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WPBA: Prescribing assessments

Publication date: 19 January 2024

Prescribing is an integral part of a GP’s work. In 2017 the GMC published a document describing Generic Professional Competences outlining broad prescribing skills. This has been updated and reviewed in Good Medical Practice 2024 under the heading “Good practice in prescribing and managing medicines and devices” and gives detailed guidance for doctors relating to all areas of medicines management.

Prescribing is a key competency that every specialty trainee needs to achieve. The RCGP has worked with a team from the University of Nottingham to create an assessment suitable for GPs in training, based on the PRACtlCe study and REVISiT intervention.

The assessment is a formative exercise to reflect on prescribing practice, which should highlight trends and learning needs within your prescribing. By reflecting on the errors identified it will enable learning plans to be put in place to improve your prescribing in the future.

Summary

  1. The trainee searches on their last 50 retrospective prescriptions
  2. Using the prescribing manual, the trainee reviews these prescriptions and maps them against potential prescribing errors
  3. The GP trainer / Supervisor reviews 20 of these prescriptions, maps these against potential errors and adds these to the spreadsheet
  4. The trainee completes the trainee reflection form in the Portfolio and in particular reflects on their prescribing using the GP prescribing proficiencies
  5. The trainee and GP trainer / Supervisor complete the assessment using the GP trainer/ Supervisor assessment form found in the Portfolio
  6. The trainee uploads the anonymised spreadsheet to their learning log
  7. Supporting documents which outline the assessment in detail can be found below

Documents required to complete the assessment

How to search for prescription items

You are required to collect the data for 50 prescriptions. Many of you will be able to use the created searches below to help facilitate the gathering of the data.

If you are unable to use this functionality, then you will need to complete this assessment of 50 prescriptions by looking through your consultations backwards, from a particular date and identifying when you have prescribed a medication. You will then need to manually enter the information onto the spreadsheet.

Training resources for TPDs, trainees and trainers

We will continue to try and work with the PMSs to provide as many trainees with an automated search but we are aware that there will be many of you who will not be able to take advantage of this and will therefore have to return to the default position of manually gathering the data.

The following resource is a spreadsheet that shows an example completed assessment form, with consultations, and trainer review and comments included. It includes electronic records for the patients, a random selection of consultations from a full 50 consultations reviewed. Though based on real patients’ various elements and characteristics have been changed to aid anonymity and enhance the educational experience. These have some past medical history (PMH) added and some other medication the patient is already on to model the information available in the real patient records. This resource should be helpful for both trainees and trainers, to demonstrate what a completed form might look like.

Comments from the 'medicines safety and effective healthcare research team from the University of Nottingham, working in partnership with the NIHR GMPSTRC' are also included to provide added value to the resource, and we'd like to thank them for their work on this resource.

Printer-friendly versions of example spreadsheets are also included below:

Instructions for trainees, trainers, programme leaders and large groups

Instructions for trainee

  1. Look at the consultation records (form 1) and for each prescription complete the trainee/ trainer self-assessment form (form 2) using the Prescribing Manual on the website to explain what each area and types of error is and the examples in the appendix to help
  2. Use BNF and other resources to check that correct prescribing happened and make suggestions for improvement and pick out examples of good prescribing as well
  3. Complete the assessment form 2 for all prescriptions using all consultations
  4. Compare your responses with the completed trainee form 3 and form 4 (Nottingham feedback)
  5. Think if there are any trends or specific learning points to take away and complete the trainee assessment form with all areas that you could complete as if the assessment was based on your own prescribing
  6. Discuss with your trainer / programme director

Instructions for trainer

  1. Look at the consultation records (form 1) and for each prescription complete the trainee/ trainer self-assessment form (form 2) using the Prescribing Manual on the website to explain what each area and types of error is and the examples in the appendix to help
  2. Use BNF and other resources to check that correct prescribing happened and make suggestions for improvement and pick out examples of good prescribing as well
  3. Complete the assessment form 2 for all prescriptions using all consultations
  4. Compare your responses with the completed trainee form 3 and form 4 (Nottingham feedback)
  5. Decide what feedback you would give to your trainee if this had been their self-assessment
  6. Think if there are any trends or specific learning points you would want your trainee to take away and complete the trainer assessment form with all areas that you could complete as if the assessment was based on your own trainees prescribing
  7. If your trainee has also done this exercise discuss the results with them and complete any additional areas in the assessment forms to familiarise yourself with them

Instructions to Programme directors and large group leaders

  1. Use the prescribing PowerPoint presentation (PPT file, 3 MB) to explain the new assessment as a large group, making as interactive as possible
  2. Use the instructions above relevant to the group you are teaching to explain how to use the resources
  3. Get all the delegates to complete the assessments either individually or in small groups and discuss their results
  4. Share the results with the larger group and benchmark
  5. Discuss any problems, concerns using the FAQs on the website to help
  6. Summarise the main learning points from the sessions and remind all where they can find further resources to help

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