Developmental frameworks for professional pharmacy education improve the quality and safety of pharmaceutical health service delivery around the world
Submitting InstitutionUniversity College London
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
In response to growing calls for competence-based continuing professional development across
healthcare professions, Professor Ian Bates and colleagues at the UCL School of Pharmacy have
led multi-disciplinary collaborative research to develop frameworks for the professional
development of pharmacists. These have been adopted across the UK, and are now the norm for
pharmacist development. In addition, the cumulative evidence base was used by the Department
of Health to establish the first NHS Consultant Pharmacist posts in England. The frameworks are
increasingly being adopted for use in different countries around the world and, most recently, have
underpinned a global framework for practitioner development under the auspices of the World
Health Organization and UNESCO.
The 2001 Kennedy Report into children's heart surgery at the Bristol Royal Infirmary highlighted
the need for all healthcare professionals to "undergo appraisal, continuing professional
development and revalidation to ensure that [they] remain competent to do their job."1 In response
to this, Bates and colleagues established a multi-disciplinary collaborative - the Competency
Development and Evaluation Group (CoDEG) - to systematically tackle these national imperatives
in the area of pharmacy. The group initially published a series of influential discussion papers, and
identified a number of drivers now regarded as fundamental for post-registration development of
pharmacists. These incorporated prior research by academic members of the group which had
shown that traditional provision of postgraduate clinical programmes in pharmacy was largely not
fit for purpose and had difficulty demonstrating competence and performance outcomes .
CoDEG concluded that existing provisions for education and training did not meet the post-
registration needs of NHS practitioners. In particular, the collective CoDEG output identified:
- A lack of systematic competency-based approaches to development;
- Inequity of accessing support;
- No demonstrable links between formal education and practitioner development;
- Little engagement with NHS employers;
- No clear linkage with the patient safety agenda;
- A danger that Pharmacy was losing relevance and losing touch with other professions.
There were two parallel strands to our response: creating and testing practitioner development
frameworks which would help to train a first-rate pharmaceutical workforce for the nation; then
developing an innovative overall model for post-registration practitioner development.
We constructed and tested a series of practitioner development frameworks using evidence-based
educational methods: the General Level Framework (GLF) for foundation and early year
pharmacists and the Advanced Level Framework (ALF) for advanced career pathways. The
evidence was published as a series of advances [2, 3, 4] including one of the very few controlled
trials published in educational practice . This latter work, using CoDEG's first validated version
of the GLF , recruited 30 NHS Trusts into the study and showed, by comparison with control
Trusts, that using an evidence-based framework design, practitioner competence across a defined
scope of practice could be both accelerated and improved.
The research foundations of the frameworks used a mixed methodology of grounded qualitative
analysis, Delphi approaches for consensus building, controlled trial methodology and advanced
statistical applications such as HOMALS and a translational application of Kaplan-Meir techniques.
In the parallel stream, the frameworks and evidence were incorporated by the research group into
new models for formal post-registration professional education. Innovative workplace education
models, a completely new approach using competence and performance-based methods, were
subsequently developed by the CoDEG and UCL team, as a partnership with NHS employers, and
received a HEFCE Strategic Development Fund grant of £1.3 million in 2006, establishing the Joint
Programmes Board (JPB). This set the scene for national reform of post-registration education,
which was linked, for the first time, with workforce capability.
More recently, this evidence and application have been further extended to develop a professional
recognition (credentialing) model  which is now a central core of the Royal Pharmaceutical
Society's Faculty whereby advanced levels of practice can be identified and peer reviewed; the
historical evidence produced by CoDEG, and the translation into new models of workforce
development, are now being used to create a new royal college for the profession in 2013.
References to the research
 Quinn J, Bates I, Cox R. Postgraduate clinical pharmacy programmes in the UK: a comparative
content analysis. Int J Pharm Pract. 1997 Dec;5:209-15. http://doi.org/dmk4gs
 Meadows N, Webb D, McRobbie D, Antoniou S, Bates I, Davies G. Developing and validating a
competency framework for advanced pharmacy practice. Pharmaceutical Journal. 2004; 273:
 Mills E, Farmer D, Bates I, Davies G, Webb DG. The General Level Framework: use in primary
care and community pharmacy to support professional development. Int J Pharm Prac 2008;
16: 325-31. http://dx.doi.org/10.1211/ijpp.16.5.0008
Details of the impact
Over the last 10 years, the cumulative evidence from the CoDEG group, in relation to the
development of practitioner development frameworks, policy formation and novel professional
education models has improved the quality of pharmacy services through the reform of educational
provision and the implementation of practitioner development frameworks. Educational research
work that aimed to address clear national health service needs to define and assure capable and
competent pharmacist practitioners, has grown into a world-wide project that has international
recognition from nation states and UN agencies for the impact that the evidence-base and
translational developments have had — and are continuing to have — on developing safe and
capable clinical pharmacists. The key theme of our work throughout has been the application of
research-driven educational enquiry to the development of health service capability, in a manner
never before applied in the profession.
1. National impact.
In 2005, ALF evidence was used as a basis for Department of Health guidance to establish the first
NHS Consultant Pharmacist posts in England [a]. As a result, over 50 Consultant Pharmacists
were in post across England in 2013 [b]. In 2006, the formal JPB partnership described above was
set up [c]. This has become the accepted foundation pathway for all early years' practitioners
across most of England's NHS Trusts and the GLF has been adopted for use by over 90% of all
Band 6 (junior) pharmacists in England. The cumulative research also supported adoption in Wales
and Northern Ireland. The royal college for pharmacy is now using this educational approach as
the basis for its national foundation standard [d].
