CPPE resource to support IPs to extend their scope of practice

As a qualified independent prescriber (IP), you will have a defined scope of prescribing competence. In the holding room after my OSCE, towards the end of my IP course, the conversation turned to scope of practice. As you progress in your career, you may wish to extend your scope of prescribing practice.

However, many in the post OSCE holding room, knew of other IPs in their organisation who put the task of extending their scope on the “too difficult pile.” This meant that either the person became an inactive prescriber, stuck to a limited scope of one condition and a three or four of medicines, or they completely disregarded their scope and prescribed widely beyond this. Everyone in the room agreed that none of these solutions were acceptable.

What was less certain from our discussion was how to extend your scope, in a way that was safe and also realistic and achievable. This is a conversation that I have had with experienced IPs too. The CPPE Extending the scope of prescribing practice online e-course, takes the learner through a process to create a portfolio of evidence. ?

The course considers key principles to consider when extending your scope of prescribing practice. It focuses on using the activities of reflection, peer review, assurance of competence and prescribing governance to support your approach to the learning and development of new clinical skills and expertise. The RPS Prescribing Competency Framework for all Prescribers is used thought out the course.

During the course learners meet Sarah Hale who has already extended her initial scope from hypertension to include other cardiovascular conditions. Sarah has now been asked to lead on medicines optimisation in the three large care homes. Using Sarah's situation as an example the course takes you through a process to extend your own scope.

I recently qualified as an IP with a scope of vaccines and travel. However, a key motivation for me was to be able to do prescribe for people with common acute conditions, for example those listed in the Delivery plan for recovering access to primary care. Although I do not (yet) have NHS funding, with the support of my employer, I wanted to start to offer this on an affordable private basis.

I knew that I already had the clinical examination skills necessary through the IP course and services that I already provided under PGD. I had also already written a formulary of medicines that I would prescribe and had discussed this with my superintendent pharmacist, an IP who is experienced in this area. I had undertaken informal case based discussion. I hadn’t considered including meetings with key stakeholders, including other staff that the pharmacy and at the local GP surgery within my portfolio of evidence. Nor had I considered asking pharmacists who shadowed me who have recently undertaken learning on shared decision to give me feedback on this area.

This course helped me to identify a learning need that I had not considered, using professional judgement to communicate effectively when patients asked me to go beyond my scope. I have been able to address this area in a reflective account and a peer discussion that I will use towards my GPhC revalidation.

For me the biggest gain of undertaking this course was to have a defined process by which to extend my scope that I could be confident in and to have a portfolio of evidence at the end of this course to demonstrate my competence. I had feared that compiling a portfolio of evidence would be an onerous task, however much of this work included activities that I had already planned to do or needed to do anyway as part of my revalidation.?