Primary care pharmacy education

Assessment handbook

Primary care pharmacy education pathway

Assessment handbook

Version 7
January 2023

PCPEP/AH23

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Assessment handbook

Acknowledgements
Authors
Helen Middleton, lead pharmacist, Clinical pharmacists in general practice education, CPPE London
and South East

Contributors
Dianne Bell, education supervisor, CPPE
Lesley Grimes, head of learning development, CPPE
Sneha Varia, regional manager, CPPE
Nuala Hampson, senior pharmacy professional, CPPE
Rachel Kenward, education supervisor, CPPE
Mira Makhecha, education supervisor, CPPE
Samantha Buckland, education supervisor, CPPE

Reviewer
Sally Greensmith, head of national pathways for primary care education, CPPE
Clare Smith, senior pharmacist, national pathways for primary care education, CPPE

Acknowledgement
With thanks to Christine Gratus, a patient, for generously sharing her experiences and suggestions for how
pharmacy professionals can communicate with patients about workplace-based assessments.

Editor
Emma Rhys, assistant editor, CPPE
Disclaimer
We have developed this learning programme to support your practice in this topic area. We recommend
that you use it in combination with other established reference sources. If you are using it significantly after
the date of initial publication, then you should refer to current published evidence. CPPE does not accept
responsibility for any errors or omissions.

External websites
CPPE is not responsible for the content of any non-CPPE websites mentioned in this programme or for the
accuracy of any information to be found there.

All web links in this resource were accessed on 8 August 2022.

Published in December 2022 by the Centre for Pharmacy Postgraduate Education, Division
of Pharmacy and Optometry, The University of Manchester, Oxford Road, Manchester,
M13 9PT. www.cppe.ac.uk

© Copyright controller HMSO 2022

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Contents
Section 1 – Assessment overview
• Where to find assessment forms and portfolio recording templates
• Module 1 assessments
• Module 2 assessments
• Module 3 assessment
• Module 4 assessment
• Module 5 assessments
• Recording progress with assessments
• Programmatic assessment
• Deadlines for submitting your reflective essays and marking deadlines
• Portfolio
• CPPE Statement of assessment and progression

Section 2 – Case-based discussion

• Preparing for your CbD assessment
• How to choose a case
• CbD assessment session
• After the CbD assessment session
• Assessment criteria for the CbD
• Case-based discussion assessment form

Section 3 – Multisource feedback

• Who should I request feedback from?
• Registering for the online MSF tool
• Stepwise process for using the MSF
• Reflection on MSF feedback report template

Section 4 – Clinical examination and procedural skills assessment record

• Clinical examination and procedural skills log
• Minimum skills required for CEPSAR
• FAQs about the CEPSAR logs
• CEPSAR additional skills form
• CEPSAR case studies form
• Case studies
• Example case studies
• Reflective essay
• Example reflective essay

Section 5 – Patient Satisfaction Questionnaire

• Using the PSQ if you work in general practice
• Using the PSQ if you work in care homes
• PSQ feedback and reflective essay
• FAQs about the PSQ
• Example reflective essay – general practice

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• Reflective essay marking and feedback

• Example reflective essay – care homes
• Reflective essay marking and feedback
• PSQ template
• PSQ form

Section 6 – Consultation skills direct observation of practice

• Patient consent
• Preparing for your consultation skills assessment
• Assessment criteria
• Medicines Related Consultation Assessment Tool (MR-CAT)
• Reflecting on your practice to prepare for your assessment
• Examples of good consultation practice
• Stepwise processes in general practice and care homes

Section 7 – Portfolio
• ‘Evidence of impact in role’ template
• Examples of topics for portfolio entries for pharmacy professionals working in primary care
• Assessments
• Personal development plan
• Sharing your portfolio with your education supervisor
• Zipping up your files on your Canvas ePortfolio

Section 8 – Statement of assessment and progression

• What is included in the SoAP?

Section 9 – Guidance on time needed to complete assessments

• Module 1 assessments
• Module 2 assessments
• Module 3 assessment
• Module 4 assessment
• Module 5 assessments
• Portfolio and Statement of assessment and progression

References

Appendix 1 – PDP template

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Section 1 – Assessment overview

The Primary care pharmacy education pathway assessment strategy is multimodal with multiple
evidence points to provide assurance that the learner has gained knowledge, skills and behavioural
insight, which allows us to form an overall individual profile against the curriculum. Assessments
are linked to workplace roles for relevancy. Assessments include e-assessments, workplace-based
assessments, reflective essays, a portfolio and a statement of progression at the end of the
education. The assessment tools are accessible to all learners. Online assessments are completed
remotely at any time. Our assessment strategy is proportionate, providing assurance of patient
safety within a manageable time burden. See Section 9 for guidance on the time needed to
complete each assessment.

Our assessment strategy is broadly based on Miller’s pyramid,1 which is used to describe levels of
competence. It starts at the bottom and works upwards, and every step is a building block towards
the next level.

Figure 1: Miller’s pyramid

• Level 1: The first level is ‘knows’, or

demonstrating that you know something.
‘Knows’ is tested via CPPE e-
assessments.
• Level 2: The next level is ‘knows how’, or
applying your knowledge to show that you
know what it is for. ‘Knows how’ is also
tested via CPPE e-assessments.
• Level 3: The next level is ‘shows how’, ie,
you should be able to show how
something is done. This is often in a
simulated environment such as a
classroom.
• Level 4: The last level in the process is
‘does’, when you have moved beyond
‘showing how’ to ‘doing’. You are able to
routinely do it reliably and safely in the
workplace. Level 4 is assessed using
workplace-based assessments, eg, case-
based discussion, direct observation of
practice, multisource feedback, etc.

Assessments are linked to modules and are progressive, eg, the Consultation skills e-assessment (Module
1) demonstrates ‘knows’ and ‘knows how’. The consultation skills direct observation (Module 5)
demonstrates ‘does’. Our assessment strategy includes workplace-based assessment to provide
ongoing assurance of patient safety, monitor progression and provide feedback to help learning in
line with General Medical Council guidance on assessment.
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On completion of the pathway you will receive a Statement of assessment and progression (SoAP)
from CPPE. The SoAP measures your role progression and progression with the learning and
assessments.

The figure below provides an overview of Primary care pharmacy education pathway including
module assessments.

Figure 2: Overview of the Primary care pharmacy education pathway

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We have provided a brief summary of the assessments in this section of the assessment
handbook. There is more information about each of the workplace-based assessments and the
statement of progression in the subsequent sections of the handbook.

You must complete all CPPE assessments and you cannot substitute these with local
assessments or assessments completed as part of a diploma or independent prescribing
course.

You must ensure that you maintain confidentiality and therefore you must not include any
patient identifiable data in any of your assessments.

You must not use the same cases or evidence for more than one assessment. See section on
programmatic assessment on page 11.

Where to find assessment forms and portfolio recording templates

We have included copies of the assessment forms and portfolio templates in this handbook for
completeness. All assessment forms and portfolio templates can be downloaded as iPDF and/or
Word documents from the assessment section of Canvas (the CPPE virtual learning environment).

Recording progress with assessments

CPPE has designed a pathway progress tracker to record the key activities and assessments you
undertake as you progress with the Primary care pharmacy education pathway. This will help you
to track your progress with assessments throughout the pathway.

To record and view your progress with assessments, you will click on the pathway progress button
on the Primary care pharmacy education pathway page of the CPPE website:
www.cppe.ac.uk/career/pcpep/pcpep-training-pathway

You will need to sign up for the assessment tracker for each module. When you are signed up, you
will see that each assessment is a separate activity in the tracker. The date that you passed e-
assessments and reflective essays will be automatically populated in the pathway progress
trackers from the CPPE database. You need to manually record the dates that you passed the
other assessments. You can clearly see which activities you have completed, as they will be
marked with a tick. Your education supervisor will be able to use the data from your tracker to
monitor your progress with assessments.

Module 1 assessments
Pharmacy professionals will complete the following assessments as part of their induction, within three
months of starting the pathway, ie, by the end of Module 1. You can access e-assessments via the links in
the Module 1 activity series: https://www.cppe.ac.uk/career/pcpep/pathway-progress

Assessment Format
Safeguarding children and adults at risk: e-assessment – Activity 1
level 2 e-assessment (cohorts 1–10 only)*
elearning for healthcare (elfh) Equality, e-assessment – Activity 2
diversity and human rights e-assessment
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Primary care essentials e-assessment e-assessment – Activity 3

Care homes: supporting people, optimising e-assessment – Activity 4
medicines e-learning
Consultation skills e-assessment e-assessment – Activity 5
ePortfolio on Canvas Set up and add link to Activity 6 on the
pathway progress tracker
Statutory and mandatory training: Activity 7
Safeguarding children and adults training
and assessment**

*Cohorts 1–10 were required to complete the CPPE Safeguarding children and adults at risk: level 2 e-
assessment as part of Module 1 of the pathway. The CPPE Safeguarding children and adults at risk: level 2
e-assessment was withdrawn in September 2022 because safeguarding learning and assessment are
available via elfh and other providers. Therefore, cohort 11 onwards will not be required to complete the
CPPE Safeguarding children and adults at risk: level 2 e-assessment. Learners from all cohorts will be
asked to declare on their pathway progress tracker that they have completed statutory and mandatory
safeguarding training within three years of starting the pathway.
**The UK Core Skills Training Framework (CSTF) sets out 11 statutory and mandatory training topics for all
staff working in health and social care settings. Safeguarding adults and safeguarding children are two of
these topics.

Pharmacy professionals should complete the following as part of induction and refresher training every
three years:
• Safeguarding adults level 1 and 2 training and assessment
• Safeguarding children level 1 and 2 training and assessment
The pharmacy professional and their employer are responsible for ensuring that statutory and mandatory
training is completed during induction, and that refresher training is completed every three years.
The minimum level of safeguarding training for pharmacy professionals is level 2. However, some clinical
commissioning groups (CCG) recommend level 3 safeguarding training for all pharmacy professionals, and
some CCGs recommend level 3 safeguarding training only for healthcare professionals who work
predominantly with children and young adults. Pharmacy professionals should check the local requirements
for safeguarding training with their employer, CCG safeguarding lead and/or local safeguarding children
board.

Module 2 assessments
Pharmacy professionals will complete the following assessments within nine months of
starting the pathway, ie, by the end of Module 2.
You can access and record your assessments via the links in the Module 2 activity series.

Assessment Format
Case-based CPPE CbD assessment tool.
discussion (CbD) 1 Assessed by clinical mentor.
Record the date that you passed this assessment on the CPPE website
pathway progress tracker Module 2 assessments. (Activity 1)
Upload written feedback to assessments section of portfolio.

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Multisource feedback Online questionnaire – feedback provided by clinical and non-clinical staff in
(MSF) 1 the pharmacy professionals practice setting.
Access MSF via Activity 2.
Professional discussion with peers during group tutorial.
Record the date that you passed this assessment on CPPE website pathway
progress tracker Module 2 assessments. (Activity 2)
Complete MSF reflection template and upload to assessments section of
portfolio.
Inhaler technique for CPPE e-assessment Getting it right e-learning. (Activity
health professionals 3) Needs to be completed before Case 1 Module 2.

