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Competency framework to meet the needs of all prescribers

By Jane Brown, PhD, MRPharmS, and Catherine Picton, MBA, MRPharmS

Since 2000, the healthcare professionals who have taken on prescribing responsibilities have been supported in the development of safe, effective prescribing practice by the publication of profession-specific prescribing competency frameworks.1 Developed by the National Prescribing Centre, these resources included frameworks for supplementary and independent pharmacist prescribers. (From last month the team delivering the work of the NPC now forms the NICE Medicines and Prescribing Centre and sits alongside the clinical guidelines team within the institute’s Centre for Clinical Practice.)

The implementation of nurse and pharmacist independent prescribing has been evaluated and it is seen as generally safe and accepted by patients.2 Prescribing rights have recently been extended to allow pharmacist and nurse independent prescribers to prescribe schedule 2 to 5 Controlled Drugs3 (see Box, PDF top right) and a recent Department of Health consultation proposed the extension of independent prescribing to physiotherapists and podiatrists.5,6

However, recent evidence demonstrating the risk to patient safety associated with poor prescribing practice serves as a reminder to all prescribers of the need to maintain their prescribing competency.4,7 To continue supporting prescribers in this, the NPC has produced a single prescribing competency framework for use by all prescribers, regardless of their professional background.

Why a single framework

Although NPC prescribing competency frameworks were previously published on a profession-specific basis, the development process consistently made use of multidisciplinary expertise. Over time it became clear that a common set of competencies underpins prescribing regardless of professional background.

Indeed, patients should expect the same quality of care regardless of the professional background of the person prescribing for them. The single competency framework provides an outline of common prescribing competencies that, if acquired and maintained, can help all prescribers to become and remain effective prescribers in their area of practice.

How it was developed

The existing prescribing frameworks were consolidated and updated to produce a generic framework applicable for any prescriber — doctor, dentist or non-medical. This process was supported by a steering group with representation from across all the independent prescribing professions. The framework was validated by a focus group of existing prescribers from across the professional groups and patients. Its usability and implementation were tested by a second multidisciplinary focus group.

For supplementary prescribers several modifications and additions were made to the framework related to the nature of the supplementary prescribing partnership.

The need for context

The single prescribing competency framework is relevant to all prescribers. However, the framework should be interpreted in the context in which individuals are prescribing, taking into account their scope of practice. This means that the framework will be put into context by the different professional groups. For pharmacists this could mean that the framework is developed and adapted for prescribers practising in different clinical areas, for example paediatrics, intensive care or chronic disease management.

To support the framework’s dissemination and implementation, and to help put it into context, an external reference group of professional regulators, professional bodies, education providers and other stakeholders was established. Pharmacy representatives included the General Pharmaceutical Council and the Royal Pharmaceutical Society.

Using the framework

NPC prescribing competency frameworks have been validated repeatedly and used extensively in practice. The frameworks can be used to:

  • Support continuing professional development of prescribers and help them identify strengths and areas for development through self-assessment, appraisal and structured feedback from colleagues
  • Inform curricula and the development of the postgraduate training required by non-medical prescribers
  • Support staff development processes within organisations, including assessment of training needs and appraisal
  • Help healthcare professionals prepare to prescribe and provide the basis for ongoing education and development programmes and revalidation processes (eg, used as a framework for a portfolio to demonstrate prescribing competency)
  • Provide professional organisations or specialist groups with a basis for the development of levels of prescribing competency (eg, from recently qualified prescriber through to advanced prescriber)

Framework design

The competency framework sets out what good prescribing looks like. There are three domains, each containing three dimensions of competency (nine in total). Each of the nine dimensions contains statements which describe the activity or outcomes prescribers should be able to demonstrate. The figure above illustrates the structure of the framework.

The framework has been published with tips to support its use. A Microsoft Word version of the competency statements is also available for users to add comments or evidence about how they can demonstrate they have achieved each area of competency.

The framework can be found at


1    National Prescribing Centre. Prescribing competency frameworks. (accessed 14 May 2012).
2    Latter S, Blenkinsopp A, Smith A, et al. Evaluation of nurse and pharmacist independent prescribing. October 2010. (accessed 14 May 2012).
3    HM Government. Misuse of Drugs (Amendment No 2) (England, Wales and Scotland) Regulations 2012. (accessed 14 May 2012).
4    Cousins D, Gerrett D, Warner B. A review of medication incidents reported to the National Reporting and Learning System in England and Wales over six years (2005–2010). British Journal of Clinical Pharmacology 2011 (online).
5    Doran T, Ashcroft D, Heathfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. December 2009.
causes_of_prescribing_errors.pdf_28935150.pdf (accessed 14 May 2012).
6    Avery A, Barber N, Ghaleb M, et al. Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe study. A report for the GMC. May 2012.
May_2012_48605085.pdf (accessed 14 May 2012).
7    National Patient Safety Agency. Rapid response report: reducing dosing errors with opioid medicines. July 2008. (accessed 14 May 2012).

Citation: Clinical Pharmacist URI: 11102020

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Supplementary images

  • The nine dimensions of prescribing competency

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