EC Self-declaration form example 1NOV13

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Declaration of Competence

for community pharmacy services

Emergency Contraception

1. Introduction to the Self-assessment Process

Pharmacists have a professional responsibility to develop their knowledge and competence.

This self-assessment process provides pharmacists with a framework to demonstrate to themselves, their employers and the service commissioners that they have the skills and knowledge necessary to deliver an Emergency Contraception (EC) service which includes the supply of a prescription only medicine (POM) using a patient group direction (PGD). The framework includes details of available learning mapped to a range of core competencies which include the clinical, ethical, cultural and legal aspects of delivering this service. In addition to this it is expected that pharmacists:

Practice within the GPhC Standards of Conduct, Ethics and Performance

Observe the Standards for Registered Premises

Meet the Professional Standard for Consultation skills in pharmacy practice as determined by Modernising Pharmacy Careers.

This concept is built on the successful approach to harmonisation of accreditation for service delivery. Although initially developed in the North West this framework presents a national solution for the Declaration of Competence for the delivery of community pharmacy services.

2. Self-assessment of Core Competencies.

The self-assessment against the core competencies has been developed in conjunction with

CPPE, national experts and professional groups. It takes into account national competency frameworks/standards and has considered the British Society for Sexual Health and HIV

(BASHH) guidelines and the Royal Pharmaceutical Society (RPS) Public Health Standards relating to this service.

If you are NOT able to answer ‘yes’ to all of the self-assessment questions then you are not yet ready to deliver the service and should refer to Section 3 to further your learning and development.

3. Learning and Development

The table in section 3.1 contains details of the various CPPE training programmes that you can use to help develop your skills and knowledge to satisfy the self-assessment. Information relating to learning acquired from other training providers can be entered in section 3.2.

What is CPPE?

The Centre for Pharmacy Postgraduate Education (CPPE) is funded through the NHS Multiprofessional Education and Training Fund from Health Education England to provide learning to support all pharmacists and pharmacy technicians providing NHS services in England.

Further information and an online tool to facilitate your self-assessment process are available at www.cppe.ac.uk

. Learning outcomes for each of the above programmes and information about the features and objectives of the workshop are available on the CPPE website.

Self-Assessment of Competence for Community Pharmacy

Emergency Contraception Service

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3.1 CPPE Programmes, Workshops & Assessment

Training / Learning

CPPE Emergency contraception e-learning and assessment.

CPPE Safeguarding children and vulnerable adults e-learning and assessment.

Competencies linked to the learning a, c, d, e, f.

g.

CPPE Contraception open-learning programme and assessment.

c, d.

CPPE Public Health workshop emergency contraception and associated preworkshop task.

CPPE Patient Group Direction open-learning programme and assessment for pharmacists unfamiliar with the concept of PGDs . a, b, e, f, h, i h,

3.2 Learning & Assessment completed from other Training Providers

Training courses and workshops delivered by other trainers may be used, provided that they deliver the equivalent knowledge and learning outcomes as the CPPE programmes listed in

Section 3.1. You should list these in the table below if undertaken in place of the CPPE programmes.

Training / Learning / Competencies / Assessment

(list below)

4. Declaration of Qualifications and Competence to deliver

Emergency Contraception Services

An example of a declaration form of qualification and competence to deliver emergency contraception services that can be downloaded from the CPPE website is included in this document. This should be printed and signed by the pharmacist and can be used as evidence of competence for employers and service commissioners.

5. Reassessment of Competence

Pharmacists are responsible for reassessing their competence to deliver this service at least once every three years. This should involve revisiting the self-assessment of core competences, reflecting on each competency and identifying personal learning needs to assure self-declaration again at this point. Where changes are introduced to the commissioned service, pharmacists and their staff will need to update themselves as part of their usual continuing professional development.

6. Endorsement and support

This model of “Declaration of Competence” has received endorsement from the following national pharmacy organisations:

Royal Pharmaceutical Society (RPS)

Pharmaceutical Services Negotiating Committee (PSNC)

Pharmacy Voice (PV)

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Emergency Contraception Service

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Self-assessment of Core Competences

Competency: Are you / do you?

(Statements should be supported by appropriate evidence whenever possible)

If the learning you have completed applies to more than one competency then you do not need to repeat this information. This is for your own self-assessment purposes a)

Understand the aims of the EC service and other sexual health services in your community.

Yes. Because I have undertaken the following:

1. Completed the CPPE emergency contraception e-learning and assessment (Date)

2. Attended a CPPE Public Health workshop on emergency contraception (Date)

3. Met with the local sexual health community nurse to discuss services in the area b)

Apply effective consultation skills to communicate with clients appropriately and sensitively?