Module 3 assessment
Pharmacy professionals will complete the following assessment alongside Module 3, and should
complete by the end of Module 3 or soon afterwards.
You can access the reflective essay and record your assessments via the links in the Module 3
activity series.
Assessment Format
Clinical examination Activity 1 – Direct observation in the practice setting by GPs, nurses and
and procedural skills senior pharmacy professionals to complete a CEPSAR logbook.
assessment record and two case studies, discussed with your clinical supervisor, written up on
(CEPSAR) the CEPSAR case studies template and uploaded to the assessments section
of your portfolio.
Record the date that you completed the logbook and case studies on the
CPPE website pathway progress tracker Module 3 assessment. (Activity 1)
Activity 2 – Reflective essay, submitted via the pathway progress tracker on
CPPE website, to be marked by your education supervisor.

Applying for exemptions to Module 3

If you are an Independent Prescriber, you can apply for exemption to Module 3, Clinical
assessment skills, if you are able to demonstrate equivalent knowledge, skills and experience. You
can find information on how to apply for exemptions on the CPPE website:
https://www.cppe.ac.uk/career/pcpep/exemptions

A panel will review your application and inform you of the outcome, which will be either reject,
exempt from the Module 3 residential only, or exempt from the Module 3 residential but not exempt
from the CEPSAR assessment. It is not possible to apply for an exemption from the CEPSAR
assessment only, because if you need to refresh your knowledge and skills by attending the
residential course, then you will also need to demonstrate your competence by completing the
CEPSAR assessment.

Module 4 assessment
Pharmacy professionals will start the quality improvement project before or during Module 4, and
present this to their peers at least one month before the end of the pathway. You can record
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completion of your assessment via the links in the Module 4 activity series.

Assessment Format
Quality improvement Presentation of the quality improvement project to peers in a group tutorial in
(QI) project the last two months of the pathway. Peer review of project and peer feedback.
Record the date that you completed the QI project presentation on CPPE
website pathway progress tracker Module 4 assessment. (Activity 1)
Abstract to be uploaded to your portfolio.
Copies of QI project abstracts will be uploaded to Canvas by your education
supervisor to share good practice.

Applying for exemptions to Module 4

You can apply for exemption to Module 4, Leadership and management, if you are able to
demonstrate equivalent knowledge, skills and experience. You can find information on how to
apply for exemptions on the CPPE website: https://www.cppe.ac.uk/career/pcpep/exemptions

A panel will review your application and inform you of the outcome, which will be either reject or
exempt from Module 4 workshops only. All learners on the pathway need to complete the QI project,
including those who are exempt from Module 4, because QI is an important part of the role for all
pharmacy professionals working in primary care networks (PCNs).

Module 5 assessments
Pharmacy professionals will complete Module 5 assessments in the last six to eight months of the
pathway. They must complete the MSF reflection template and reflective essays at least two
months before the end of the pathway, and all other assessments at least one month before the
end of the pathway.

You can access the reflective essay and MSF, and record completion of your assessments via the
links in the Module 5 activity series.

Assessment Format
Case-based CPPE CbD assessment tool.
discussion (CbD) 2 Assessed by clinical mentor.
Record the date that you passed this assessment on the CPPE website
pathway progress tracker Module 5 assessments. (Activity 1)
Upload written feedback to assessments section of portfolio.

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Multisource feedback Online questionnaire – feedback provided by clinical and non-clinical staff in
(MSF) 2* the pharmacy professional’s practice setting.
Access MSF via Activity 2.
Professional discussion with peers at group tutorial.
Record the date that you passed this assessment on CPPE website pathway
progress tracker Module 5 assessments. (Activity 2)
Complete MSF reflection template and upload to the assessments section of
your portfolio.

Reflection on patient CPPE Patient Satisfaction Questionnaire (PSQ).

feedback Upload collated feedback to the assessments section of your portfolio and
include the link to this in your reflective essay.
Reflective essay on the learning from feedback from the PSQ, submitted via
pathway progress tracker on CPPE website, to be marked by your education
supervisor.
You can access this reflective essay by clicking on Activity 3 in the Module 5
activity series.
Consultation skills Direct observation of practice by clinical supervisor using the Medicines
assessment (MR- Related Consultation Assessment Tool (MR-CAT).
CAT) x 2 Both should be done in the final three months of the pathway, on two separate
occasions.
Record the date that you passed these assessments on the CPPE website,
pathway progress tracker Module 5 assessments. (Activity 4 and 5)
Upload feedback forms to the assessments section of your portfolio.

*Pharmacy professionals should complete their second MSF approximately six months after their
first MSF to allow sufficient time to action the development needs identified in the first MSF.

Programmatic assessment
Our assessment strategy is an evidence-based programmatic assessment which builds up an authentic
picture of the learner’s ability by undertaking multiple low stakes assessments throughout the duration of
their training programme. Therefore, learners must not use the same cases or evidence for more than one
assessment. For example:
• The QI project must not be written up as an evidence of impact (EOI) entry.
• Case studies for the CEPSAR assessment must not be used for your CbD.
• You must not use the same consultations for the consultation skills direct observation of practice
(using the Medicines Related Consultation Assessment Tool [MR-CAT]) as you use for the
CEPSAR case studies.
• The two CEPSAR case studies must be on two patients (not one consultation with a patient where
you used more than one clinical assessment skill). The CEPSAR cases must also be on two
different skills.
• You must not use cases or evidence that you have used for another course, eg, a clinical diploma or
independent prescribing (IP) course for your pathway assessments. Using cases or evidence more
than once is considered to be self-plagiarism.

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Deadlines for submitting your reflective essays and marking deadlines

As mentioned earlier, you must complete the MSF reflection template and reflective essays at least
two months before the end of the pathway and all other assessments at least one month before the
end of the pathway. To allow you to organise your work in a manageable and predictable way, all
reflective essays for the Primary care pharmacy education pathway have a submission deadline of
the end of the month. To comply with University of Manchester standards, your essays will be
marked within 15 working days of the deadline. For example, if your deadline is 31 August, any
essays submitted in August will be marked by 21 September. If you miss the end of the month cut
off, your essays may not be marked until the subsequent month which could delay your pathway
completion.

Portfolio
You will record your portfolio online via Canvas. A well-constructed portfolio should demonstrate the
breadth of your role, how you work effectively as a pharmacy professional in primary care, and
provide evidence of your impact in your role. You will complete your portfolio throughout the
duration of the Primary care pharmacy education pathway. You will share your portfolio with your
education supervisor and discuss your portfolio as part of your group tutorials. You will submit your
portfolio for review at least one month before your pathway completion deadline, alongside your
SoAP.

CPPE Statement of assessment and progression

Upon completing the pathway, you will receive a SoAP. This award is recognised by NHS England
as evidence of completion of the training required for pharmacy professionals working in primary
care in a patient-facing role. It details the learning undertaken and confirms the assessments you
have passed.

You will submit your SoAP and portfolio for review at least one month before your pathway
completion deadline. Your education supervisor will review your SoAP and portfolio and provide
feedback and suggestions for further development.

When your education supervisor has completed the review, they will release your SoAP, and you
will be able to access a PDF copy via the CPPE website.

You can use your SoAP and portfolio entries when applying for jobs to demonstrate your completion
of the pathway, your progression with learning and assessment, and evidence of how you have
applied your learning to develop your role in primary care.

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Section 2 – Case-based discussion

The case-based discussion (CbD) assessment is a retrospective structured discussion, designed to
assess your input into patient care. The CbD encourages you to reflect on your practice and allows
your assessor and other pharmacy professionals to ask questions about their case.

The CbD focuses on the following areas:

• application of pharmaceutical knowledge and skills in order to undertake and support
structured medication reviews (SMR) and manage pharmaceutical care plans (in
partnership with the patient)
• a person-centred approach and shared decision making
• reasoning and judgement skills, including identification of problems and clinical decision-making skills
• the ability to apply evidence to practice and work with conflicting evidence
• the ability to recognise and manage complexity safely, including identification and stratification of risk
• professional autonomy
• communication and consultation
• teamwork, including working with the multidisciplinary team and cross sector team working where
appropriate.

The CbD encourages you to reflect on your practice and allows your peers and your assessor to
ask questions about your professional judgement, clinical decision-making and the application of
pharmaceutical knowledge in the care of your patients. The CbD is not designed to be a pure test
of knowledge.

You will be required to undertake two CbD assessments. The first CbD assessment will take place
approximately six months after you start the Primary care pharmacy education pathway, while you
are completing Module 2. The second CbD should take place approximately six months after the
first CbD.

All CbD sessions will run as workshops on Zoom with up to 30 learners. Once in the session, you
will be put into a breakout room with up to six learners and a clinical mentor who will be the
assessor.

Preparing for your CbD assessment

• Book onto a CbD assessment session via the CPPE website in the same way as you
would book workshops. Your cohort will be informed of when to book CbD1 and CbD2 via
Canvas announcements and keycodes. Booking links will be available on your cohort page
on Canvas.
• Familiarise yourself with the CbD assessment form and criteria, and reflect on how your
case demonstrates the criteria (see table on 19). The assessment criteria are the same for
both CbDs, but your choice of case should differ to demonstrate role progression. As you
progress in your role, you will be able to deal with increasing complexity; therefore, we would
expect your second CbD to be more complex than your first. See examples of entry level,
intermediate and advanced clinical care in the role progression handbook.
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• Choose a case which demonstrates your contribution to patient care and which enables
you to demonstrate the assessment criteria. Choosing an unsuitable case is the most
common reason for pharmacy professionals not to pass their CbD. See table on page 14–
15, which provides more information on choice of case for pharmacists and pharmacy
technicians. Pharmacy technicians can choose a non-patient facing case for their first
CbD if they are not seeing patients but the second CbD must be patient facing.
• Watch the recordings of a CbD and CbD feedback session on Canvas to familiarise
yourself with the process prior to your first CbD. You can find these in the CbD page on
the assessments section of Canvas (see under the heading ‘CbD resources’).
• Complete section 1 of the CbD assessment form to help you focus your thoughts and
plan how you will present your case.
o Make sure that you save this as an iPDF.
o If you are a pharmacy technician and your first CbD is not patient facing don't
include patient details or medication on the CbD assessment form. Patient agenda
may still be relevant for your case eg, if you have improved services based on
feedback from patients.
o You will need to share a copy of your CbD assessment form during your CbD
assessment via Zoom chat or by emailing your assessor at the start of the session.
• Do not prepare a PowerPoint presentation as you will not be able to use this at the CbD
assessment session. Remember that this is a case-based discussion and not a
presentation. The assessment is designed to reflect real-life practice, eg, when you bring
a case for discussion at a team meeting at your PCN or discuss a case with your clinical
supervisor.
• Focus the CbD on the most important parts of the case and what you did and why. Don’t
read through a long list of medicines and doses if they are not relevant to the case. For
example, don’t present information detailing the pathophysiology of asthma or how steroid
inhalers work. The CbD is not designed to test this type of knowledge, which will have
been tested when you were a student.
• Rehearse what you will say and time yourself as you will be allocated 15 minutes to present
your case.
• Anticipate questions you might be asked and be prepared to explain your decision-making
process and justify your actions. See pages 18–20, which include some of the questions
you might be asked during your CbD.

