La configuración del consentimiento en el RGPD

To meet the current and future challenges envisaged for the delivery of health and social care, health care professionals will need to ensure that the use of medicines is optimised to generate maximum benefit for patients and the best value from the money spent by the NHS. Pharmacists will play a key role in this and will be required to work more closely with patients and other healthcare professionals than is currently the norm. They will need to take a greater level of direct clinical responsibility for decisions about medicines prescribed and focus on the delivery of patient care, as well as improving the prescribing practice of others. They will need to be supported by pharmacy technicians who have undertaken the necessary training and competence assessment to enable them to complete tasks such as final

dispensing accuracy checking and medicines reconciliations safely and effectively.

With the shift of complex conditions from hospitals to primary care, medicines optimisation practice will need to become embedded outside secondary care. The development and implementation of advanced services in community pharmacy over the last decade such as the Medicines Use Review (MUR) Service and the New Medicines Service (NMS), aimed to improved adherence and help patients to maximise the benefits of their medicines,60 have started to shift the focus of community pharmacy practice away from medicines supply. Medicines optimisation will build on these services but require community pharmacists to spend more time with patients, in some cases outside the pharmacy, for example in GP practices, care homes and in their own homes. For them to be able to do this whilst also being responsible for the safe and effective running of a pharmacy, the ability to manage a team, allocate tasks appropriately, and to maintain appropriate levels of safety and quality through the implementation of quality systems, will be crucial.

At this stage, it is not clear how medicines optimisation policy will be implemented. The legislative framework relating to prescribing could be changed to allow pharmacists to make more changes to what is dispensed without referring back to the prescriber. Alternatively, medicines optimisation could require more pharmacists to register and practice as

independent prescribers. It is however, clear that more pharmacists will need to be able to demonstrate the competences needed to prescribe.61

Taking the National Prescribing Centre Single Prescribing Competency Framework as the starting point, it is clear that the “competency domain” for consulting (which includes the following competency statements:

• Knowledge: Has up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to own area of practice

• Options: Makes or reviews a diagnosis, generates management options for the patient and follows up management

• Shared decision making: (with patients care givers and advocates) Establishes a relationship based on trust and mutual respect and recognises patients as partners in the consultation),

could form the required competence domain for medicines optimisation.

60

Impact Assessment on the Introduction of the New Medicine Service, Department of Health, (2011):

Available: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_130234 [6 Mar 2012].

61 _{Single Prescribing framework (2012), National Prescribing Centre: Available:}

Pharmacists with a few years of experience, practising in either community, hospital or primary care pharmacy, will have developed expert practice in many aspects covered in the consulting domain. Many of the assessments and accreditations carried out to enable payment for provision of MURs and NMS services in community, and to allow progression from AfC band 6 to 7, relate to a number of the competency statements. However, none, with the exception of those qualified and practising as a prescriber, will have met them all and been assessed in the workplace as part of programme accredited by the GPhC.

5.1 Enhancing the skills of the pharmacy team in the delivery of public health messages

We do not see public health as a separate and additional competence domain. Pharmacists and pharmacy technicians should be able to identify and discuss health-related behaviours as an integral part of the sale and supply of medicines, as well as part of clinical practice. However, we recognise that work may be needed to enhance the confidence of pharmacists, pharmacy technicians and other members of the pharmacy team in delivering public health messages and, where appropriate, brief interventions as an integral part of all consultations. Delivery of public health advice is already included within the required learning outcomes for pharmacist independent prescribers.62 However, there may be a need to review the

underpinning professional and core knowledge required for consulting and to update accordingly to ensure an understanding of the public health context.

Proposal 2

We propose that the MPC Programme Board completes a detailed review of current post-registration learning, development and assessments relevant to the delivery of medicines optimisation and public health services.

This work should consider:

for the development of the current pharmacist workforce63:

• whether a standard assessment of core competencies can be designed and piloted to inform the development of a flexible learning and development programme to up-skill pharmacists in order to deliver comprehensive medicines optimisation;

• the most appropriate form of summative assessment to assure patients, the public, other healthcare professionals and employers and commissioners that pharmacists have the appropriate skills, knowledge and behaviours to deliver safe and effective optimisation of medicines and/or prescribing competence;

• the resources that will be required for the learning, development and assessments needed to deliver the medicines optimisation workforce;

• the number of pharmacists competent in medicines optimisation that will be needed to deliver a comprehensive service to all patients that need this level of care with their medicines, wherever they might need that care;

62 _{Pharmacist Independent Prescribing Programme. Indicative syllabus and Learning Outcomes, General}

Pharmaceutical Council (2010): Available:

http://www.pharmacyregulation.org/sites/default/files/Pharmacist%20Independent%20Prescribing%20- %20Learning%20Outcomes%20and%20Indicative%20Content.pdf

63

Proposal for the reform of pharmacists’ preregistration education and training, endorsed by Medical Education England (MEE) in June, 2011, will address the future pharmacist workforce.

for the development of pharmacy technicians:

• the learning and development needs of pharmacy technicians in relation to medicines management to support the delivery of medicines optimisation;

for pharmacists and pharmacy technicians:

• the leadership and management skills development needed within the two professions to maintain the safe and effective running of a pharmacy; and

for the development of the whole pharmacy team:

• the inclusion of teaching, learning and assessments relevant to delivery of public health messages within programmes to enhance the competence of the pharmacy team in consulting.64

This proposal is seen as an interim measure that will need to be reviewed again if undergraduate education and pre-registration training are reformed to deliver significant clinical focus65 and/or the prescribing legislation is developed and reformed.

64

This skillset is relevant to medicines optimisation too.

65 _{Pharmacist Prescriber Training Working Group Report for the MPC Programme Board Available:}