A Competency Framework

for all Prescribers

PUBLISHED: SEPTEMBER 2021

E F F E C T I V E DAT E : S E P T E M B E R 2 0 2 2

R E V I E W DAT E : S E P T E M B E R 2 0 2 6
Contents
INTRODUCTION3

P U R P O S E4

S C O P E5
To support the effective and timely
implementation of this framework, organisations,
healthcare professional regulators, higher T H E C O M P E T E N CY F R A M E WO R K
education institutes and individuals will have FO R A L L P R E S C R I B E R S  6
until September 2022 as a transition period
to fully implement the framework in practice.
G LO S S A RY  2 1
However, higher education institutes and other
organisations are encouraged to implement and
embed the framework as soon as possible. REFERENCES23

AC K N OW L E D G E M E N T S  2 4

2
1
Introduction
Doctors are by far the largest group of prescribers, For further information on the 2021 update including
who along with dentists, are able to prescribe on why and how it was updated, and the changes
registration. They have been joined by non-medical made, please see the RPS website here:
independent and supplementary prescribers from https://www.rpharms.com/cfap
a range of other healthcare professions, who are
able to prescribe within their scope of practice
once they have completed an approved education
programme. This extension of prescribing
responsibilities to other professional groups is likely
to continue where it is safe to do so and there is a
clear patient benefit.

To support all prescribers in prescribing safely

and effectively, a single prescribing competency
framework was published by the National
Prescribing Centre/National Institute for Health and
Care Excellence (NICE) in 2012 1 . Based on earlier
profession-specific prescribing competency
2,3,4,5,6,7
frameworks , the 2012 single prescribing
competency framework 1 was developed because it
became clear that a common set of competencies
should underpin prescribing, regardless of
professional background.

NICE and Health Education England approached

the Royal Pharmaceutical Society (RPS) to manage
the update of the framework on behalf of all
the prescribing professions in the UK. The RPS
agreed to revise and update the framework in
collaboration with the other prescribing professions
and members of the public. The Competency
Framework for all Prescribers was first published
by the RPS in July 2016. Going forward, the RPS will
continue to maintain and publish this framework
for all regulators, professional bodies, education
providers, prescribing professions and patients/
carers to use.

3
 This framework can be used to:

2 • Bring professions together and harmonise

education for prescribers by offering a

Purpose •
competency framework for all prescribers.

Inform the design and delivery of education

This competency framework has been developed programmes, for example, through validation

and updated to support prescribers in expanding of educational sessions (including rationale for

their knowledge, skills, motives and personal traits, need), and as a framework to structure learning

to continually improve their performance, and and assessment.

work safely and effectively. When acquired and • Help healthcare professionals prepare to
maintained, the prescribing competencies in this prescribe and provide the basis for on-going
framework will help healthcare professionals to be continuing education and development
safe and effective prescribers who support patients programmes, as well as revalidation processes.
in getting the best outcomes from their medicines. For example, use as a framework for a portfolio
This framework has been developed for multi- to demonstrate continued competency in
professional use and provides the opportunity to prescribing.
bring prescribing professions together to ensure • Help prescribers identify strengths and areas
consistency in the competencies required of all for development through self-assessment,
healthcare professionals carrying out the same appraisal and as a way of structuring feedback
role. from colleagues.

This framework can be used by various groups: • Provide professional organisations or specialist
groups with a basis for the development of
• It can be used by any prescriber at any
levels of prescribing competency, from ‘recently
point in their career to underpin professional
qualified prescriber’ through to ‘experienced
responsibility for prescribing.
prescriber’.
• Prescribers can use the framework as a self-
• Stimulate discussions around prescribing
assessment tool when expanding scope
competencies and multidisciplinary skill mix at
of practice, changing scope of practice or
an organisational level.
returning to practice.
• Inform organisational recruitment processes
• Regulators, education providers, professional
to help frame questions and benchmark
organisations and specialist groups can use
candidates’ prescribing experience.
it to inform standards, the development of
education, and to inform guidance and advice. • Inform the development of organisational
systems and processes that support safe and
• Individuals and their organisations can use it to
effective prescribing. For example, local clinical
analyse the way they do their jobs.
governance frameworks.
• Prescribing trainees can evidence the
• Inform the development of education curricula
framework to demonstrate they are delivering
and relevant accreditation of prescribing
the competencies required of their role.
programmes for all prescribing professions.