How to choose a case

Pharmacy technicians Pharmacists

• Clinical responsibilities of pharmacy • Both cases must be patient facing for
technicians outlined in the Primary pharmacists, and to demonstrate role
Care Network Contract Directed progression you might present a ‘core
Enhanced Service include clinical care’ case (see the Pathway
undertaking patient-facing roles to and role progression handbook) for
ensure effective medicines use, your first CbD and an ‘advanced clinical
through shared decision-making care’ case for your second CbD.
conversations with patients.

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• We recognise that it might take • Choose a clinical case where you have
some time for pharmacy technicians made a contribution to patient care (this
to establish themselves in these can be either a face-to-face or virtual
clinical patient-facing roles; consultation), and that demonstrates
therefore, the first CbD for pharmacy your ability to support patients to
technicians does not have to be optimise their medicines, undertake or
patient facing, eg, you might have support SMR or manage
developed systems for self- pharmaceutical care plans.
medication in a care home, • Your case should also demonstrate
undertaken medicines reconciliation your ability to use your professional
or undertaken some patient safety judgement and clinical decision-making
audits around high-risk medicines. skills, eg, a complex medicines review,
You could choose these examples or managing a care plan for a patient
for your first CbD. with long-term conditions or multiple
• By the time you complete your morbidities.
second CbD, we would expect you
to have progressed in your role and
to be consulting with patients (either
a face-to-face or virtual consultation);
therefore, your second CbD must be
patient facing.
• If you are struggling to establish a
patient-facing role, then please
discuss with your education
supervisor at the earliest possible
opportunity.

CbD assessment session

The CbD is discussed in groups because this is an ideal opportunity to reflect on your clinical practice with
other pharmacy professionals and to discuss specific cases in depth. This is an effective way to help you
critically review and improve your practice. You will learn from your own cases, and also learn from the
cases presented by other pharmacy professionals.

“[I] dealt with a patient differently the next day as a direct result of listening to someone else’s case.”
– Clinical pharmacist

Your assessor will be a clinical mentor who is an experienced clinical pharmacist, and who has completed
CPPE CbD assessor training before they conduct your CbD assessments.

Each CbD assessment session will last for up to three hours (six CbD assessments). Each CbD will last for
a maximum of 30 minutes. When you are a presenter, you will deliver a 15-minute case presentation, and
then your assessor and the other pharmacy professionals will ask you questions about your case (15
minutes). We are unable to predict exactly what questions you will be asked at your CbD. When you are not
the presenter, you are expected to participate by listening to the presentation and asking questions. There
are examples of questions to ask on pages 18–20.

Your assessor is responsible overall for assessing your CbD and completing the CbD assessment form
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(see pages 21–30). You will not be told the outcome of your CbD assessment during the CbD assessment
session, as this is part of the one-to-one verbal feedback session that you will have with your assessor
within one week of the CbD assessment session.

After the CbD assessment session

You will participate in a verbal feedback session with your assessor by phone or Zoom/Teams within one
week of the CbD assessment session. This is a two-way discussion where you and the assessor discuss
whether you have demonstrated each assessment criterion. Your assessor might ask you more questions
about your case at the verbal feedback session if they felt that there was insufficient evidence for them to
make an assessment decision on the day of your CbD assessment. The assessor will also provide
feedback on strengths and areas for development at the verbal feedback session. At the end of the verbal
feedback session, your assessor will inform you of the overall outcome of the assessment, which will be
either:
• You have passed this assessment
• You did not demonstrate sufficient assessment criteria to pass this assessment.

The assessor will also agree an action plan with you, including any support needed. The action plan
is especially important if you do not pass the assessment. The assessor will complete the CbD
assessment form and email it to you and your education supervisor within one week of the verbal
feedback session.

After the verbal feedback session, you should:

• reflect on the feedback you have received and identify development areas for your personal
development plan (PDP)
• file a copy of the completed CbD assessment form in your Canvas portfolio
• record the date that you passed your CbD assessment on the progress tracker on the CPPE
website
• if you did not demonstrate sufficient assessment criteria to pass your CbD assessment, please
contact your education supervisor as soon as possible to discuss next steps. You will need to do
another CbD using a different case in order to pass the assessment. Your education supervisor will
ensure that you have sufficient time to address development needs before you are reassessed and
will agree a time with you when you will be reassessed. Further support will be provided where
necessary.

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Figure 3: Summary of steps for CbD

Prepare your CbD

• Familiarise yourself with the assessment criteria

• Choose a suitable case
• Prepare for your CbD and complete the template on page 1 of the CbD assessment form
• Prepare for any questions you may be asked

Participate in CbD

• Discuss your case at the CbD assessment session

• Answer questions from your assessor and other pharmacy professionals
• Participate in the verbal feedback with your assessor within one week of the CbD session

Reflect on your CbD

• Reflect on learning points from your CbD, including strengths and development needs
• Address your development needs as part of your PDP

Record details of your CbD

Upload your completed CbD assessment form to your Canvas portfolio

Record the date you passed your CbD assessment on the pathway progress tracker for Module 2 and 5 assessments

Assessment criteria for the CbD

The assessment criteria are derived from the Royal Pharmaceutical Society’s (RPS) Advanced Pharmacy
Framework (APF), which is suitable for all pharmacy professionals. The assessment criteria for the CbD are
divided into two clusters of competencies (see table below).
Cluster Competencies Demonstrating overall competence
Cluster 1: Expert 1.1 Expert knowledge and skills Majority principle – The pharmacy
professional 1.2 Delivery of professional expertise professional must demonstrate at least
practice 1.3 Reasoning and judgement three of the four competencies in cluster
1.4 Professional autonomy 1 to demonstrate this cluster overall.
Cluster 2: 2.1 Communication Majority principle – The pharmacy
Collaborative 2.2 Team work professional must demonstrate both
working competencies in cluster 2 to
relationships demonstrate this cluster overall.

More information on the assessment criteria, including descriptions for each of the competencies,
is included in the CbD assessment form (see pages 21–30).

Assessment decisions

• The assessor should make a judgement on whether each competency was demonstrated, or

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whether there was insufficient evidence for them to make a judgement.

• Where there is insufficient evidence, the assessor should elicit the information through questioning.
• The assessor must also make a judgement on whether you demonstrated clusters 1 and 2 overall
using the majority principle (see table above).
• To pass the assessment, you must demonstrate the majority of competencies for both clusters 1
and 2.
• Your assessor will inform you of the outcome of the assessment after the verbal feedback session.
• Your assessor will also provide feedback on your strengths and areas for development for you to
include in your PDP.

If you do not demonstrate the majority of the assessment criteria, you will not pass the assessment.
You will need to do another CbD using a different case in order to pass the assessment. Your
education supervisor will ensure that you have sufficient time to address development needs
before you are reassessed, and will agree a time with you for when you will be reassessed.

Figure 3 summarises the steps for preparation of your case, participation in the CbD, reflection on feedback
after your CbD, and recording details of your CbD.

Examples of questions which might be asked during the CbD

The CbD assesses professional judgement, clinical decision-making and the application of
pharmaceutical knowledge in the care of patients. Therefore, please refrain from asking questions
that purely test clinical knowledge; instead, focus on questions that test application of knowledge.
The questions should also be framed around the actual case rather than hypothetical events, and
the main purpose of asking questions is to elicit evidence of competence in relation to the
assessment criteria.

We have compiled a list of questions that you can use during the CbD. We do not intend for this to
be an exhaustive list and we do not suggest that you ask all of the questions on the list. You will
also identify your own questions to ask, based on the case. The questions have been designed to
help you to assess the pharmacy professional in relation to competencies in clusters 1 and 2. We
have mapped most of the questions to the competencies. Sometimes the questions will map to
more than one competency.

Competencies

Cluster 1: Expert professional practice

1.1 Expert professional practice
1.2 Delivery of professional expertise
1.3 Reasoning and judgement
1.4 Professional autonomy

Cluster 2: Collaborative working relationships

2.1 Communication
2.2 Teamwork and consultation

2.3
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General questions:
• What made you choose this example for your CbD?
• Describe how your approach was person-centred?
• What were you trying to achieve?
• What was the outcome and what were your reflections on this?
• What do you think you did well or what went well?
• What would have made it even better?
• What would you do differently next time?
• Can you give me an example?

Expert knowledge and skills, and delivery of professional expertise:

• What was your role in the overall management of this patient/care home resident? (1.2)
• Describe how you applied your pharmaceutical knowledge and skills in order to manage
the patient’s pharmaceutical care plan. (1.1, 2.1)
• How did you involve the patient in shared decision making to negotiate a mutually
acceptable pharmaceutical care plan? (1.1, 2.1)
• How did you and the patient review and monitor the pharmaceutical care plan? (1.1)

Reasoning and judgement:

• What are the issues raised in this case? (1.3)
• What was challenging or complex about this issue and how did you deal with this? (1.3)
• What were the risks involved and how did you manage these? (1.3)
• How did you apply the evidence base in this case? (1.3)
• What other evidence could have been useful? (1.3)
• What clinical decision-making tools did you use and how did you use them? (1.3)
• If the patient presented with multiple issues, how did you and the patient prioritise
the issues to address? (1.3, 2.1)
• What were the options to address these issues? How did you and the patient decide
which option to choose? (1.3, 2.1)
• How did you know the patient/care home resident had the mental capacity to make
decisions about their medicines? (1.3, 1.4, 2.1)

Professional autonomy:
• What policies, procedures, formularies and guidelines did you need to consider? (1.3, 1.4)

Communication:
• How did you establish the patient’s point of view? (2.1)
• How did you respond to the patient’s agenda, health beliefs and preferences? (2.1)
• How did you ensure that any information or advice given was appropriate for the
patient’s needs? (1.2, 2.1)
• How did you overcome the challenges to communication with a person (who lacks
mental capacity) when the carer or family member was making the decisions about the
care? (2.1)
• What was the difference in language you needed to use when communicating with the carers
and other members of the multidisciplinary team involved in the case? (2.1)
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Team working:
• Which other members of the multidisciplinary team did you involve in this case and why? (2.2)
• Who else could you have involved? What might they have been able to offer? (2.2)

The following questions could be used for pharmacy technicians presenting non-clinical cases for
CbD1:
• How did you apply your pharmaceutical knowledge and skills to indirectly impact on patient care?
(1.1)
• Describe how this case demonstrates that you are accountable for delivery of professional
services to groups of patients or service users as part of a team. (1.2)
• What was your role in this process? (1.2)
• What knowledge and skills did you need to undertake this process, and did you perform
any training with the care home/practice staff (think of any training and reading you did
before undertaking this change)? (1.1, 2.1, 2.2)
• How did you persuade XXX to start using this system? Did you use shared decision
making to negotiate a mutual agreement? (1.1, 2.1)
• Did you discuss the advantages of using this system for XXX? (1.1)
• What issues were raised during your conversations or when setting up this system with the
care homes/practices? (1.3)
• What was challenging or complex about this issue and how did you deal with this? (1.3)
• What were the risks involved and how did you manage these? (1.3)
• Was there any data about how this has been used in other care homes/practices that you
could have presented?
• How did you persuade the teams? Did you use any tools or information to inform them?
(1.3)
• What policies, procedures, and guidelines did you need to consider? (1.3, 1.4)
o How did you establish the care homes/practices’ ideas, concerns and expectations?
(2.1)
o How did you respond to the care homes/practices’ agenda and preferences? (2.1)
o How did you ensure that any information or advice given was appropriate to the needs of
the care homes and practices? (1.2, 2.1)

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Case-based discussion assessment form

The form is presented here to show you the form that the assessor will be using. Do not type into this form.

