Designated Prescribing Practitioner

If you’re considering becoming a pharmacist prescriber, you need to find someone willing to act as a designated prescribing practitioner (DPP), or you are stuck!

Faheem Ahmed, award-winning pharmacist prescriber

Some background

I also struggled. Finding someone to act as a designated prescribing practitioner (DPP) was and still is an absolute nightmare. I spent over 2 years trying to find one, and since then, I have heard some horrific stories of pharmacists even paying DPPs. Look, I do not have an issue with paying to learn, but I do have a problem paying and NOT getting value in return!

MEDLRN helps you to find a Designated Prescribing Practitioner, please contact us.

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What is a designated prescribing practitioner?

A designated prescribing practitioner, or DPP, is a workplace-based supervisor who supports the pharmacist in the experiential part of the independent prescribing course. The DPP aids in ensuring that the pharmacist may safely and effectively prescribe medicines. In addition, the DPP can offer advice on prescription concerns and assist with any queries the pharmacist might have. Finally, while under the direct supervision of the DPP, the pharmacist is also able to provide patient care services.

What is the difference between a designated prescribing practitioner and a designated medical practitioner?

A designated medical practitioner (DMP) is a doctor or dentist who supports a student on an independent prescribing course (also known as a non-medical prescribing course).

However, a designated prescribing practitioner (DPP) includes doctors, dentists and other ‘non-medical’ professionals such as a nurse or a pharmacist, (amongst others) who can also support a student on a prescribing course.

The term designated medical practitioner has been replaced by designated prescribing practitioner because it encompasses a wider range of healthcare professionals who can act as supervisors.

Who can act as a designated prescribing practitioner for a non-medical prescribing course?

In 2018/19, professional regulatory changes have allowed for a wider variety of healthcare professionals to take on the role of the designated prescribing practitioner. This means that they can help supervise a pharmacist during their learning period for prescribing medicines. This includes doctors, dentists and other ‘non-medical’ prescribing professionals such as a nurse or pharmacists. Previously, the only professional who could act as a designated prescribing practitioner was a doctor or dentist.

The Royal Pharmaceutical Society (RPS) has worked on the development of a competency framework for this position. A DPP is defined as “a registered independent prescribing practitioner (medical/non-medical) who: Is registered by their professional regulator, with the necessary annotation to act as a non-medical prescriber.”

What is the selection criteria for a designated prescribing practitioner?

The following criteria should be met by those considering acting as a DPP:

  • is someone who has experience in prescribing medication to patients ie., is an active prescriber. This usually entails having at least three years of recent clinical experience in the relevant field. For medical prescribing professionals, this typically means working within a GP practice. Alternatively, they could be a specialist registrar, clinical assistant, or consultant within an NHS Trust or other NHS employer.
  • agrees to supervise, observe and assist the student in developing the prescribing competencies
  • has experience in teaching or training healthcare professionals
  • is supported by the employing organization to provide supervision and opportunities to develop competencies in prescribing

What is the role of the designated prescribing practitioner?

The role of the designated prescribing practitioner is to help pharmacists in training develop their independent prescribing practice.

They will have identified an area of clinical practice in which to focus, and will work closely with the pharmacist in order to ensure that they are able to prescribe safely and effectively. This includes providing support and advice, as well as monitoring the pharmacist’s prescribing practice.

The DPP will also be responsible for supervising, teaching, and assessing the pharmacist’s achievement of the necessary behaviors, skills, knowledge, and understanding to meet the learning outcomes and RPS prescribing competencies. This will ensure that the pharmacist is able to safely and effectively prescribe medications when they finish the course.

In addition, the DPP is in charge of assisting with the formal assessment procedures used on the course, as well as evaluating and certifying students’ competence to prescribe. To pass the course, both the DPP and pharmacist prescriber in training must work together at all levels: university, learning in practice setting(s), and pharmacist organizations.

What is learning in practice?

In general, learning in practice refers to the process of acquiring new skills or knowledge and using them in a practical setting.

One of the most important aspects of learning in practice is reflection. By reflecting on our own practice, we can identify areas for further development and improve our overall practice. There are a number of different reflective models which can be used to help structure our reflections, including the Gibbs Reflective Cycle and the Kolb Model.

Reflection is not simply about thinking about what we have done, it is also about considering how we feel about our practice. This may include exploring our values and beliefs and how they influence our work.

When it comes to learning in practice, there is no one-size-fits-all approach. What works for one person may not work for another, so it is important to find a method that works for you and that you are comfortable with. There is no right or wrong way to reflect, as long as you are taking the time to think about your practice and how you can improve it.