• Inform and assure patients/carers about the

competencies of a safe and effective prescriber.

Further examples of uses of the framework in

practice can be found on the RPS website here:
https://www.rpharms.com/cfap

4
 General scope of the framework:

3 • It is a generic framework for any prescriber

regardless of their professional background or

Scope setting. Therefore, it does not contain statements

that relate to specialist areas of prescribing.

• It must be contextualised to reflect different

areas of practice, levels of expertise and
settings.

• It reflects the key competencies needed by

all prescribers; it should not be viewed as a
curriculum but rather the basis on which one
can be built.

• It applies equally to independent prescribers,

community practitioner nurse prescribers
and supplementary prescribers, but the latter
should contextualise the framework to reflect
the structures imposed when entering a
supplementary prescribing relationship.

5
 This competency framework for all prescribers

4
sets out what good prescribing looks like. Its
implementation and maintenance are important

The Competency
in informing and improving practice, development,
standard of care and safety (for both the prescriber

Framework for all

and patient).

Prescribers are encouraged to use their own

Prescribers professional codes of conduct, standards and

guidance alongside this framework. Prescribers
are also responsible for practising within their own
scope of practice and competence, including
delegating where appropriate, seeking support
when required and using their acquired knowledge,
skills and professional judgement.

It is important to recognise that healthcare

professionals need to apply professionalism
to all aspects of their practice. The principles
of professionalism are the same across the
professions and these are behaviours that
healthcare professionals should always be
demonstrating, not just for prescribing. There are
elements of wider professional practice that will
impact on how healthcare professionals behave
when they prescribe. These include the importance
of maintaining a patient-centred approach
when speaking to patients/carers, maintaining
confidentiality, communication skills, leadership,
the need for reflection, maintaining competency
and continuing professional development, and the
importance of forming networks for support
and learning.

6
STRUCTURE OF THE FRAMEWORK PLEASE NOTE

• The framework competencies and supporting

DOMAINS statements are not in any particular order.
The numbering is mainly to support mapping
The competencies within the framework are
purposes and does not reflect the level of
presented as two domains and describe the
importance of the statement. They are not
knowledge, skill, behaviour, activity, or outcome that
designed to be used as a script or in isolation
prescribers should demonstrate:
as they may overlap with others.
Domain one - the consultation
• Due to the generic nature of the framework,
This domain looks at the competencies that
it may be that not every competency or
the prescriber should demonstrate during the
supporting statement is relevant to your
consultation.
practice or setting. However, you should still be
Domain two - prescribing governance able to consider how you could demonstrate
This domain focuses on the competencies that the supporting statement.
the prescriber should demonstrate with respect to
prescribing governance.
F U R T H E R I N F O R M AT I O N

The further information sections under each

CO M PE TE N CY AN D S U PPO R TI N G
competency provide prescribers with information
S TAT E M E N T S
and examples (list not exhaustive or definitive),
Within the two domains there are ten which provide clarity and meaning to the
competencies, as shown in Figure 1. supporting statements. The recommendation
for this framework is to use it alongside any
Each of these competencies contains several
relevant further information sections to support
supporting statements related to the prescriber
implementation into practice.
role which describe the activity or outcome
that the prescriber should actively and routinely For further supporting resources, please see the
demonstrate. RPS website here: https://www.rpharms.com/cfap

Figure 1:
The Competency Framework for all Prescribers

PRESCRIBING
 T H E C O N S U LTAT I O N
GOVER NANCE

1. Assess the patient 7. Prescribe safely

PR ESCR I B I NG GOVER NANCE

2. Identify evidence-based 8. Prescribe professionally

T H E C O N S U LTAT I O N

treatment options
9. Improve prescribing
available for clinical
practice
decision making
DOMAIN 2
DOMAIN 1

10. Prescribe as part of

3. Present options and
PAT I E N T a team
reach a shared decision

4. Prescribe

5. Provide information

6. Monitor and review

7
The

1
Consultation
1. A S S E S S T H E PAT I E N T

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

1.1. Undertakes the consultation in an appropriate setting a .

1.2. Considers patient dignity, capacity, consent and confidentiality b .

1.3. Introduces self and prescribing role to the patient/carer and confirms patient/carer identity.

1.4. Assesses the communication needs of the patient/carer and adapts c consultation appropriately.

1.5. Demonstrates good consultation skills d and builds rapport with the patient/carer.

1.6. Takes and documents an appropriate medical, psychosocial and medication historye including allergies
and intolerances.