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Section 3 – Multisource feedback

The multisource feedback (MSF) assessment is completed twice during the Primary care pharmacy
education pathway. You will use the MSF tool to request feedback from colleagues who can
provide feedback on your professionalism and clinical performance.

We have adapted the Royal College of GPs MSF tool for pharmacy professionals working in primary care:
https://www.rcgp.org.uk/gp-training-and-exams/training/workplace-based-assessment-
wpba/assessments

The MSF feedback tool consists of two parts:

• part one is an assessment of your overall professionalism, which will be completed by all
respondents
• part two is an assessment of your overall clinical performance, which will be
completed by clinical professionals only.

When giving feedback for your MSF, your colleagues will use the seven-point rating scale below,
and comment on your strengths and development areas.

Rating scale

1. Very poor
2. Poor
3. Fair
4. Good
5. Very good
6. Excellent
7. Outstanding

We have also provided some suggestions that your reviewers may wish to provide feedback on
when completing your MSF feedback (see table below).

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Areas to consider for overall professionalism Areas to consider for overall clinical
(linked to the GPhC standards for pharmacy performance
professionals)
• Person-centred care • Influences safe, appropriate, and
• Working in partnership with other members of cost-effective prescribing
the multidisciplinary team • Clinical assessment, examination and
• Effective communication with patients and monitoring skills (where appropriate to role)
colleagues • Person-centred approach to consultation and
• Maintaining, developing and using professional communication skills
knowledge and skills • Shared decision making
• Professional judgement • Medicines optimisation and care of people
• Behaving in a professional manner with long-term conditions
• Respecting and maintaining privacy and • Safe and evidence-informed use of
confidentiality medicines
• Speaking up when they have concerns or when • Medication reviews and deprescribing for
things go wrong inappropriate polypharmacy
• Demonstrating effective leadership

Who should I request feedback from?

Aim to get feedback from 15 people who you work with. The more invites you send the better, as not
everyone will respond. Please check that the email addresses that you include are correct, as you
can’t change these after you have sent the invites. The invite will be sent from [email protected] so
it is good practice to ask people first if they will give you feedback, and then you can prompt them to look
for the invite email as this might go to junk.

Please ensure you request feedback from your clinical supervisor. You can also request feedback from
GPs, nurses, pharmacists and pharmacy technicians working in primary care, practice managers,
receptionists, care home managers, care workers and any other members of the multidisciplinary team who
you work closely with, including community pharmacists. Make sure that you ask a range of people
because the different professionals who you work with will have different perspectives on your practice
depending on their role and how you work with them. Please note: non-clinical professionals can only give
feedback on your professionalism, whereas clinical professionals can also give feedback on your clinical
practice. A minimum of six responses is required before your education supervisor can release your
feedback report.

Do not request feedback from patients for your MSF. You will use the Patient Satisfaction
Questionnaire (PSQ) to collect patient feedback as part of Module 5 assessments.

Do not request feedback from your education supervisor for your MSF. They need to remain
impartial in order to support you to take the MSF feedback on board.

Registering for the online MSF tool

Log into the CPPE website and go to the pathway progress tracker in order to access the MSF.

Then, click into the relevant activity series and activity to access the MSF tool:
• to access MSF 1: sign up for Module 2 assessments and go to Module 2 assessments,
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where you will find the link for MSF1 (Activity 2)

• to access MSF 2: sign up for Module 5 assessments and go to Module 5 assessments,
where you will find the link for MSF2. (Activity 2)

Then, click on the Access the MSF tool button, which will take you to a new screen. You will now be
able to use the MSF tool to request feedback.

Stepwise process for using the MSF

Step 1: Send a link to your peers

Send a link to your colleagues/peers to invite them to give feedback. Add the title, first name,
surname and email address of the first person that you are inviting to give feedback and click the
send an invite button. Ensure that you are using correct and up to date email addresses. Once
entered into the system, the email address cannot be changed.

The person’s name and email address will appear in the invites sent section at the bottom of the
screen. Continue to invite people until you have invited at least ten people.

After you submit an invitation, your colleague/peers will receive an email from [email protected]
requesting feedback. The email will contain a link to the MSF tool, and a two-week deadline to
complete the feedback.

To maintain anonymity of the process, please do not ask the person providing feedback to
forward you their private link.

You will be able to see the number of invites sent and responses received at the top of your screen.
However, you won’t be able to see who has responded to maintain anonymity.

You can use the resend invite to remind your colleagues to submit feedback. The message will
instruct your colleagues to ignore the email if they have already submitted feedback.

Step 2: Self-assessment
Click on the Complete your self-assessment button to complete a self-assessment of your
professionalism and clinical performance. This will take you to a new screen, where you will rate
your professionalism and clinical performance using the seven-point rating scale. You will also
comment on your strengths and development areas.

When you have completed your self-assessment, click on the Submit button. A pop-up box will appear to
inform you that your responses have been submitted.

Step 3: Feedback report

The average (mean) scores from your colleagues will be calculated for each section of the MSF and
these average scores will be reported in your MSF feedback report. Your colleague’s comments will
be anonymised and collated and included in your MSF feedback report. The report will enable you
to compare your own scores and comments with those of your colleagues.

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At least six of your colleagues will need to complete the MSF questionnaire, and you will need to
complete your self-assessment before we can generate your MSF feedback report.

Your MSF feedback report will include:

• the number of people who provided feedback and their professional role
• your self-assessment score for parts one and two of the MSF
• the average (mean) scores from your colleagues/peers for parts one and two of the MSF
• your comments on your strengths and areas for development for parts one and two of the MSF
• anonymised comments from your colleagues/peers about your strengths and areas for
development for parts one and two of the MSF.

Your education supervisor will receive your completed MSF feedback report and they will release
this to you. You will be able to access it by clicking on the Access your feedback report button
(step 3 of the MSF tool).

The MSF survey will close when your education supervisor releases your feedback report. If any of
your colleagues click the link to complete feedback after the survey has closed, they will see a
message on the screen explaining that the survey is closed and feedback can no longer be submitted.

You will use the template on pages 35–37 to reflect on your MSF feedback report and the
strengths and areas for development identified by your colleagues/peers. You can download a
copy of this template from the assessment section of Canvas. You will have a professional
discussion with your peers at a group tutorial to discuss the feedback report and your
development areas for your PDP.

Use the Reflection on MSF feedback template to record your reflections prior to the tutorial, and
upload a copy to your Canvas portfolio. All assessment forms and portfolio recording forms can be
downloaded as iPDF and/or word documents from the assessment section of Canvas.
Record the date that you discussed your MSF report with your peers on the pathway progress
tracker assessment activity series.

The first MSF assessment is completed around month five or six, as one of the assessments for Module 2.
The second MSF is completed approximately six months later, as one of the assessments for Module 5

We recommend that you have a six-month gap between your first and second MSF to allow sufficient time
for you to address learning needs identified from your first MSF.

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Reflection on MSF feedback report template

Use this template to reflect on your multisource feedback (MSF) report prior to your professional discussion
in your group tutorial.

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Section 4 – Clinical examination and procedural skills assessment record

The clinical examination and procedural skills assessment record (CEPSAR) has been designed to
allow you to collect evidence of practical experience for common clinical procedures, and it is the
assessment for Module 3. CEPSAR will support you to:
• contribute to urgent care support by increased understanding of history-taking and
clinical examination
• demonstrate ability to make a clinical assessment, including in patient groups where
communication may be especially challenging
• document history and clinical findings in an appropriate format
• use physical assessment techniques (inspection, palpation, percussion and auscultation)
and apply these to clinical examination of a range of body systems
• interpret normal and abnormal findings on physical examination for a range of body systems
• demonstrate an ability to perform an examination of body systems to manage a wider range
of conditions
• apply the principles of hygiene and infection control in the clinical setting.

The Clinical examination and procedural skills assessment has three parts:
• clinical examination and procedural skills log
• two case studies – discussed with your clinical supervisor and written up on the CEPSAR case
studies template uploaded to your portfolio)
• reflective essay on clinical and procedural skills practice – submitted via the pathway
progress tracker on CPPE website, for marking.

There is a separate logbook for CEPSAR. You will be given a hard copy at the Module 1 residential
days 3 and 4; you can also download an iPDF version from the assessment section of Canvas.

Clinical examination and procedural skills log

The clinical examination and procedural skills log is designed to allow you to collect evidence of
practical experience for common clinical procedures. The procedures included in CEPSAR are not
exhaustive, nor is it anticipated that every pharmacy professional would have the requirement to be
trained in each skill. The respiratory examination and the cardiovascular system examination are
included to enhance the training and development of experienced clinical pharmacists only. These
examinations are not suitable for pharmacy technicians.

Minimum skills required for CEPSAR

We expect all pharmacy professionals working in patient-facing roles to be able to perform basic
clinical examination and procedural skills. Competency in these basic skills will enable you to
identify acutely ill patients, including those with sepsis by using the National Early Warning Score
(NEWS2), and ultimately to save lives. The table on page 39 lists the clinical examination and
procedural skills that all pharmacy professionals on the pathway are expected to demonstrate in
order to complete the CEPSAR assessment. You will learn how to perform these skills on Day 4 of
the Module 1 residential, which you should then practice with colleagues until you can competently
perform them. In addition to the skills listed in the table, you should agree with your clinical
supervisor which other clinical examination and procedural skills are relevant to your role, and
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develop a plan to learn how to competently demonstrate these skills.

Clinical assessment skills that all pharmacy professionals must demonstrate to complete
the CEPSAR assessment and details of equipment required

The table above lists the equipment needed for each of the skills. Your employer might provide the
equipment for you, or you might need to purchase this yourself. If you are buying your own
equipment, this should be reputable. You should be aware of the need for calibration and quality
assurance, and should discuss this with your clinical supervisor. You can buy equipment from
Amazon or via a medical supplier, eg, Medisave (www.medisave.co.uk) or Healthcare Equipment
(www.hce-uk.com). You can claim tax relief on equipment that you purchase for work purposes on
your tax return. You can also claim tax relief on your GPhC registration fees, professional body
memberships and indemnity insurance.