There are a number of different ways to learn in practice, including:

  • Reading articles and research papers on relevant topics
  • Attending workshops, seminars and conferences
  • Watching videos or listening to podcasts on related subjects
  • Discussing cases with other professionals
  • Taking online courses or eLearning modules
  • Engaging in learning communities or peer mentoring programmes
  • Shadowing other professionals
  • Volunteering in different settings

What is the role of learning in practice and the non medical prescribing course?

When it comes to learning in practice, the General Pharmaceutical Council (GPhC) believes that a successful independent prescribing course should aim to provide students with the necessary skills, knowledge and experience required to prescribe safely and effectively. In order to achieve this, GPhC recommends that courses should:

  • Provide students with an understanding of the legal and professional framework within which they will be working.
  • Enable students to develop their clinical skills and knowledge through both theoretical and practical sessions.
  • Offer opportunities for students to gain experience in prescribing under supervision.

By following these guidelines, GPhC believes that students will be well equipped to start practising as independent prescribers when they finish their course.

How many hours do I need to dedicate towards learning in practice?

It is a condition of the GPhC that the student spends 12 days (90 hours) in practice learning, during which he or she should collaborate with the DPP and other members of the multidisciplinary team to acquire attitudes, abilities, and competencies necessary for a prescriber.

The student’s Learning in Practice shadowing is intended to be linked to their future prescribing career, for patient groups and circumstances within the student’s scope of practice, as well as for which they are anticipated to prescribe and should help develop the necessary skills and competencies.

However, students are also expected to do shadowing in more extensive areas of practice in order to gain more practical experience. Learning in practice must be done in clinical surroundings with direct access to patients and should amount to at least 90 hours of study. Students may want to spend over 90 hours studying in practice.

Although it is not expected that the DPP will need to spend all 90 hours with the student, he or she should be willing and able to devote enough of his or her time to provide adequate support and assistance.

During Learning in Practice, the student may spend some of their time with members of the multidisciplinary team that aren’t involved in his or her clinical care. The university requires that at least 20 hours of the student’s Learning in Practice time be spent with a designated prescribing practitioner within the chosen scope of practice. At least 45 hours of learning in practice should be spent with your DPP.

What are the benefits of learning in practice?

One of the main objectives of the non-medical prescribing programme is to enable learners to develop the skills and knowledge required for safe and effective prescribing. It is therefore important that learners engage in reflective practice, which will allow them to critically appraise their own performance and make changes where necessary. The following are some of the key benefits of learning in practice:

  • Learners can apply the theory they have learned in a real-world setting, which can help them to understand it better.
  • Learners can receive feedback from professionals who are experienced in prescribing, which can help them to improve their practice.
  • Learners can develop their problem-solving skills and learn how to deal with difficult situations.
  • Learners can build their confidence and gain experience in prescribing.
  • Learners can network with other professionals and learn from their experiences.

The benefits of learning in practice are vast, and they can help learners to develop into safe and effective prescribers. It is therefore important that practitioners make the most of this valuable resource.

What is supervised practice?

At all times throughout their Learning in Practice time, a qualified healthcare professional must be in charge of a trainee pharmacist independent prescriber.

Supervision is defined as:

The supervising practitioner having the ability to observe and control the actions of the student at all times to verify that decision-making is sound, that patient safety is number one, and that other hazards are avoided. This should take into account the possibility of ‘unconscious incompetence’ in the student’s prescribing skills.

How can I find a designated prescribing practitioner?

I’ll tackle the concept of finding the right DPP later; let us look at how to find one. The first thing you need to understand is that COVID-19 has not helped and that many G.P. surgeries have their own pharmacists in-house. So if you read between the lines, what I am trying to say is; surgeries are not short of pharmacists. So with that in mind, you have to develop a strategy, and it is not hard. Just keep reading the steps below.

Don’t forget, MEDLRN helps all pharmacists to find a designated prescribing practitioner, contact us now before running out.

Step 1: Be clear about what you need

Before searching for a DPP, make sure you are aware of what it is you need. Think about the following; (1) how many hours do you need supervision (usually out of the 90 hours required, at least 45 hours should be with the DPP)? (2) Is the DPP suitable? This is not limited to the criteria set by the GPHC and the Competency Framework for Designated Prescribing Practitioners, but also most universities now require DPPs to have experience in teaching and require evidence of this ie, completion of the E-LfH educator training resources modules may suffice, (3) can the DPP provide you with a structure to ensure you get the best out of your learning within your scope of practice? We will talk more about this in future articles in more depth.