1.7. Undertakes and documents an appropriate clinical assessment f .

1.8. Identifies and addresses potential vulnerabilities g that may be causing the patient/carer to seek
treatment.

1.9. Accesses and interprets all available and relevant patient records to ensure knowledge of the patient’s
management to date.

1.10. Requests and interprets relevant investigations necessary to inform treatment options.

1.11. Makes, confirms or understands, and documents the working or final diagnosis by systematically
considering the various possibilities (differential diagnosis).

1.12. Understands the condition(s) being treated, their natural progression, and how to assess their severity,
deterioration and anticipated response to treatment.

1.13. Reviews adherence (and non-adherence h) to, and effectiveness of, current medicines.

1.14. Refers to or seeks guidance from another member of the team, a specialist or appropriate information
source when necessary.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 1

a. Appropriate setting includes location, environment and medium.

b. In line with legislation, best practice, regulatory standards and contractual requirements.

c. Adapts for language, age, capacity, learning disability and physical or sensory impairments.

d. Good consultation skills include actively listening, using positive body language, asking open questions,
remaining non-judgemental, and exploring the patient's/carer's ideas, concerns and expectations.

e. Medication history includes current and previously prescribed (and non-prescribed) medicines, vaccines,
on-line medicines, over-the-counter medicines, vitamins, dietary supplements, herbal products,
complementary remedies, recreational/illicit drugs, alcohol and tobacco.

f. Clinical assessment includes observations, psychosocial assessments and physical examinations.

g. Safeguarding children and vulnerable adults (possible signs of abuse, neglect, or exploitation), and
focusing on both the patient’s physical and mental health, particularly if vulnerabilities may lead them to
seek treatment unnecessarily or for the wrong reasons.

h. Non-adherence may be intentional or non-intentional.

9
2. I D E N T I F Y E V I D E N C E - B A S E D T R E AT M E N T O P T I O N S AVA I L A B L E F O R C L I N I C A L
DECISION MAKING

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

2.1. Considers both non-pharmacological a and pharmacological treatment approaches.

2.2. Considers all pharmacological treatment options including optimising doses as well as stopping
treatment (appropriate polypharmacy and deprescribing).

2.3. Assesses the risks and benefits to the patient of taking or not taking a medicine or treatment.

2.4. Applies understanding of the pharmacokinetics and pharmacodynamics of medicines, and how these
may be altered by individual patient factors b .

2.5. Assesses how co-morbidities, existing medicines, allergies, intolerances, contraindications and quality of
life impact on management options.

2.6. Considers any relevant patient factors c and their potential impact on the choice and formulation of
medicines, and the route of administration.

2.7. Accesses, critically evaluates, and uses reliable and validated sources of information.

2.8. Stays up to date in own area of practice and applies the principles of evidence-based practice d .

2.9. Considers the wider perspective including the public health issues related to medicines and their use, and
promoting health.

2.10. Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial
stewardship measures.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 2

a. Non-pharmacological treatment approaches include no treatment, social prescribing and wellbeing/

lifestyle changes.

b. Individual patient factors include genetics, age, renal impairment and pregnancy.

c. Relevant patient factors include ability to swallow, disability, visual impairment, frailty, dexterity, religion,
beliefs and intolerances.

d. Evidence-based practice includes clinical and cost-effectiveness.

10
3. PRESE NT OPTIONS AN D RE ACH A SHARE D DECISION

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

3.1. Actively involves and works with the patient/carer to make informed choices and agree a plan that
respects the patient’s/carer’s preferences a .