You will be assessed by direct observation of practice and will need to demonstrate three competent
attempts. The first two attempts can be supervised by a healthcare professional who is competent
and experienced in undertaking the clinical examination or procedure. Your clinical supervisor
should decide who will observe you in undertaking clinical examinations and procedures, and agree
this with you. The final observation and sign-off should be done by your clinical supervisor. If your
clinical supervisor has delegated the final sign-off to another competent healthcare professional,
they should countersign the record to this affect.

Some pharmacy professionals might need to demonstrate competence in other clinical assessment

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skills, in addition to the minimum skills listed in the table above. For example, if you are seeing
respiratory patients you would need to demonstrate competence in using a peak flow meter and
possibly competence to undertake full respiratory examination. You will discuss with your clinical
supervisor whether you need to perform additional clinical assessment skills in your role.

You should use the logbook to record the minimum clinical assessment skills (listed in the table
above) and any additional clinical assessment skills you need to perform in your role. Procedures for
completing clinical assessments and how to complete the logs are included in the CEPSAR logbook
so have not been repeated here. You must demonstrate that you can undertake each procedure
consistently well to be considered competent.

The range of examinations and procedures and the number of observations will depend on your
particular needs and the professional judgement of your clinical supervisors You should discuss
your learning needs during meetings with your clinical supervisor and record your plans in the
learning log and your PDP.

FAQs about the CEPSAR logs

I work remotely, so how can I be assessed for my CEPSAR logs?

You can practice skills on colleagues or family members. Aim to arrange a time when you can visit
the practice to be assessed on a range of clinical assessment skills so that you can demonstrate all
of the skills at the same visit. If it is not possible to arrange a visit to the practice, you can arrange
for your clinical supervisor to assess you by observing you online via Zoom or Teams.

Why are frailty assessment tools and MUST scores NOT included in CEPSAR?
CEPSAR is designed to support you to develop the skills to be able to physically examine patients.
The assessment of frailty (in the main) will comprise physical observations as opposed to direct
clinical assessment skills.

Frailty is a clinically recognised state of increased vulnerability. It results from ageing associated
with a decline in the body’s physical and psychological reserves. Frailty varies in its severity, and
individuals should not be labelled as being frail or not frail but simply that they have frailty.

We know that frailty is a distinct health state where a minor event can trigger major changes in
health from which the patient may fail to return to their previous level of health. Frailty assessment
provides a picture of a resident’s resilience if they develop an illness and as such will inform the
treatment plan that will be created by either the pharmacy professional or another member of the
multidisciplinary team. A practitioner will need to be extremely prompt and careful in handling a
resident who is frail, as they will never fully bounce back to their former health should they get ill
and could suffer further complications of whatever illness they were suffering from.

Understanding a person’s nutritional status and whether they are living with frailty when you
complete a medication review is really important, as we know both aspects can affect long-term
outcomes. Therefore, we encourage you to familiarise yourself with nutritional status (MUST
scores) and whether the person you are reviewing is living with frailty, even though they are not
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direct clinical examination skills.

What if there are clinical examination and procedural skills that are relevant to my role but
not included in the log?
You can use the same method of observation of supervised attempts to develop your practical
experience of undertaking these clinical examinations and procedures. You can find process
checklists in clinical examination textbooks and confirm the process with your clinical supervisor
before undertaking the clinical examination or procedure. You can use the CEPSAR additional
skills form to record competence in these skills.

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CEPSAR additional skills form

A copy of the form is presented here. You cannot type into this form.

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CEPSAR case studies form

The form is presented here to show you how you should record the case studies that you discuss with your
clinical supervisor. You cannot type into this form.

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Case studies
You are required to write two case studies (800 to 1000 words) about two different patients to
demonstrate how you apply clinical assessment skills when consulting with patients. Each case
study should evidence your use of a clinical examination skill that is relevant to your practice, and
each one should be about a different skill.

A professional discussion of these case studies with your clinical supervisor forms part of the sign-off
process. The written case studies should describe your actions, your discussion with the patient
about the examination, your findings, the significance of your findings and any action plan agreed
with the patient. Case studies should be written up in the CEPSAR case studies form on page 43–
44, and in the assessment section of Canvas. You should upload the case studies to the
assessment section of your portfolio after the discussion with your clinical supervisor, including any
learning points, as well as an action plan as a result of the discussion. Examples of written case
studies have been provided on pages 45–42.

Your case studies can be based on phone or online consultations if your role does not involve seeing
patients face-to-face. In these circumstances, you will not actually perform the clinical assessments
yourself and your case would focus on initiation of monitoring, interpretation of the results, discussion
with the patient about the results and any advice or changes to treatment due to the results. For
example, you might be doing a hypertension review by phone. You could ask the patient to do home
blood pressure monitoring and report the results back to you. You would then discuss the results with
the patient, the significance of the results, provide healthy lifestyle advice and potentially initiate or
change medication as a result of the blood pressure readings, or refer to another healthcare
professional to make changes where appropriate. Another example could be an asthma review
where the patient would complete the peak flow assessment themselves and share the results with
you so that you can interpret the readings and make treatment suggestions where necessary.

Example case studies

We have provided some examples of case studies on the following pages. These are real case
studies written by pharmacy professionals who have completed the pathway and have been
included in this handbook with their permission. Case studies 1 and 2 are written by pharmacists
working in general practice, case studies 3 and 4 are written by pharmacy technicians working in
care homes, and case study 5 is an example of a remote consultation written by a pharmacy
technician working in a PCN. However, these case studies showcase how any pharmacy
professional could use clinical assessment skills in their role.

Example case study 1

I carried out a hypertension check with a patient who had been referred by the practice’s advanced
nurse practitioner (ANP). She had seen Brian (pseudonym) ten days earlier and found his blood
pressure (BP) to be high (164/97 mmHg). This might have been explained by uncontrolled thyroid
function, a large meal before the appointment or his rush to get to the practice, so she called him
back to check.

After reading through the notes, I welcomed Brian into the consultation room. I didn’t think we had
met before so I introduced myself as the practice pharmacist and checked what he preferred me to

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call him.

He agreed that he was comfortable, consented for me to carry out the consultation and confirmed
that he didn’t need a chaperone; he had no questions at this stage so I began to gather information.

I asked open questions to explore Brian’s ideas, concerns and expectations, such as, “Tell me why
you think you were asked to come back for this appointment” and “Can you explain what you know
about high blood pressure”. He said he knew that his BP had been high and that being overweight
wasn’t helping. He was a little worried about the future and wanted advice to lose weight. He was
also resigned to needing more medicines.

Brian was familiar with the need for BP examination and the process so I just reminded him about
being still and quiet and reconfirmed his consent. I’d already checked the equipment at the start of
clinic so I moved directly to handwashing. The range finder confirmed that a standard cuff would be
too small, so I used a large cuff. I located the brachial pulse, applied the cuff and palpated the radial
pulse while inflating the cuff to estimate systolic BP (145 mmHg). I then inflated the cuff to 175
mmHg and released the pressure at a rate of 2 mm/second. I auscultated the brachial artery and
observed the sounds from 144 mmHg until 93 mmHg giving a BP of 144/93 mmHg. It’s good
practice to take a second in the same arm, which I did using the same technique, and found 142/92
mmHg. While palpating the radial pulse I had established a heart rate of 72 bpm. Brian’s height
(184 cm), weight (127 kg) and BMI (37.51 kg/m2) had been recorded by the ANP at the last
appointment.

I asked Brian if he understood what these results meant. He said that he thought it needed to be
below 140 and 80, but wasn’t sure. I explained that we were aiming for below 140 and 90 in
someone of his age (66) who’s already taking medicines for high BP. That led nicely on to
confirming adherence with his medicines and then social history. I won’t go into detail, because it’s
beyond the scope of a case study about clinical examination skills, but having confirmed those
things we discussed options and follow-up, and Brian left with a plan to improve his diet, reduce his
alcohol intake and come back to see me in a month.

The consultation seemed to go well. I was prepared for the clinical examination and I’d had chance
to familiarise myself with Brian’s case before he came into the room. Having this background gave
me more time in the appointment, and allowed me to spend time getting a good understanding of
Brian’s perspective. I think this helped to build rapport and helped Brian to settle, which might even
have helped his BP. I gathered information in a structured manner, but allowed the conversation to
flow naturally, and found out a lot about what Brian already knew, rather than telling him
everything on automatic pilot. His honesty about adherence to medicines and alcohol consumption
evidenced an effective practitioner-patient relationship.

I was generally happy with my examination technique and managed to complete almost every step
as I’d been taught, including using the handwashing time to go through my mental checklist. I did
ask a couple of double questions, which Brian coped with, but I need to avoid in future. I’ve often
struggled to find brachial pulse, especially in people who are overweight, but I managed it quite
easily this time. I realised that I hadn’t allowed Brian to rest for five to ten minutes before I took his
BP, but I think the appointments are too short to allow that. However, I did confirm that he’d arrived
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a little early and had been sitting in the waiting room before I called him in, he hadn’t been in a
particular rush and hadn’t had a big meal before he came.

We also had a brief chat before I applied the cuff. I’m not sure that I could do any more than that without a
longer appointment, and the GPs have much the same approach. I guess that’s why we do so much home
BP monitoring these days. I recorded the results in Brian’s notes and my GP supervisor has complimented
me on my record-keeping, which was really good to hear. I think we made an appropriate decision to
pursue lifestyle modification, rather than increasing medicines straight away; Brian seemed committed to
this from the start of the consultation and we have an appointment in a month to check progress. We have
a clinical meeting in the practice where we discuss cases and offer peer review so I might take it there and
see how other people would have approached the borderline result.

I’m not sure there’s much that I would do differently next time, other than trying not to ask double questions,
and trying to increase the amount of resting time before taking BP measurements. However, I will ensure
that I’m prepared as I was this time, and take time to explore the patient’s understanding of process and
results, and what they want to know before I start telling them what I think they need to know. (986 words)

Example case study 2

I chose to reflect on this case, because respiratory examination is essential to my role running
asthma clinics. I was signed off for this clinical skill during my prescribing course, and have already
done several unsupervised, although my clinics run alongside my GP supervisor’s so I have
support if needed. For the purposes of confidentiality, I will refer to the patient as Kim (pseudonym).

I looked through Kim’s medical notes before calling her in and found that she was 57 years old
and had been complaining of a cough in recent months. She had undergone chest x-ray nine
months ago, which was normal, and had received two courses of antibiotics since then.