Yes. Because I have undertaken the following:

1. I have completed the CPPE Patient-centred care open-learning programme (Date)

2. I have completed the CPPE Dealing with difficult discussions programme (Date)

3. Peer review session with sexual health nurse – feedback documented in portfolio (Date) c)

Know the most up to date information about contraception and sexual health and understand the different types and methods of hormonal contraception and non-hormonal contraception; their use, advantages, failure rates and complications?

Yes. Because I have undertaken the following:

1. CPPE contraception open-learning programme and assessment (Date) d)

Understand the pharmacotherapy for the full range of available medication and appropriate clinical guidance relating to these (e.g. NICE)?

Yes. Because I have undertaken the following:

1. Read the Faculty of Sexual Health and Reproductive Healthcare Clinical Guidance (version) e)

Able to counsel and advise using an evidenced based approach?

Yes. Because I have undertaken the following:

1. Completed 50 consultations in the last 6 months f)

Understand how, when and where to refer clients and when to ask for support and advice yourself?

Yes. Because I have undertaken the following:

1. Identified appropriate routes for signposting clients

2. Obtained and displayed appropriate resources to share with clients g)

Understand confidentiality issues and are you aware of your role in the process of safeguarding children and vulnerable adults?

Yes. Because I have undertaken the following:

1. Completed CPPE Safeguarding children and vulnerable adults e-learning and assessment

(Date)

2. Read the GPhC guidance documents on patient confidentiality, maintaining clear sexual

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Emergency Contraception Service

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boundaries and the provision of pharmacy services affected by religious and moral belief h)

Understand the legal implications of using a patient group direction (PGD)?

Yes. Because I have undertaken the following:

1. I have been using PGDs in practice for the last ten years and have vast experience (for example) i)

Able to demonstrate knowledge of the clinical content of the relevant patient group direction(s)?

Yes. Because I have undertaken the following:

1. Read, understood and signed the local patient group direction (version X) j)

Able to develop your pharmacy team to support the delivery of a safe and effective service?

Yes. Because I have undertaken the following:

1. Developed or updated the standard operating procedures for the emergency contraception service (Date)

2. Updated the pharmacy team about the new service and on particular the ethical, cultural and legal aspects of the service (Date)

3. Updated the pharmacy team about the relevant GPhC Standards of Conduct, Ethics and

Performance and the Standards for Registered Premises and associated guidance

Local Commissioner Requirements

Pharmacists should be aware that service specifications, documents and contact details may vary from one area to another; hence you must ensure that you are familiar with the local service and documents in the area in which you are providing this service.

Training / Learning Competency h, i.

Date

Completed

1 Aug 2013

Date review due

Review of most recent service documents relating to provision of the service – patient group direction, contract or service level agreement, claims procedures, etc.

Review and / or develop relevant SOP(s) in your practice. j. 1 Aug 2013

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Emergency Contraception Service

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Personal Declaration of Qualifications and

Competence to deliver Emergency Contraception

Services

Pharmacy professional John Smith

GPhC number: 20202020

About CPPE

We are the Centre for Pharmacy Postgraduate Education (CPPE) based within the Faculty of Medical and Human

Sciences at the University of Manchester. CPPE is funded through the NHS Multi-professional Education and

Training Fund from Health Education England and is committed to providing quality learning to support all pharmacists and pharmacy technicians providing NHS services in England.

Statement of Qualification

The above pharmacy professional has completed the following learning and assessment from CPPE. Assessments are only listed if accessed and passed

Emergency Contraception

Contraception

Contraception

Emergency contraception open learning 11-Feb-2013 e-assessment 24-Apr-2013 e-learning 24-Jan-2013

Emergency contraception - public health

Safeguarding children and vulnerable adults

Safeguarding children and vulnerable adults e-learning 24-Apr-2013

Learning and assessment completed from other providers (please print off and list) workshop 24-Apr-2013 e-assessment 29-Apr-2013

Declaration by pharmacy professional

I declare that:

I have completed the ‘self-assessment’ of core competencies framework and answered yes to

ALL of the statements.

The information above is a true representation of my learning and assessment.

I have the necessary knowledge and skills to deliver the Emergency contraception service and can demonstrate these.

I have signed and attached a copy of the relevant PGD(s) for this service which cover the supply of the following medicine(s):

Pharmacist signature…………………………. Date………………………

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Emergency Contraception Service

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