Step 2: What do you want from the DPP

If you think the DPP is there to ‘teach, think again. Do you really believe in 6 months, you can learn and be competent in diagnosing, managing, and treating disease?

Furthermore, the prescribing course is not designed to teach or for you to learn clinical skills. Instead, it is designed to build on your’ existing knowledge’. So, in simple terms, if you do not have the skills to take a thorough, structured patient history/consultation and examine body systems underpinned by an understanding of anatomy, physiology, and clinical medicine, you need to develop these skills first!

Moving on!

In my opinion, the DPP should provide you with a clear structure to enhance your existing skills, examples of which include; (1) allowing you to undertake patient consultations under their supervision, (2) observing and critique your examination skills, (3) providing feedback and (4) regular case-based discussions, so you are exposed to a range of clinical problems.

Step 3: Begin your search

With the above in mind, you can now start your search. 

I suggest you begin by contacting your local doctors directly asking for a callback. Literally, pick up the phone and ask the receptionist to message the G.P. regarding your course. But, before you do this, make sure you can demonstrate what the practice or G.P. will get in return (please don’t offer money because why pay if you can get it for free?); I have an example for you in step 4.

Step 4: Example of exchange in value

Don't forget, MEDLRN helps all pharmacists to find a designated prescribing practitioner, contact us now before running out.
Send an email to find a designated prescribing practitioner. Image source: Canva

You can use an example as an email or even as a pitch to the surgery/G.P. 

Dear XXX,

Thank you for your time earlier today. 

As explained I would like to undertake the Pharmacist independent prescribing course and have attached a document explaining the input that I would require from a G.P. surgery in order to complete the course.

As you are probably aware the benefits of having a pharmacist prescriber within the G.P. practice are well documented and include;

Reducing waiting times for appointments by offering a minor ailment clinic Responsibility for all prescription-related queries and undertaking clinical medicines reviews. What this would involve is tackling all medicine/prescribing queries that come in to the practice from patients and others such as hospital doctors or district nurses, and handle the numerous prescription requests that would have been sent to G.P.s

Take responsibility or advise on the business management of the dispensary
Identify and improve areas where the surgery is lacking with their QOF targets i.e., running clinics to improve patient health outcomes such as an asthma clinic or hypertension clinic etc

Save G.P. practice locum costs

The requirement for me to undertake the course is to identify an area to prescribe, i.e., uncomplicated hypertension stages 1,2 & 3, and I would need 12 days of study time within the surgery.

Just to clarify, the 12 days of study would be a discussion I would have with the G.P. and agree with my learning needs, i.e., some of the days I could sit within the G.P. surgery, and the remaining days I could do self study with the surgery. There is no set way of learning so I would like to make it as easy as possible without causing any disruption.

I have attached 2 documents of which the first documents explain the role of the G.P. within my study and the second outlines the benefits of having a pharmacist within a surgery.

If you were happy to help me undertake the prescribing course, I would like to give something back to the surgery and work as a volunteer on an agreed time frame which would be beneficial to the practice once I have qualified.

Thank you
XXXX

Step 5: Do not give up

The key to finding a DPP is no more than good old persistence. Remember, when one door closes, another opens. With this in mind, do not give up. If the local surgeries cannot help, then contact the out-of-hours clinicians. I have found them extremely helpful, and I am sure you will find the same.

Step 6: Consider working in general practice.

The Primary care pharmacy education pathway may be a suitable option for some but may not appeal to everyone and certainly would not appeal to me if the only reason I went into general practice was to gain my qualification. However, having said that, sometimes you do what you have to do!

Can I get funding for my non-medical prescribing course if I have a designated prescribing practitioner?

Non medical prescribing (NMP) courses are funded by a number of methods. Many NMP courses are paid for by health education england (HEE) across the North, and there are requirements that must be fulfilled in order to receive this funding (see below). This may include your organization’s or CCG’s permission to utilize their allocation of money. Employers can directly finance training courses.

What criteria must be satisfied to qualify for funding from health education England?

To be eligible for a HEE-funded place on a prescribing course, you must:

  • Be employed in or providing an NHS service where NMP may be used as part of the service (i.e., not private aesthetic services);
  • Have access to the designated prescribing practitioner
  • Meet the health education England admission criteria
  • Meet the requirements of the employer’s requirements

The moral of the story

In summary, there is no hard and fast rule for finding a DPP. Ultimately you need to build relationships and offer value in return. So stay positive and keep trying and never give up. 

As I mentioned earlier, it took me over 2 years to find a DPP, and although it was disheartening, I never gave up because there is a will, there is a way. 

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