I introduced myself to Kim, explaining my role. I then confirmed her name and date of birth,
discussed confidentiality, asked if she was comfortable to proceed and gained consent. I could tell
from her head nodding and verbal agreement that she was OK with the situation. I use the Calgary–
Cambridge framework to structure my consultations and began with an open question, “What brings
you here today?” Kim said that she was still suffering from a persistent, dry cough that was worse at
night and that she felt wheezy at times. She thought it had improved after the course of the
antibiotics. I used the LICEF acronym to prompt further exploration about how it was impacting on
Kim’s quality of life, which revealed that she was concerned about the risk of cancer.

I said that it was important to gather a range of information so that we could establish what we were
dealing with, because I didn’t want to provide false assurances. We then talked through her
previous medical and surgical history, drug history, social history and family history. Kim said that
she had never smoked and had no previous medication problems, took no medicines and had no
relevant family history. She denied weight loss, night sweats and haemoptysis. However, she
worked as a cleaner, so I wondered whether there might be an occupational link.

I then suggested a respiratory examination. Kim said she had had this done before, but seemed
unsure why I would need to examine her chest. I explained that there are many possible causes of
cough, and that it was important to consider all possibilities. I explained the process, which she
said sounded familiar and she agreed. I asked Kim to lie on the couch, which was adjusted to 45o,
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while I washed my hands, and checked whether she had any questions before I started. I began by
observing Kim briefly from the end of the bed, noting that she was not breathless and seemed
quite relaxed. I then moved onto her hands and found no clubbing, discolouration or tremor.

Her capillary refill was less than two seconds, which is fine. She had good colour in her face as
well. I then asked her to sit up straight and remove her t-shirt so that I could examine her back. I
could see no scars and on palpation her breathing appeared symmetrical, there was no tenderness
and trachea was central. Percussion was normal throughout and auscultation revealed no
crackles, crepitations or absences. I repeated this inspection, palpation, percussion, and
auscultation (IPPA) sequence from the front and found nothing significant, although she coughed a
couple of times during the examination, confirming that it was a dry cough.

I completed the examination with basic observations: manual BP was 134/88 mmHg, pulse
rate was 80 beats/minute, respiratory rate was 14 breaths/minute, and oxygen saturation was
98 percent. I explained to Kim that I had found nothing of concern, but that I would like to refer
her to the practice nurse for some breathing tests (spirometry) and then talk again when we
had the results. Kim agreed and said she had no questions so I typed up my findings on her
record, booked the appointment with the practice nurse and a follow-up appointment with
myself.

Despite causing a little alarm when I suggested respiratory examination, I think I was able to build
a good rapport with Kim. I tried to ask open questions at first and showed active listening. I felt
calm and confident while I undertook the examination, and relieved that she presented with no
abnormal findings. I hoped that Kim found this reassuring, and that by requesting the spirometry I
showed her that I was keen to establish the cause of her cough.

I need to work on explaining the need for examination and I wonder whether this is partly because
patients don’t expect a pharmacist to undertake examinations. I’ll talk to my GP supervisor at our
next review about how to better explain the rationale. I could also have spent a little longer allowing
Kim to explain her concerns about cancer, but I was reluctant to explore this in too much detail,
because of the time pressure of a full examination in a ten-minute appointment. I’m not sure there’s
a specific action here, but I will try to be more aware of finding the right balance. I was quite
confident in most of the technical aspects of the examination and, having checked back through the
process checklist, I don’t think I missed anything. I was particularly conscious to auscultate apices,
because I’ve missed that in the past. The only slight hesitation I had was ensuring her chest sounds
were in fact clear, but I think this was lack of experience, rather than uncertainty that I had got it
right.

Finally, I need to discuss with my GP clinical supervisor whether spirometry assessment is an

appropriate skill for me to develop. Although I couldn’t have done it within the scope of a single
appointment on this occasion, I could have maintained continuity of care if I was able to book Kim
to see me for that and discuss the relevance of results. However, there is only one set of
equipment in the practice nurse’s room so I’ll need to check whether it (or I) can be moved to
facilitate this. (996 words)

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Example case study 3

The quality and care home team decided to conduct clinical assessments in our residential
homes as we noticed as a team the residential homes didn’t have any nurses on their staff.
In some cases, patients’ vital signs had not been measured for years. We decided to start
will all residents on digoxin.

Matron had trained me on my clinical skills and had suggested I take the lead and she would
watch me. I jumped on this opportunity. Matron and I booked an appointment to check
pulse on all the residents on digoxin. We tied it up to do this with the morning medication
round so the carer can understand the importance and procedure on how to do it just
before administering digoxin.

When we went to check Ms A’s pulse, Ms A was already informed about our visit a few days
back and she was waiting for us in the lounge. She did not seem her usual self to me. She
looked tired and under the weather. Ms A knew me from before as I had previously
conducted a medication review with her. I introduced my colleague and explained the
purpose of our visit. Ms A was pleased and willing for me to carry out the assessments.

I explained to her I will be checking her BP and pulse. She asked me to measure
her pulse first. I placed my two fingers on her radial pulse and used the clock which was on the
wall right opposite me. I measured her pulse for 30 seconds. Her pulse was 26 for 30
seconds. I measured it again, this time for a whole minute and this time her pulse was 52. I
explained to Ms A and the carer that her pulse was under 60 beats per minute and with
digoxin it should be 60 beats or over per minute. If the pulse is below 60 beats per minute,
then wait five minutes and measure the pulse again before administering digoxin. If it is still
under 60 beats per minute, then one should seek medical attention. After waiting for five
minutes, we checked the pulse again and it was 25 beats in 30 seconds. We decided to seek
medical attention.

I was not able to measure her BP as I could see she was not very comfortable by
then and was feeling lethargic. We decided to do it at a later date. Ms A told me she was
very grateful for our understanding.

She felt assured and was pleased that she was involved with what was going on. She
commented that she was never told this detail before by anyone and no one took the time
to explain these things to her. I recorded the reading on the notes.

However, while waiting Ms A seemed to be getting increasingly unwell. She was usually very
bubbly and talkative. While chatting, she mentioned she was feeling nauseous and had
diarrhoea and so was very run down. I asked her since when was she feeling under the
weather, and she said it was since the day before and it seems to be getting worse. I checked
with the carer if anyone else in the care home was having diarrhoea or vomiting so that we
could rule out Norovirus. No one in the care home had reported any vomiting or diarrhoea.

My first thought was could it be digoxin toxicity? After consulting with Matron and the care
home manager, Matron decided to call the ambulance. I explained to Ms A that we should
seek medical attention as she was visibly quite unwell and her pulse was under 60 after
measuring it three times, twice manually and once through the oximeter that we had taken with
us, to make sure our measurements were correct. She was also feeling something is wrong
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and agreed to go to hospital.

Ms A was taken to hospital where she stayed for nearly two weeks before she was discharged.
The hospital diagnosed digoxin toxicity and decided to reduce her dose of digoxin, and
frequent blood tests were done by her GP to monitor her treatment further.

Through this exercise we were able to identify the gaps and training needs, and we as a team decided to
train our residential care homes with some basic assessments like automatic BP check and pulse.

This case was also discussed in our monthly GP meetings because if we had not gone to check the vitals
this would have been easily missed or further delay could have been fatal for Ms A.
On a later date, this was a project that was taken up by the PCN as a whole to focus on
measuring clinical assessments at least twice a year in residential homes, as there was great
awareness that residential homes often get missed due to limited resources provided to
them by the primary care team.

We liaised with our secondary care and ambulance service to analyse the quarterly data
which showed reduction in hospital admissions from residential care homes by 16 percent since
this project was launched. (843 words)

Example case study 4

I was asked by the GP to visit the care home to review the medication of Mr B as he was
having frequent falls. The matron was going to accompany me so I could practice my clinical
skills and she could watch me do it correctly. This was a good chance to measure blood
pressure. We had decided that I would measure BP and respiratory rate.

I rang the care home to book an appointment to see Mr B and to get general information
from the carer about Mr B’s medication and lifestyle. I also looked into his medical records
at the doctor’s surgery. The matron and myself arrived at the care home and found Mr B
waiting for us in his room.

We introduced ourselves. I asked him if he was ok with me taking his BP. Mr B

was very cooperative. I explained to him that the cuff might feel tight, I also asked him to
remain quiet and not cross his legs while I measure his BP. He was wearing
short sleeves so it was very convenient; he didn’t have a preference on what hand he
wanted the cuff on. I chose his left hand as it was near the table so it was convenient for it
to rest while I measured his BP. I used the automatic BP machine. I took three readings and they
were all fine considering his age. My matron confirmed the same. I made a note of the
readings in his care plan assessment chart.

While taking his BP I also measured his respiratory rate. It was very easy to
measure as he was sat quietly. I could clearly see his chest rise up and down. I measured
this by looking at the time on my wristwatch. His respiratory rate was 22.

After generally talking to Mr B, I gathered he felt dizzy and light-headed after waking up
when lying down. I also saw there was a pattern to his falls which were all in the morning.
The first thought that came to me was this could be postural hypotension.

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I explained to Mr B and the carer what this meant. I also suggested that Mr B record his BP at different
times of the day and when standing and sitting in a diary to see if there is a pattern to it. I advised Mr B to
sit on the bed before getting up and to avoid getting up and walking straight away. I also advised it is very
important he is hydrated and drinks enough fluids throughout the day.

I briefed the GP about my visit and we arranged to see Mr B together in a week’s time – by then we would
have a diary entry of a week’s worth of his BP taken on different times which would give us an idea of what
is causing the falls. I also reviewed his medication; there was nothing that indicated drowsiness or light-
headedness. (500 words)

Example case study 5

Hypertension is one of the priorities for our PCN as it is linked with the Impact and Investment
funding. Our PCN decided to involve the pharmacy team to lead this project called ‘BP@Home’.
Our clinical commissioning group (CCG) provided us with searches of qualifying patients who had
a one-off reading of high BP in a history of two years. We ran searches and identified patients who
qualified for a BP check.
Our pharmacy team had a clear pathway in place on what to do if the reading was out of range.
The target range was in the region of 135/85 mmHg for adults under 85 years of age and the
target for over 85 years was 145/85 mmHG if measured at home.
Mr X (age 62) was booked in for a telephone consultation with me after he submitted his BP
reading which was 154/92 mmHg. I rang him and introduced myself, checked he was OK to talk
and was expecting my call. Mr X was expecting my call and was pleased I called on time. Before
proceeding I checked Mr X’s date of birth and first line of address. I then asked him his
understanding on how he measured his BP. Mr X said he had got a text from the surgery to submit
BP readings and had just remembered while walking the dog, so he submitted the readings as
soon as he returned home.
I asked Mr X if he was happy to submit a further seven days’ ambulatory reading twice a day. Mr X
was happy to submit another reading. We booked another telephone consultation for the following
week.
I advised Mr X to rest for five to eight minutes before measuring BP, not to cross legs, eat or drink
or talk while measuring BP; taking deep breadths would help.
Mr X was very thorough; he had submitted the seven-day diary of his BP readings. Before ringing
him, I had a good look at the 14 readings he had submitted over seven days. Most of the readings
were over 145/90. I rang him the following week as planned. Mr X was expecting my call and had
a copy of his readings in front of him. I explained to Mr X that his BP was slightly high. He was not
on any BP tablets. We discussed lifestyle changes. I asked Mr X open and closed questions like
symptoms of dizziness, headaches, blurred vision, breathlessness, light-headed to name a few to
get a good understanding of his lifestyle and beliefs. We also discussed the possibility of going
onto a BP tablet. Mr X was happy to try BP tablets to see if that helped with bringing his BP down.

