National Competency Standards Framework for Pharmacists in ...

to the concept of competence is the inference of
assessment of performance in a given circumstance
against a specified external measure.
The Competency Standards in this National Framework
include performance criteria that specify the level of
performance expected of a competent pharmacist.
They focus only on key aspects of performance and
express what a competent professional would do in
terms of observable results or behaviours. This allows
the Competency Standards to serve as the external
measure of expected performance against which actual
performance can be assessed.
1.5.2 Defining ‘advanced’ practice
It is not intended to determine here how ‘advanced’
pharmacy practice will be identified and recognised.
That remains a future task for the pharmacy sector.
However, changes in practice and the practice
environment since the last review of the Competency
Standards have been considerable. It is therefore timely
to consider how the well accepted concept of ‘advanced’
pharmacy practice might be described or defined.
In a model of competence proposed by Miller 4
(refer to Figure 1 below) a distinction is made between
competence and performance. Under the model a
practitioner may be able to demonstrate competence
by being able to explain or show a professional
capability (‘knows’ or ‘shows how’) if required, but until
they integrate that capability as a regular part of their
practice (‘shows how’ and ‘does’) it cannot be seen as
performance. Under this scenario, it is possible for one
practitioner to demonstrate competence in a given scope
of practice as defined by the competency standards but
for another practitioner, who has accumulated expertise
through clinical experience, to demonstrate much
higher levels of performance across the same scope of
practice. For this reason it is inappropriate to try to define
‘advanced’ practice by relying exclusively on the use of
competency standards.
Figure 1: A simple model of competence
Professional authenticity
Does
Shows how
Knows how
Knows
Professional performance is a dimension of professional
practice that is underpinned by the expertise of the
individual. It exists as a continuum from the lowest to the
highest levels of professional performance. Progression
within the continuum is a function of sustained practice
and experience leading to enhanced expertise.
Within the performance continuum, usually observed
behaviours would be regarded as ‘general’ level
performance and the term ‘advanced’ performance
would be applied where professional practice behaviours
are beyond those usually observed. This concept
underpins the definition of advanced practice developed
by the Royal Pharmaceutical Society of Great Britain, 5
an adaptation of which appears below.
Advanced Practice is practice that is so significantly
different from that achieved at initial registration that
it warrants recognition by professional peers and
the public of the expertise of the practitioner and the
education, training and experience from which that
capability was derived.
A number of approaches have been used by different
health professions for describing ‘advanced’ practice.
The competency standards for advanced practice have
been described for nursing in Australia (enrolled nurse/
advanced enrolled nurse; registered nurse/advanced
registered nurse) using discrete sets of competencies.
A three level (foundation, excellence and mastery)
competency standard framework has been developed
for ‘advanced’ pharmacy practice in the UK by the
Competency Development and Evaluation Group.
The Group has also developed competencies for ‘general’
level practice but using a different competency set.
The Pharmaceutical Society of New Zealand developed,
in 1999, a single competency standard set to recognise
three levels of expertise by creating three performance
levels (Pharmacist, Practitioner Pharmacist and Specialist
Pharmacist). This concept was replaced in 2006 by a
new medicines management competence framework
developed by the Pharmacy Council of New Zealand
(see www.pharmacycouncil.org.nz/comp_framework).
The use of a single competency standard set is favoured
and seen as the logical way forward since it:
• reinforces the concept that it is performance rather
than scope of practice that determines whether
practice is ‘advanced’;
• is supportive of the view that expertise and
performance operate on a continuum;
• presents ‘advanced’ performance criteria in a manner
that is likely to be aspirational for pharmacists; and
• consolidates the value of the National Competency
Standards Framework for supporting and facilitating
professional practice and growth in the interests of
public safety.
1.5.3 Recognition of ‘advanced’ practice
The legislation supporting the operation of the national
health profession registration boards provides for a
number of different categories of registration, including
provisional, general and non-practising. Use of the term
‘specialist’ is strictly controlled under the legislation. While
some professions, most notably medicine and dentistry,
1
The Competency Standards Framework
4 Miller GE. The assessment of clinical skills/ competence/ performance.
Acad Med (Supp) 1990; 65:S63-7.
5 Royal Pharmaceutical Society of Great Britain. Pharmacy practice 2008:
medicines focussed and patient centred. Pharmacy Practice Framework.
February 2009. Available at: www.rpsgb.org.uk/pdfs/practiceframework.pdf
National Competency Standards Framework for Pharmacists in Australia 2010 5