Over a billion items are prescribed each year in England alonei, but reports from the General Medical Council have shown that approximately 9% of NHS prescriptions contain errors and newly graduated doctors see prescribing as particularly challenging.ii,iii
Since 2007, the British Pharmacological Society (BPS) and MSC Assessment have worked together to enhance patient safety in the UK’s complex health environment by addressing the lack of standardised prescribing skills in the UK, and enabling medical students to demonstrate that they have achieved basic competency in the safe and effective use of medicines.
Developing a national prescribing assessment
The Prescribing Safety Assessment (PSA) was created as the first single, national, online assessment of prescribing competency, and has seen positive responses from around the world as a powerful way of enhancing patient safety.iv It is led and part-funded by BPS and MSC Assessment, with additional funding from Health Education England and NHS Education Scotland.
BPS and MSC Assessment, in collaboration with stakeholders, identified that a reliable and valid assessment was the best way to demonstrate that new doctors have the necessary competencies to begin prescribing independently. Although local assessments had been developed by medical schools and hospitals, no widely accepted measure of prescribing performance existed before 2007.
The partnership has leveraged the skills of both organisations’ memberships, their own funding, public funding, and input from a diverse group of stakeholders to create, pilot, and prove the concept of a validated prescribing assessment. The stakeholders who have supported and shaped delivery include students, junior doctors, medical schools, Government, regulators, employers and publishers.
Since 2014, all publicly funded undergraduate medical schools in the UK have provided their students with an opportunity to complete the Prescribing Safety Assessment before graduation.
From 2016 all new doctors will be required to take the Prescribing Safety Assessment before their first year of practice after graduating (Foundation Year 1) – as announced by the Foundation Programme Office on behalf of the Health Departments of England, Wales, Northern Ireland and Scotland.v
In total now, around 36,000 UK medical students have participated in the Prescribing Safety Assessment, with approximately 8,000 students completing the assessment each year. With eight prescriptions as part of the assessment, and further set as part of practice papers, it is estimated that participants have written a total of almost 500,000 prescriptions.
Student feedback demonstrates that it is a relevant and appropriate test of prescribing skills at graduation level and that the online interface is easy to use. Talking to Student BMJvi, trainee doctor Dr David Houghton talked about his experience of the assessment before his recent graduation, “It makes a huge difference. You’re safe knowing that what you’re prescribing is right.” Comments also suggest preparing with online practice papers and participating in the assessment itself has engendered an enhanced sense of confidence about their future prescribing of drugs.
Pharmacy schools are now actively seeking to explore how the Prescribing Safety Assessment can help ensure pharmacy patients benefit from a national benchmark of competency.
Healthcare students should receive support from their institution to prepare them for the PSA. We strongly encourage candidates use the practice papers on the PSA website.
The BPS also provides resources which can help prepare for the PSA. Prescribe is an interactive and informative e-learning resource that enables students to develop a firm grounding in the principles of clinical pharmacology and the use of medicines.
Get involved: Becoming a registered author for the Prescribing Safety Assessment
Authors from all clinical backgrounds are welcome to become a registered Prescribing Safety Assessment author, if they meet the following eligibility criteria:
• registered UK doctor or pharmacist
• in active clinical practice
• experienced in medical undergraduate and/or Foundation year doctor teaching
• able to attend an item-writer training workshop
• willing to commit to writing 10-15 items per year
• able to attend a peer review event
Please contact prescribing@bps.ac.uk for further information about how to get involved.
References
[i] Health & Social Care Information Centre. 2014. Prescriptions Dispensed in the Community, Statistics for England - 2003-2013. Available online: www.hscic.gov.uk/catalogue/PUB14414/pres-disp-com-eng-2003-13-rep.pdf. Last accessed: 27 July 2016.
[ii] General Medical Council. 2009. Tomorrow’s Doctors. Available online: www.gmc-uk.org/Tomorrow_s_Doctors_1214.pdf_48905759.pdf. Last accessed: 27 July 2016.
[iii] General Medical Council. 2014. Be prepared: are new doctors safe to practise? Available online: www.gmc-uk.org/Be_prepared___are_new_doctors_safe_to_practise_Oct_2014.pdf_58044232.pdf. Last accessed: 27 July 2016.
[iv] British Pharmacological Society. 2015. National prescribing assessment needed to enhance patient safety. Available online: www.bps.ac.uk/news-events/news/british-pharmacological-society-in-the-news/articles/national-prescribing-assessment-needed-to-enhance. Last accessed: 27 July 2016.
[v] UK Foundation Programme Office. 2016. Prescribing Safety Assessment Guide for Foundation Doctors. Available online: www.foundationprogramme.nhs.uk/download.asp?file=PSA_Guide_Trainees_2016.docx. Last accessed 23 August 2016.
[vi] Student BMJ. 2015. Preparing to prescribe. Available online: student.bmj.com/student/view-article.html?id=sbmj.h316. Last accessed 27 July 2016.