He did not have any of the symptoms mentioned above apart from occasional headaches.

His last blood tests were a year ago, so we agreed on getting a blood test done for fasting HbA1c,
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LFTs, U&Es, Lipids and ACR in the urine. I advised Mr X to visit the optician to gets his eyes
checked as well to make sure there was no damage.

I booked him a blood test for the following morning and booked a telephone appointment in two
days’ time. I advised Mr X to seek medical attention in the meantime if he experienced any
symptoms of dizziness, headaches, blurred vision. I then made consultation notes on the GP
clinical system and tasked Mr X’s GP to review my consultation. I recommended on starting Mr X
on ramipril 1.25 mg daily and blood tests for U&Es in two to three weeks’ time.

The GP was in agreement with my recommendation and issued a 28-day prescription of ramipril
1.25 mg. I rang Mr X and explained to him that the GP has issued a prescription for ramipril 1.25
mg tablet, one to be taken daily. I also advised Mr X that we needed to check his kidney function
in two to three weeks, along with his BP. I made him a further appointment with the nurse for a BP
check and blood test in roughly 18 days time. Mr X mentioned he was very grateful and felt he
was well looked after by his GP practice.
I assured Mr X that I will ring him in a week’s time to see how he is getting on with his medication.
I rang Mr X after a week; he was not feeling any different. He was taking his ramipril every day. He
stated he had been measuring his BP twice a day since he started the tablets. He started giving
me the readings over the phone. It was good to know his average reading was around 130/75. Mr
X was very pleased with the readings and was glad he was started on ramipril on time. He told me
he had an optician appointment booked in the coming days. He mentioned he had reduced salt
intake in his food.
Mr X had taken ownership of his health and feIt he was listened to which enhanced shared
decision making and patient engagement along with providing patient-centred care. (851 words)

Reflective essay
Once you have developed your clinical examinations and procedural skills, as agreed with your
clinical supervisor, you must write a reflective essay.
Your reflective essay should focus on your overall practice using clinical examinations and
procedural skills. In your reflective essay, you should describe the steps that you have taken to
improve your skills, reflect on your practice, include a short description of how you have applied
your learning to your practice and detail your action plan for further development. You should not
include individual patient cases as part of your essay.
Academic referencing is not required for this piece of work.
The key differences between the reflective essay and the case studies are:
• the case studies focus on individual patients
• the reflective essay focuses on your overall practice.
Your reflection should be between 800 and 1000 words and must be submitted on the Clinical
assessment and procedural skills assessment which you can access via the pathway progress
tracker. (Activity 2)
We suggest that you write your essay in a Word document first, and then copy and paste it to the
reflective essay. There is no formatting, so your essay must be in text with no tables. If your essay
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is less than 800 words or longer than 1000 words, you will not be able to submit it, and the submit
button will be disabled on the website. You therefore need to check your word count before pasting
your essay into the website.
Your reflective essay will be marked by an education supervisor. Your work will be marked on its
evidence that you have used clinical examination and procedural skills in your role, whether your
reflection is patient- centred, if you have identified your strengths and areas for development, and
your action plan for further development. Your essay is a reflective account and we do not expect
you to write an academic style of essay with references.
We have provided the marking scheme below (which can also been found on page 43 of the
CEPSAR assessment record), which will be used by the education supervisor who marks your
reflective essay. It is very important that you refer to the marking criteria before writing your essay.

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If you do not pass the assessment, you need to read and reflect on the feedback that we provide
before revising your essay. You can then submit it on the CPPE website again. We have provided
an example of a reflective essay and education supervisor’s feedback below.

Example reflective essay

My first main role within the practice is a hypertension clinic so I focused first on BP monitoring. I’d
used automated BP machines in my previous job, but I wasn’t familiar with the manual technique
and recognise that it’s important for patients with atrial fibrillation (AF). I agreed with my GP clinical
supervisor, Connie, that I would also check height, weight, BMI, radial pulse and urinalysis as part of
these hypertension reviews if appropriate.

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I revised the technique for automated BP monitoring using the resources on the British
Hypertension Society website and the McLeod demonstration videos on YouTube. Connie
observed my technique with three of her patients during a clinic one afternoon, and signed off that
procedure in my clinical skills log. After clinic, she demonstrated the technique with the manual
sphygmomanometer and then I had a few attempts on a couple of colleagues. I made a bit of a
mess of the first few attempts, because I was struggling to locate the brachial artery and to hear the
Korotkoff sounds. Connie suggested that I slow down with both of these things and try using her
cardiology stethoscope until I was familiar with the sounds. This seemed to solve the problem and
she allowed me to verify their BP with the automatic machine. Once I’d managed to get all of the
parts of the process right she said that I could try out my technique in clinic the following day. My
first attempt was a disaster, because I was really nervous, but the next patient was better. She
suggested that I try using my own stethoscope for the next patient and, when I knew what I was
listening for, it went well. After the next two patients, although the flow wasn’t great, she was happy
to sign me off. After clinic we agreed that I would arrange for six patients to come in for half hour
appointments with me and she would supervise.

I measured height and weight, calculated BMI, assessed radial pulse and did urinalysis for
proteinuria as well as checking manual BP. Connie signed off all of these techniques after the first
three patients and I saw the next three patients alone. It felt a lot more natural once I didn’t have her
watching over my shoulder and I’m happy to continue alone now.

I was quite confident about automated BP monitoring, because I’ve done this many times in
previous jobs. I was less confident with the manual technique, and struggled at first. I suspect I was
a little complacent about the other techniques, because they seemed more like common sense
than anything. I realised that I wasn’t as prepared as I had been for taking BP, but I had made sure
that I had all the equipment and knew how to use it, and managed well enough.

My revision for the automated BP monitoring went well and prepared me for successfully completing
the observed attempts. I’ve spent a lot of time on patient-centred consultations in the past so I felt I
was able to build rapport with patients quite well; one of the patients complimented me on how well
I had explained everything and how relaxed that made her feel. However, this attention to the
explanation meant that I took a little too long over the process. Conversely, I realised that I needed
to slow down with the actual BP monitoring, rather than expecting to be able to do it at the speed of
an experienced GP straight away. I also realised that I need to consider all of the processes as
being important and not dismiss some as incidental. I suspect that, having recently learned to do
urinalysis at the induction residential, it seemed quite familiar, but I hadn’t actually done it in
practice before. In the past, I’ve been frustrated by how long it takes for the handwashing process,
but I now see the value of it as a chance to make sure I’ve done everything.

My approach to development of these clinical skills was ultimately successful, but not particularly
consistent. I spent time revising automated and manual BP monitoring, but completely overlooked
the other processes. I was in too much of a rush to learn the new processes that I possibly slowed
myself down in the long run.

I’m also aware that, although I have developed these skills enough to be signed off, I only observed
a couple of different people’s techniques. After a couple of months of practice, I feel that I have
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developed a flowing approach and that my technique has become almost automatic so that I can
focus on the patient, rather than thinking too much about the technique and what comes next. I’ll
bear these things in mind when I look to develop the next set of skills.

I’m starting asthma and chronic obstructive pulmonary disease (COPD) clinics next month, which
means developing my respiratory examination skills. I plan to take a similar approach to the one
described above, but I have arranged to observe one of the other GPs, as well as Connie. I’ve also
thought about what ancillary techniques might be relevant. I’m already familiar with peak flow and
measuring respiratory rate, but not with full examination, pulse oximetry or taking the patient’s
temperature. I have watched the McLeod respiratory examination video and looked at the detail of
all these processes in the clinical skills log. I’m sitting in with the GPs next week and I have
identified a group of patients for my first clinics once I’m signed off. (919 words)

Reflective essay marking and feedback

See above and page 43 of the ‘CEPSAR assessment record’ for details of the assessment
criteria.

Congratulations! You have passed this assessment and your feedback can be found
below.

Assessment criteria demonstrated:

• You have shown evidence that you have used clinical examination and procedural skills.
• You have shown evidence that you have reflected on the relevance of clinical
examination and procedural skills to your current role.
• You have linked a person-centred approach to the overall discussion of clinical
examination and procedural skills.
• You have shown evidence that you have reflected on your clinical examination and
procedural skills and identified your development areas.
• You have shown evidence that you have developed an action plan to improve your practice.

Assessment criteria not demonstrated: N/A

Examples of good practice in the essay:

• You’ve described the process you used to develop your hypertension assessment skills clearly.
• You evidenced use of manual BP monitoring and height/weight/BMI/urinalysis, and you have
explained the relevance to your hypertension clinics.
• Including the encouraging feedback from patients adds to your reflection.
• You’ve clearly reflected on being unfamiliar with the manual technique for BP monitoring and the
difficulties you had initially.
• You have also used your experience of developing BP monitoring skills to inform your planning for
future clinical skills development in respiratory clinics.

Recommendations for what you can do next:

• Your reflection could be developed by considering your strengths and challenges with individual
procedures, and maintaining your competence as well as developing new skills.
• You might be more specific in your action plan to address identified development needs, eg, longer

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appointments/more succinct explanations to better manage your time.

• Have you considered shadowing healthcare professionals other than doctors?

The person-centeredness of your approach might be clearer if you explained how you communicated with
patients when things didn’t go so well, or what it was that you did to make them feel relaxed.

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Section 5 – Patient Satisfaction Questionnaire

The Patient Satisfaction Questionnaire (PSQ) provides you with the opportunity to gather patient
feedback on your key consultation skills, including how you demonstrate empathy and relationship-
building and the degree to which you take a person-centred approach and engage in shared
decision making. Shared decision making is when health professionals and patients work together to
make decisions about their own treatment and care. During shared decision making, it is important
that care or treatment options are fully explored, along with their risks and benefits.

We have adapted the Royal College of GPs PSQ for the assessment of pharmacy professionals
working in primary care: https://www.rcgp.org.uk/gp-training-and-exams/training/workplace-
based-assessment-wpba/assessment

The PSQ is one of the Module 5 assessments for the Primary care pharmacy education pathway.
The PSQ consists of ten statements about key consultation skills and behaviours. Patients/care
home residents are asked to rate these skills and behaviours using a seven-point scale from ‘poor
to fair’ to ‘outstanding’ (see below).