3.2. Considers and respects patient diversity, background, personal values and beliefs about their health,
treatment and medicines, supporting the values of equality and inclusivity, and developing cultural
competence. b

3.3. Explains the material risks and benefits, and rationale behind management options in a way the
patient/carer understands, so that they can make an informed choice.

3.4. Assesses adherence in a non-judgemental way; understands the reasons for non-adherence c and how
best to support the patient/carer .

3.5. Builds a relationship which encourages appropriate prescribing and not the expectation that a
prescription will be supplied.

3.6. Explores the patient's/carer's understanding of a consultation and aims for a satisfactory outcome for the
patient/carer and prescriber.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 3

a. Preferences include patient's/carer's right to decline or limit treatment.

b. In line with legislation requirements which apply to equality, diversity and inclusion.

c. Non-adherence may be intentional or non-intentional.

11
4. PRESCRIBE

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

4.1. Prescribes a medicine or device a with up-to-date awareness of its actions, indications, dose,
contraindications, interactions, cautions and adverse effects.

4.2. Understands the potential for adverse effects and takes steps to recognise, and manage them, whilst
minimising risk.

4.3. Understands and uses relevant national, regional and local frameworks b for the use of medicines.

4.4. Prescribes generic medicines where practical and safe for the patient, and knows when medicines should
be prescribed by branded product.

4.5. Accurately completes and routinely checks calculations relevant to prescribing and practical dosing.

4.6. Prescribes appropriate quantities and at appropriate intervals necessaryc to reduce the risk of
unnecessary waste.

4.7. Recognises potential misuse of medicines; minimises risk d and manages using appropriate processes.

4.8. Uses up-to-date information about the availability, pack sizes, storage conditions, excipients and costs of
prescribed medicines.

4.9. Electronically generates and/or writes legible, unambiguous and complete prescriptions which meet legal
requirements.

4.10. Effectively uses the systems e necessary to prescribe medicines.

4.11. Prescribes unlicensed and off-label medicines where legally permitted, and unlicensed medicines only if
satisfied that an alternative licensed medicine would not meet the patient's clinical needs.

4.12. Follows appropriate safeguards if prescribing medicines that are unlicensed, off-label, or outside standard
practice.

4.13. Documents accurate, legible and contemporaneous clinical records f .

4.14. Effectively and securely communicates information g to other healthcare professionals involved in the
patient's care, when sharing or transferring care and prescribing responsibilities, within and across all
care settings.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 4

a. ‘Medicine’ or ‘device’ includes all products (including necessary co-prescribing of infusion sets, devices,
diluents and mediums) that can be prescribed, supplied or recommended for purchase.

b. Frameworks include local formularies, care pathways, protocols and professional guidelines, as well as
evidence-based guidelines from relevant national, regional and local committees.

c. Amount necessary for a complete course, until next review or prescription supply.

d. Minimises risk by ensuring appropriate safeguards are in place.

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e. Systems include medicine charts, decision support tools and electronic prescribing systems. Also,
awareness and avoidance of potential system errors.

f. Records include prescribing decisions, history, diagnosis, clinical indications, discussions, advice given,
examinations, findings, interventions, action plans, safety-netting, referrals, monitoring and follow ups.

g. Information about clinical conditions, medicines and their current use (where necessary and with valid
consent). Ensuring that private and personal data is protected and communicated securely in line with
relevant legislation/regulations.

13
5. P R O V I D E I N F O R M AT I O N

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

5.1. Assesses health literacy of the patient/carer and adapts appropriately to provide clear, understandable
and accessible information a .

5.2. Checks the patient's/carer's understanding of the discussions had, actions needed and their commitment
to the management plan b .

5.3. Guides the patient/carer on how to identify reliable sources c of information about their condition,
medicines and treatment.

5.4. Ensures the patient/carer knows what to do if there are any concerns about the management of their
condition, if the condition deteriorates or if there is no improvement in a specific timeframe. d

5.5. Encourages and supports the patient/carer to take responsibility for their medicines and self-manage
their condition.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 5

a. Information about their management, treatment, medicines (what they are for, how to use them, safe
storage, disposal, expected duration of treatment, possible unwanted effects and what to do if they arise)
monitoring and follow-up—in written and/or verbal form.

b. Management plan includes treatment, medicines, monitoring and follow-up.

c. Reliable sources include the medicine’s patient information leaflet.

d. Includes safety-netting advice on when and how to seek help through appropriate signposting and
referral.