The emergence of Medical Education England (MEE www.mee.nhs.uk; and since April 2013, HEE
www.hee.nhs.uk) as the national commissioning agency for all medical, pharmacy, dental and
health science education and training means that pharmacy has a national Professional Advisory
Board, reporting to HEE on matters of professional development, including initial education and
career pathways. In 2012, this professional board — Modernising Pharmacy Careers —
commissioned an independent report into the use of practitioner development frameworks for the
profession [e]. The report recommended national uptake of both the GLF and the ALF, and the
Royal Pharmaceutical Society (RPS) subsequently adopted stewardship of the CoDEG
frameworks to enhance professional capability across all health sectors and impact on the quality
of health care provision. This is now the national norm for practitioner development, affecting all of
the 42,000 registered pharmacists in the UK. In a supporting statement, the RPS say that "This is
a historic time for pharmacy, a first for the Royal Pharmaceutical Society and is based upon the
decade worth of evidence generated by CODEG and Professor Bates' national and international
research in this area... The RPS can fully verify the usage of the research work, and the impact of
the work which has gone into developing the frameworks" [f].
2. European regional impact.
The evidence base generated by CoDEG was used as a basis for the Europe-wide PHARMINE
programme [g]. This multilateral programme, funded in 2009 via the European Commission for
€480,000, set out to map foundation level and advanced ("specialist") competencies for pharmacy.
The CoDEG frameworks proved to be the building blocks of the PHARMINE outcomes, which were
subsequently endorsed by major European special interest partner groups including:
- EAFP (European Association of Faculties of Pharmacy)
- EAHP (European Association of Hospital Pharmacists)
- EIPG (European Industrial Pharmacists' Group)
- EPSA European Pharmacy Students' Association)
- PGEU (Pharmaceutical Group of the European Union)
3. Other Nations
In Australia, Queensland Health, which covers about a third of the population, improved the
competency of its practitioners through development of an adapted version of the CoDEG
frameworks [h].This initial work has now been taken up nationally, impacting at both foundation
and advanced level practice, using CoDEG evidence and GLF and ALF [i]. CoDEG have acted as
advisers on the nationalisation of the original frameworks. In 2012, the Australian authorities
published their Advanced Pharmacy Practice Framework for Australia, which acknowledges the
CoDEG evidence and work as the basis for this national development [j].
Singapore has also collaborated with CoDEG to develop a national framework for foundation level
practice based on the GLF [k]. This particular work stream has driven reform of practitioner
development in Singapore along similar lines to the UK. Other countries where the GLF is being
translated and adapted for national use are Ireland (via the Pharmaceutical Society of Ireland),
Croatia (via community pharmacy providers), Serbia (via National Expert Panel and community
pharmacy providers) [l, m].
4. Global developments
In 2007, the International Pharmaceutical Federation (FIP - the global professional leadership
body representing over 3 million pharmacists and pharmaceutical scientists worldwide) established
a Global Taskforce for Education. Subsequent to this, in 2009/10, FIP Education formed
partnerships with two UN agencies, the WHO and UNESCO [n]. Practitioner competence and
pharmaceutical service capabilities were identified as key missions. The subsequent development
of a global framework for practitioner development (the Global Competency Framework - GbCF)
used CoDEG evidence and GLF methodology as a basis for development. In 2010, a formal
agreement with UNESCO established the UNITWIN programme which has an objective to
disseminate best practice using the GbCF, most recently in establishing a six-nation African Centre
of Excellence for professional education.
The original work by CoDEG has led from local to global impact on contemporary competency-
based approaches to practitioner development which impacts on development of medicines
expertise, patient safety, and the quality of pharmaceutical care services. Better training leads to
Sources to corroborate the impact
[a] Department of Health. Guidance for the Development of Consultant Pharmacist Posts, 2005.
[c] http://www.jpbsoutheast.org Email and hard copy correspondence from HEFCE confirming
award available on request.
[d] Copy of The RPS Advanced Pharmacy Framework (APF) available on request.
[f] Letter of support from the Royal Pharmaceutical Society. Copy available on request.
[g] "Pharmacy In Europe" project ID 142078-LLP-1-2008-BE-ERASMUS-ECDSP
[h] Coombes I, Avent M, Cardiff L, Bettenay K, Coombes J, Whitfield K, Stokes J, Davies G, Bates
I. Improvement in Pharmacist's Performance Facilitated by an Adapted Competency-Based
General Level Framework. J. Pharmacy Practice and Research 2010; 40 (2): 111-118.
[k] Rutter V, Wong C, Coombes I et al. Use of a general level framework to facilitate performance
improvement in hospital pharmacists in Singapore. Am J Pharm Educ. 2012 Aug 10;76(6):107.
[l] Meštrović A, Staničić Z, Hadžiabdić MO et al. Evaluation of Croatian community pharmacists'
patient care competencies using the general level framework. Am J Pharm Educ. 2011 Mar
[m] Meštrović A, Staničić Z, Hadžiabdić MO, et al. Individualized education and competency
development of Croatian community pharmacists using the general level framework. Am J
Pharm Educ. 2012 Mar 12;76(2):23. http://dx.doi.org/10.5688/ajpe76223.
[n] FIP-UNESCO UNITWIN Partnership
Bristol Royal Infirmary Inquiry (2001) Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol
Royal Infirmary 1984 -1995. Command Paper: CM 5207