/psq-for-workplace-based-assessment.aspx

4. NHS England. The framework for enhanced health in care homes. September 2016. www.england.nhs.uk/publication/the-framework-for-enhanced-health-in-care-homes

References

For information on all our programmes and events:visit our website www.cppe.ac.uk

Share your learning experience with us:email us at feedback@cppe.ac.uk

Developed by:Funded by:

Contacting CPPEFor information on your orders or bookings, or any general enquiries, please contact us by email, telephone or post. A member of our customer services team will be happy to help you with your enquiry.

Email info@cppe.ac.uk

Telephone 0161 778 4000

By post Centre for Pharmacy Postgraduate Education (CPPE)Division of Pharmacy and Optometry1st Floor, Stopford BuildingThe University of ManchesterOxford RoadManchester M13 9PT