14
6. MONITOR AND REVIEW

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

6.1. Establishes and maintains a plan for reviewing a the patient's treatment.

6.2. Establishes and maintains a plan to monitor b the effectiveness of treatment and potential unwanted
effects.

6.3. Adapts the management plan in response to on-going monitoring and review of the patient's condition
and preferences.

6.4. Recognises and reports suspected adverse events to medicines and medical devices using appropriate
reporting systems c .

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 6

a. Plan for reviewing includes safety-netting appropriate follow-up or referral.

b. Plan for monitoring includes safety-netting monitoring requirements and responsibilities, for example, by
the prescriber, patient/carer or other healthcare professional.

c. Reporting systems include following established clinical governance procedures and the Medicines and
Healthcare products Regulatory Agency (MHRA) Yellow Card scheme.

15
 2
Prescribing
Governance
7. P R E S C R I B E S A F E LY

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

7.1. Prescribes within own scope of practice, and recognises the limits of own knowledge and skill.

7.2. Knows about common types and causes of medication and prescribing errors, and knows how to
minimise their risk.

7.3. Identifies and minimises potential risks associated with prescribing via remote methods a .

7.4. Recognises when safe prescribing processes are not in place and acts to minimise risks b .

7.5. Keeps up to date with emerging safety concerns related to prescribing.

7.6. Reports near misses and critical incidents, as well as medication and prescribing errors using appropriate
reporting systems, whilst regularly reviewing practice c to prevent recurrence.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 7

a. Remote methods include telephone, email, video or communication via a third party.

b. Minimising risks include using or developing governance processes that support safe prescribing,
particularly in areas of high risk such as transfer of information about medicines and prescribing of repeat
medicines.

c. Reviewing practice include clinical audits.

17
8. P R E S C R I B E P R O F E S S I O N A L LY

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

8.1. Ensures confidence and competence to prescribe are maintained.

8.2. Accepts personal responsibility and accountability for prescribing a and clinical decisions, and
understands the legal and ethical implications.

8.3. Knows and works within legal and regulatory frameworks b affecting prescribing practice.

8.4. Makes prescribing decisions based on the needs of patients and not the prescriber’s personal views.

8.5. Recognises and responds to factors c that might influence prescribing.

8.6. Works within the NHS, organisational, regulatory and other codes of conduct when interacting with the
pharmaceutical industry.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 8

a. Prescribing decisions include when prescribing under a shared care protocol/agreement.

b. Frameworks for prescribing controlled drugs, unlicensed and off-label medicines, supplementary
prescribing, and prescribing for self, close family and friends.

c. Factors include interactions with pharmaceutical industry, media, patients/carers, colleagues, cognitive
bias, financial gain, prescribing incentive schemes, switches and targets.

18
9. I M PROVE PR ESCRI B I NG PR ACTICE

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

9.1. Improves by reflecting on own and others’ prescribing practice, and by acting upon feedback and
discussion.

9.2. Acts upon inappropriate or unsafe prescribing practice using appropriate processes a .

9.3. Understands and uses available tools b to improve prescribing practice.

9.4. Takes responsibility for own learning and continuing professional development relevant to the prescribing
role. c

9.5. Makes use of networks for support and learning.

9.6. Encourages and supports others with their prescribing practice and continuing professional
development. d

9.7. Considers the impact of prescribing on sustainability, as well as methods of reducing the carbon footprint
and environmental impact of any medicine. e

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 9

a. Processes include whistleblowing, regulatory and professional guidance, and employer procedures.

b. Tools include supervision, observation of practice and clinical assessment skills, portfolios, workplace
competency-based assessments, questionnaires, prescribing data analysis, audits, case-based
discussions, personal formularies and actively seeking regular patient and peer feedback.

c. By continuously reviewing, reflecting, identifying gaps, planning, acting, applying and evidencing learning
or competencies.

d. By considering mentoring, leadership and workforce development (for example, becoming a Designated
Prescribing Practitioner).

e. Methods of reducing a medicine’s carbon footprint and environmental impact include proper disposal
of medicine/device/equipment waste, recycling schemes, avoiding overprescribing and waste through
regular reviews, deprescribing, dose and device optimisation.

