1. Definition of Supplementary Prescribing
Fundamentally, Supplementary Prescribing differs from Additional Supply in that it requires the establishment of a ‘prescribing partnership’.
The criteria that are currently set in regulations for lawful Supplementary Prescribing by optometrists are:
- The Independent Prescriber (IP) must be a Registered Medical Practitioner
- The Supplementary Prescriber (SP) must be a Registered Optometrist
- There must be a written Clinical Management Plan relating to a named patient and to that patient’s specific conditions. Agreement to the Plan must be recorded by both the Independent and Supplementary Prescriber before Supplementary Prescribing can take place
- The Independent and Supplementary Prescriber must share access to, consult and use the same common patient record.
Supplementary Prescribing places no legal restrictions on the clinical conditions which Supplementary Prescribers may treat. Supplementary Prescribing requires a prescribing partnership with an Independent Prescriber and a Clinical Management Plan for the patient, and it is likely to be most useful in dealing with long-term conditions such as glaucoma. There is no specific formulary or list of medicines for Supplementary Prescribing. Supplementary Prescribers are able to prescribe any medicines prescribed by the Independent Prescriber provided they are itemised in the patient’s Clinical Management Plan.
2. Learning Outcomes
The General Optical Council have specified the following learning outcomes for the practical element of ‘Supplementary Prescribing’ in addition to those laid down for Additional Supply:
- an ability to develop an effective relationship with an Independent Prescriber
- an ability to develop and document a Clinical Management Plan within the context of a prescribing partnership
- an ability to review the nature and severity of the presenting condition and generate treatment options within the Clinical Management Plan
- an ability to monitor the response to treatment and modify the clinical management plan or refer back to the Independent Prescriber if necessary
- an understanding of the legal and professional framework for accountability and responsibility in relation to Supplementary Prescribing
Examiners in the Common Final Assessment for Specialist Therapeutics must be satisfied that these learning outcomes have been met.
3. Assessment in Supplementary Prescribing
The key difference between the programme for Supplementary Prescribing and that for Additional Supply concerns the 'learning in practice' module. Candidates applying for assessment in Supplementary Prescribing will require to have undertaken/evidenced the following:
3.1 Clinical Placements
Complete a minimum of 14 additional clinical sessions (equivalent to 7 days), [ie in addition to the 10 sessions (equivalent to 5 days) required for Additional Supply], in the Hospital Eye Service or Specialist General Practice under the supervision of a designated ophthalmologist.
(Thus candidates applying for assessment in Additional Supply + Supplementary Prescribing should have completed a minimum of 24 clinical sessions - equivalent to 12 days).
It should be ensured that during these further 14 clinical sessions for Supplementary Prescribing emphasis is placed on those conditions which could be managed within the context of a prescribing partnership, and that the Portfolio reflects this distinction through the nature of extended case reports selected for submission.
Candidates must see a range of cases.
3.2 Clinical Management Plan
Include one Clinical Management Plan, which has been developed in conjunction with their mentor, for a hypothetical patient with a condition which would be suitable to manage as a Supplementary Prescriber (a template can be found in Section 9).
3.3 Extended Case Reports
Submit an additional 4 extended case reports ie in addition to the 4 required for Additional Supply, based upon a chosen selection from the cases seen during the clinical sessions. Original jottings relating to those cases selected to be used for extended case reports must be submitted with these reports.
Candidates must include a range of cases and provide a synopsis of those cases.
At least two of the four extended case reports for Supplementary Prescribing must be Glaucoma cases. Candidates should also ensure that the cases chosen for the extended reports are:
- suitable for Supplementary Prescribing
- show evidence of patient follow-up
- show evidence that the response to treatment has been monitored
It is essential that the extended case reports evidence the breadth and depth of experience acquired and that they reflect those ranges which are most likely to be managed by the optometrist in practice
Each extended case report should be informed by a review of the clinical literature. References should be cited in the text and a bibliography included at the end of each report. Particular emphasis should be given to evidence-based practice i.e. using the medical literature to support any clinical intervention.
An extended case report should include full information regarding each patient’s clinical presentation, management and follow up. The discussion and the literature search should be relevant to each patient. Candidates will be tested on their independent ability to critically comment on the literature relevant to the case.
Candidates should work up the case reports with particular reference to evidence-based practice and any existing professional good practice guidelines.
Each extended case report should be no longer than 1000 words. The following checklist should be used when preparing an extended case report:
- Actual presentation (signs and symptoms) versus expected presentation
- Differential diagnosis
- Clinical evidence for the clinical intervention
- Indications, contraindications, cautions and adverse effects of any pharmaceutical treatment used
- Consideration of the holistic needs of the patient (e.g. psychomotor, physical)
- Management from an optometric viewpoint (e.g. professional accountability, codes of conduct in relation to additional supply/supplementary prescribing)
3.4 Portfolio: completion of all other aspects of the Portfolio. General presentation must be consistent with a Higher Qualification professional examination and show:
- Clear indexing and summary
- All information with appropriate dates
- Sequence of case history to be presented in chronological order
- Observance of patient anonymity
- Key to abbreviations used
- Relevant supporting documentation
- Each sheet to have a patient number and candidate number
- Any copied documentation should be of good quality
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