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Do competency based approaches work?

By Pamela Mason

David Webb

Devid Webb

David Webb, of London and Eastern NHS, UK, asked if competency based approaches are working. Speaking at an FIP Congress session on 8 October 2012, he said: “Is there a paradigm shift to a competency base?” Competence is an observable ability – what today is really about, he said. He continued by asking have competency based approaches worked in the past. Do they work now? Will they work in the future? Evidence suggests that they have worked to drive forward practice competency. They are useful for both practitioners and patients as an assessment for development and to take people forward, but there is a danger in getting into a tick box mentality. This is about development, he emphasised.

Looking in more detail as to whether competency based frameworks work now, he cited the example of CoDEG (Competency Development and Education Group). This group has previously proposed four levels of practice in pharmacy, namely a registered pharmacist (MRPharmS), a general pharmacist practitioner (GPP), an advanced pharmacist practitioner (APP); and a consultant pharmacist (CP). The CoDEG general level framework (GLF) supports the development of an individual practitioner from registration to a general level of practice and has found widespread application in hospital pharmacy across the UK. A controlled trial of the first edition GLF has demonstrated that its use accelerates and sustains pharmacists’ development while an evaluation of the second edition of the GLF showed successful results in primary care and community pharmacy. Consultant NHS pharmacists are now in post across England, with these posts being developed using guidelines issued by the Department of Health, and supported using the advanced to consultant level framework (ACLF).

He went on to explain that a strategy to develop registered pharmacists to general level has been implemented by the Joint Programmes Board (JPB). This particular model provides a mechanism for more seamless career development from post-registration to more advanced levels of practice. Practitioners are able to plan and monitor personal development by mapping their CPD and CE activities using the advanced practitioner framework, which allows judgements to be made on an individual's current level of practice and highlights future developmental needs.

Turning to the question of whether competency-based frameworks would work in the future, he said that complexity is going to increase and no clinician can know everything. The aim must be to focus on core competencies not time served in the job. Effective care is collaborative and multidisciplinary. The modernising pharmacy careers programme board has proposed that the GLF should be reviewed and updated with formative and summative processes developed within a formal infrastructure and has also proposed the continued use and development of the ACLF. In summary, there is evidence that competency based frameworks work, he concluded.