19
1 0 . P R E S C R I B E A S PA R T O F A T E A M

S TAT E M E N T S S U P P O R T I N G T H E C O M P E T E N CY

10.1. Works collaborativelya as part of a multidisciplinary team to ensure that the transfer and continuity of
care (within and across all care settings) is developed and not compromised.

10.2. Establishes relationships with other professionals based on understanding, trust and respect for each
other’s roles in relation to the patient's care.

10.3. Agrees the appropriate level of support and supervision for their role as a prescriber.

10.4. Provides support and advice b to other prescribers or those involved in administration of medicines where
appropriate.

F U R T H E R I N F O R M AT I O N O N T H E S U P P O R T I N G S TAT E M E N T S F O R C O M P E T E N CY 1 0

a. Working collaboratively may also include keeping the patient/carer informed or prescribing under a
shared care protocol/agreement.

b. Advice may include any specific instructions for administration, advice to be given to the patient/carer
and monitoring required immediately after administration.

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5
Glossary
Adherence: Adherence presumes an agreement Independent prescriber: A prescribing healthcare
between prescriber and patient about the professional who is responsible and accountable
prescriber’s recommendations. Adherence to for the assessment of patients with undiagnosed
medicines is defined as the extent to which or diagnosed conditions and for decisions about
the patient’s action matches the agreed the clinical management required, including
recommendations. Non-adherence may limit prescribing.
the benefits of medicines, resulting in lack of
Material risk: According to the Montgomery ruling,
improvement or deterioration in health. 8
a material risk occurs if “a reasonable person in
Antimicrobial stewardship: An organisational or the patient's position would be likely to attach
healthcare-system-wide approach to promoting significance to it, or if the doctor is or should
and monitoring judicious use of antimicrobials to reasonably be aware that their patient would be
preserve their future effectiveness. 9 likely to attach significance to it”. 13 This is applicable
to all prescribing professionals. All prescribers have
Carer: A person who provides support and
a duty of care to ensure that their patient is aware
assistance, be that formal or informal, with various
of any material risks involved in proposed treatment
activities to patients. This may be emotional or
and of reasonable alternatives.
financial support, as well as hands-on help with
a range of tasks. Carer, in this document, is also Non-medical prescriber (NMP): This term
an umbrella term used to cover parents, legal encompasses healthcare professionals (excluding
guardians, patient advocates or representatives, doctors and dentists) working within their
including paid and unpaid carers. 10 clinical competence as an independent and/
or supplementary prescribers or community
Competency framework: A structure which
practitioner nurse prescribers. 13 Further information
describes the competencies (demonstrable
on the types of non-medical prescriber and what
knowledge, skills, characteristics, qualities and
they can prescribe can be found in the British
behaviours) central to a safe and effective
National Formulary (BNF).
performance in a role. 11
Off-label: Using a licensed medicinal product
Deprescribing: The process of stopping or reducing
outside the terms of its marketing authorisation
medicines with the aim of eliminating problematic
(licenced use). 14
(inappropriate) polypharmacy, and then monitoring
the individual for unintended adverse effects or Patient: Umbrella term to cover the full range of
worsening of disease. It is essential to involve the people receiving or registered to receive medical
individual (and their carer) closely in deprescribing treatment or healthcare; this includes children and
decisions to build and maintain their confidence in young adults, pregnant women, service users and
the process. 10 clients. 10

Designated Prescribing Practitioner (DPP): Polypharmacy: Means ’many medicines’ and

An umbrella term used in the RPS A Competency has often been defined as being present when a
Framework for Designated Prescribing Practitioners patient takes five or more medicines. Polypharmacy
to describe the experienced prescribing is not necessarily a bad thing; it can be both
practitioner responsible for supervising the rational and required; however, it is important to
non-medical prescribing trainee’s period of distinguish between appropriate and inappropriate
learning in practice. For further information, polypharmacy. For further information, please see
please see the RPS A Competency Framework for the RPS Polypharmacy guide. 10
Designated Prescribing Practitioners 12 .
Psychosocial: Involving both psychological and
social aspects. 15
21
Scope of practice: The activities a healthcare
professional carries out within their professional
role. The healthcare professional must have the
required training, knowledge, skills and experience
to deliver these activities lawfully, safely and
effectively. They must also have appropriate
indemnity cover for their prescribing role. Scope
of practice may be informed by regulatory
standards, the professional body’s position,
employer guidance, guidance from other relevant
organisations and the individual’s professional
judgement. 16

Supplementary prescribing: A voluntary

partnership between a doctor or dentist and
supplementary prescriber, to prescribe within an
agreed patient-specific clinical management plan
(CMP) with the patient's agreement. At the time
of publication, nurses, midwives, optometrists,
pharmacists, physiotherapists, podiatrists,
radiographers, paramedics and dietitians may
become supplementary prescribers. Once
qualified, they may prescribe any medicine
(including controlled drugs) within their clinical
competence, according to the CMP.

Unlicensed (also known as specials): A medicinal

product without a valid UK marketing authorisation.
These may be medicinal products that are
imported, procured or manufactured under a
UK specials manufacturing licence. They are
prescribed to meet the special clinical needs
of an individual patient on the direct personal
responsibility of the prescriber. 14

22
6
References
1. National Prescribing Centre (2012) A single 10. Royal Pharmaceutical Society (2019)
competency framework for all prescribers, Polypharmacy: Getting our medicines right.
Available at: https://www.webarchive.org.uk/ Available from: https://www.rpharms.com/
wayback/archive/20140627111233/http://www.npc. recognition/setting-professional-standards/
nhs.uk/ (Accessed: 22nd February 2021). polypharmacy-getting-our-medicines-right.
[Accessed: 22nd February 2021].
2. National Prescribing Centre (2001) Maintaining
Competency in Prescribing. An outline 11. Whiddett S, Hollyforde, S. The Competencies
framework to help nurse prescribers. NPC, Handbook. Institute of Personnel and
Liverpool. Development, 1999.

3. National Prescribing Centre (2003) Maintaining 12. Royal Pharmaceutical Society (2019)
Competency in Prescribing. An outline Competency Framework for Designated
framework to help nurse supplementary Prescribing Practitioners. Available from: https://
prescribers. NPC, Liverpool. www.rpharms.com/resources/frameworks/
designated-prescribing-practitioner-
4. National Prescribing Centre (2003) Maintaining
competency-framework. [Accessed: 22nd
Competency in Prescribing. An outline
February 2022].
framework to help pharmacist supplementary
prescribers. NPC, Liverpool. 13. UK Supreme Court judgement in ‘Montgomery
v Lanarkshire Health Board’. Mar 2015 Available
5. National Prescribing Centre and General Optical
from: https://www.supremecourt.uk/cases/uksc-
Council (2004) Competency framework for
2013-0136.html. [Accessed: 22nd February 2021].
prescribing optometrists. NPC, Liverpool.
14. Royal Pharmaceutical Society (2016) Prescribing
6. National Prescribing Centre (2004) Maintaining
Specials Guidance for the prescribers of
Competency in Prescribing. An Outline
Specials Available from: https://www.rpharms.
Framework to help Allied Health Professional
com/resources/pharmacy-guides/specials.
Supplementary Prescribers. NPC, Liverpool.
[Accessed: 21 June 2021].
7. National Prescribing Centre (2006) Maintaining
15. Stedman’s Medical Dictionary (2016). Available
Competency in Prescribing. An outline
from: https://online.statref.com/document/
framework to help pharmacist prescribers.
agSgx7Uq0raRoiZktrvQit?categoryType=
Second edition NPC, Liverpool.
Dictionary [Accessed: 30th June 2021].
8. NICE Medicines adherence: involving patients
16. Health and Care Professions Council (2020)
in decisions about prescribed medicines
Information on scope of practice. Available
and supporting adherence [CG76] (January
from: https://www.hcpc-uk.org/registration/
2009). Available from: https://www.nice.org.uk/
meeting-our-standards/information-on-scope-
guidance/cg76/chapter/Introduction. [Accessed:
of-practice/. [Accessed: 22nd February 2021].
30th June 2021].

9. Department of Health and Social Care and

Public Health England (2013) Antimicrobial
prescribing and stewardship competencies.
Available from: https://www.gov.uk/government/
publications/antimicrobial-prescribing-and-
stewardship-competencies. [Accessed: 22nd
February 2021].

23
7
Acknowledgements

Task and Finish Group for the 2021 review

Professor Angela Alexander (Chair) Caroline Lecky

Professor Emerita, University of Reading Associate Senior Professional Officer, Northern
Ireland Practice and Education Council
Chris Bell
Standards Development Specialist, The Nursing and Andrew Lilley
Midwifery Council Pharmacy Professional Services Manager,
Lead Pharmacist and Advanced Practitioner –
Dr Paramdeep Bilkhu MCOptom Respiratory, Homecare Alder Hey Children's Hospital
Clinical Adviser and Independent Prescriber, The
College of Optometrists Carmel Lloyd
Head of Education and Learning, The Royal College
Olivia Bird of Midwives
Policy Manager, The Health and Care Professions
Council Dr Frances Lloyd
Associate Postgraduate Pharmacy Dean, Queen's
Hazel Boyce University Belfast, Northern Ireland
Skull Base Specialist and Neuro Review
Radiographer, Bristol Cancer Institute, University Simon Matthews
Hospitals Bristol NHS Trust (also representing Society Associate Chief Pharmacist – Clinical Services,
and College of Radiographers) Kings College Hospital NHS Foundation Trust

Dr Rachel Bruce Dr Trudi McIntosh

Principal Lead (Prescribing and Clinical Skills), NHS Senior Lecturer in Pharmacy Practice. Course Leader
Education for Scotland MSc, Robert Gordon University Advanced Pharmacy
Practice including Pharmacist Independent
Kat Hall Prescribing
Associate Professor of Clinical Education Director,
Centre for Inter-Professional Postgraduate Andrew Mikhail
Education and Training (CIPPET) Chief Pharmaceutical Officer’s Clinical Fellow and
Specialist Inspector, The General Pharmaceutical
Peter Hawkes Council
Lay representative
Eleri Mills
Parbir Jagpal Association for Prescribers Committee member,
Director of Postgraduate Studies, School of Programme Leader NMP, Glyndwr University
Pharmacy, University of Birmingham; Independent
Prescriber Adele Mott
Lead Pharmacist for GI Services, University College
London Hospitals

24
Catherine Picton
RPS Staff
Competency Framework Author and Health Policy
Consultant
Regina Ahmed (Lead Author)
Senior Guidance Pharmacist and Independent
Heather Randle
Prescriber, RPS
Professional Lead for Education, The Royal College
of Nursing
Dr Karen Hodson
Practice & Policy Lead – Wales, RPS. Programme
Debra Roberts
Director, Independent Prescribing, Cardiff University
Associate Dean (Pharmacy), Head of Programme
Development and Advanced Practice, Health
Jonathan Lloyd Jones
Education and Improvement Wales (HEIW)
Policy and Engagement Lead – Wales, RPS

James Rodger
Annamarie McGregor
Musculoskeletal Extended Scope Practitioner,
Head of RPS Local, RPS
Musculoskeletal Sonographer

Wing Tang
David Rovardi
Head of Professional Support and Guidance, RPS
Pharmacist Independent Prescriber and Registered
Paramedic, College of Paramedics
Stuart Carter
Digital Content Lead (External Comms)
Peter Saul
Joint Chair, Royal College of General Practitioners
Nick Hard
Wales
Planning Unit

Debbie Sharman
Consultant Podiatrist – Diabetes, Professional
lead for Podiatry Visiting Lecturer (University of
Southampton), Dorset HealthCare University
Foundation Trust

Katherine Timms
Head of Policy and Standards, The Health and Care
Professions Council

Wendy Thompson
Academic general dental practitioner at University
of Manchester, also representing The British Dental
Association

Jonathan Underhill
Associate Director, Medicines and Prescribing
Centre, The National Institute for Health and Care
Excellence

Nigel Westwood
Lay representative

Pip White
Professional Adviser, Chartered Society of
Physiotherapy

25