Rating scale
1. Poor to fair
2. Fair
3. Fair to good
4. Good
5. Very good
6. Excellent
7. Outstanding

Patients/care home residents are also asked to rate your consultation overall using the same seven-
point rating scale. See page 71 for a copy of the PSQ form. You can also access this form via
Canvas.
If the person lacks the mental capacity to make decisions about their own care and treatment, other
people will be present in the consultation, eg, a family member or care worker. A family member or
care worker can complete the questionnaire based on their experience of the consultation.
Using the PSQ if you work in general practice
Agree dates for the PSQ with your clinical supervisor and employer and any other staff who will
support you to complete this assessment, eg, practice manager and receptionists if you are working
in general practice.
Patients you have seen in consultations (face-to-face, or telephone, or virtual) should be contacted
and asked to complete the questionnaire. This could be in the form of a hard copy by post, or an
electronic copy via a virtual platform, or an online survey, or over the telephone by another member
of the practice team.

Please note: if you wish to use an online survey, you will need to create your own survey using
exactly the same questions and rating scale as the PSQ form on page 71. Please refer to Canvas
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for advice on how to create a PSQ using Google Forms (refer to the PSQ page on the assessment
section on Canvas).

This could also be done using a Microsoft Teams form. With online surveys, the practices must
agree to the use of these.

Patients using paper copies of the form will be asked to return their completed questionnaires
(unless interviewed over the telephone) to reception to ensure it’s completely anonymous and you
can’t identify individual patient’s responses.

Continue until a total of 30 completed forms have been returned (this may take a number of
months). This might seem like a lot of responses to collect, but this number is needed to ensure the
reliability of the assessment and to ensure you can see trends in your feedback which you might
not see with lower numbers. A minimum of 30 responses is required.

Data entry
• Upload a copy of your collated data to the assessment section of your portfolio. CPPE has
provided a spreadsheet for collation of questionnaire results. You can find a copy on the
PSQ page on the assessment section of Canvas. The spreadsheet contains formulae to
calculate the mean and median (middle score) for each PSQ statement, and the range of
responses (the lowest and highest score for each statement). If you used Google Forms,
your data will be presented as pie charts and the percentage of patients who gave each
score. It doesn't matter that the data is presented differently on Google docs and the
spreadsheet as both methods will enable you to identify your strengths and development
needs.
• You should not access completed questionnaires yourself as anonymity of the person
completing the questionnaire is important. The data must be inputted by another person
and you should arrange this with your employer beforehand. The questionnaires shouldn’t
be thrown away, as they may be needed for auditing purposes.

Using the PSQ if you work in care homes

Agree a time period to complete your PSQ with your employer (maximum three months, or less if
you can collect 30 PSQs in a shorter time).
• Aim to complete as many PSQ as you can during the three-month time period; any
feedback is useful but if you have a lower number of completed PSQs, it may be harder to
see patterns or trends. Write your essay based on the actual number of PSQs you manage
to collect. Include the number of PSQs that you have collected in your essay.
• Some care home residents lack the mental capacity to make decisions about their own
care and treatment so other people will be present in the consultation, eg, a family
member or care worker. A family member or care worker can complete the
questionnaire based on their experience of the consultation.
• If you only work in a few care homes, you may be working alongside the same care
workers. Only ask the same care worker to complete a PSQ a maximum of twice.
• You can ask care home residents, their families or care workers to complete the PSQ. There
is no need to ask care homes staff to give out the PSQ for you.

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• You don’t need to ask consecutive residents to complete the PSQ, but take any appropriate
opportunities to gather feedback. Have copies of the PSQ and addressed envelopes with
you at all times.
• Some care home residents will be too sick to complete the PSQ, so use your judgement
when deciding who to ask.
• PSQ responses should be anonymised, so provide an envelope with your name on it for the
person to place the completed questionnaire in. Agree with the care homes a procedure for
returning the completed questionnaires to your employer.
• If you undertake domiciliary visits, you might need to provide a stamped-addressed
envelope if the person wishes to fill it in later.

PSQ feedback and reflective essay

Reflect on your feedback report and identify your strengths and areas for development. We
suggest that you prioritise your development needs based on the PSQ questions where you had
your lowest mean ratings. You should include learning needs identified from the PSQ in your
PDP.
Use the Consultation skills for pharmacy practice: practice standards for England to support you to
develop your consultation skills and identify an action plan to improve your weaker areas.2 We have
mapped the PSQ to key consultation skills behaviours from the practice standards (see pages 63–
64). The mapping will help you to identify specific skills and behaviours to support your
development. For example, if your mean score was 4.5 for PSQ statement 3: Really listening…
(paying close attention to what you were saying; not looking at the notes or computer as you were
talking), refer to page 57 and check which of the practice standards this relates to.
Your reflection should be between 800 and 1000 words and must be submitted on the Reflection on
patient feedback assessment which you can access the via the pathway progress tracker. (Activity
3)
You should upload your collated feedback spreadsheet or Google/Teams document to the
Assessments section of your Canvas portfolio and include a link to your portfolio in your reflective
essay as evidence of completing the PSQ. This is an essential part of the essay. If you do not
include a link to your collated data, the essay will be failed and you will be required to
resubmit it.
The screenshot below shows where you can find the link: under the heading ‘Your ePortfolio is
private’. Do not share the link next to the padlock in the URL bar at the top of the page.

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We suggest that you write your essay in a Word document first and then copy and paste it to the
reflective essay. There is no formatting in the essay dashboard, so your essay must be in text with
no tables. If your essay is less than 800 words or longer than 1000 words, you will not be able to
submit it and the submit button will be disabled on the website. You therefore need to check your
word count before pasting your essay into the website.

Your essay is a reflective account and we do not expect you to write an academic style of essay
with references.
If you do not pass the assessment, you need to read and reflect on the feedback that we provide
before revising the essay. You can then submit it on the CPPE website again.

Assessment criteria
A CPPE education supervisor will assess your reflective essay using the assessment criteria
which are listed in the table below.

Assessment criteria Essential or desirable Additional guidance notes

1. Is there evidence that Essential criteria You need to upload your collated feedback spreadsheet
the learner has to your Canvas ePortfolio and include a link to the
completed the PSQ? spreadsheet in your reflective essay to demonstrate that
you meet criterion 1.

2. Is there evidence that Desirable criteria Focus on your highest scoring PSQ statements.
the learner has
reflected on the
patient feedback and
identified their
strengths?

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3. Is there evidence that Essential criteria Focus on your lowest scoring PSQ statements.
the learner has
reflected on the
patient feedback and
identified areas for
development?
4. Is there evidence that Desirable criteria Consultation skills for pharmacy practice: practice
the learner has used standards for England can be found via the following link:
the Consultation skills www.consultationskillsforpharmacy.com/docs/docc.p
df
for pharmacy practice:
practice standards for
England to support
their development?
5. Is there evidence that Essential criteria Provide evidence of any actions you have already having
the learner has an taken or actions that you are planning to take to address
action plan to improve your weaker areas.
their practice?

You will need to demonstrate that you meet the three essential criteria (as a minimum) to
pass this reflective essay. If you do not pass you will be required to resubmit your reflective
essay.

Feedback on your reflective essay

Your assessor will provide written feedback on your reflective essay that will include the following:
• information on whether you have demonstrated each of the assessment criteria or not
• examples of good practice in the essay
• recommendations for further learning and development
• the outcome of your essay – pass or fail.

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Mapping of Patient Satisfaction Questionnaire (PSQ) to key consultation skills behaviours from the
Consultation skills for pharmacy practice: practice standards for England

PSQ statement Key consultation skills behaviours from Consultation skills for
pharmacy practice: practice standards for England
1. Making you feel at 1.10 Set the scene of the consultation professionally and appropriately while
ease… (being friendly building rapport with the patient
and warm towards
you, treating you with
respect; not cold or
abrupt)
2. Letting you tell ‘ your’ 1.11 Hear and acknowledge the patient’s agenda without interrupting and further balance
story… (giving you with your own agenda before negotiating a shared agenda
time to fully describe
any issues about your 1.17 Demonstrate respect for the patient’s perceptions and support the patient in
health and your self-expression
medicines in your own
words; not interrupting
or diverting you)

3. Really listening… 1.16 Listen actively, focusing completely on what the patient is saying (and the non-verbal
(paying close attention cues demonstrated by the patient) without interrupting, to understand the meaning of
to what you were what is being said in the context of the patient’s desires
saying; not looking at 1.18 Apply tools to facilitate the consultation (such as interview schedules) in such
the notes or computer a manner that it does not detract from the patient focus of the consultation
as you were talking) 1.19 Use questioning techniques that reflect active listening, draw out the information
needed to gain maximum benefit from the discussion and challenge the patient at a
level which is appropriate for them
1.20 Check understanding at points within the consultation while allowing the patient time
and space to reflect
4. Being interested in 1.12 Communicate positively and effectively throughout the session, using language that
you as a whole is appropriate and respectful to the patient (non-technical, non-jargon) that has the
person… greatest positive impact on the patient
(asking/knowing 1.15 Recognise that patients are diverse; that their behaviour, values and attitudes vary as
relevant details about individuals and with age, gender, ethnicity and social background, and that you should
your life, your not discriminate against people because of those differences
situation; not treating 1.29 Know that consultations with patients can have psychological and social as well as
you as ‘just a clinical components, with the relevance of each component varying from
number’) consultation to consultation
1.30 Identify the extent to which other healthcare professionals, relatives, friends and
carers are involved in decisions about a patient’s health, while balancing a patient’s
right to confidentiality
1.32 Accept that patients may wish to approach their health (and illness) in a non-scientific
way. The reality for patients is that they make their own choices on the basis of their
own values and not necessarily on the basis of clinical evidence

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PSQ statement Key consultation skills behaviours from Consultation skills for pharmacy
practice: practice standards for England
5. Fully understanding 1.22 Appreciate and respect the reasons for non-adherence to a management plan
your concerns… (practical and behavioural, intentional and non-intentional) when deciding how
(communicating that best to support patients; assess adherence in a non-judgemental way
he/she had accurately 1.23 Deal sensitively with the patient’s emotions and concerns
understood your 1.24 Explore the patient’s attitudes towards taking medicines, or following advice they
concerns; not have been given about their health and wellbeing, while identifying and
overlooking or respecting the patient’s values, beliefs and expectations
dismissing anything) 1.31 Understand that your patient’s views and perspectives may change during the
course of a long-term condition
6. Showing care and 1.23 Deal sensitively with the patient’s emotions and concerns
compassion… (seeming
genuinely concerned,
connecting with you on a
human level; not being
indifferent or ‘ detached’)
7. Being positive… 1.12 Communicate positively and effectively throughout the session, using language
(having a positive that is appropriate and respectful to the patient (non-technical, non-jargon) that
approach and a positive has the greatest positive impact on the patient
attitude; being honest but 1.13 Share information and discuss options in an open, honest and unbiased manner
not negative about your to support the patient in assessing the risks versus benefits in relation to
problems) medicines- taking and making changes to lifestyle
8. Explaining things 1.13 Share information and discuss options in an open, honest and unbiased manner
clearly… (fully to support the patient in assessing the risks versus benefits in relation to
answering your medicines- taking and making changes to lifestyle
questions, explaining 1.14 Adapt your communication skills and consultation skills to meet the needs of
clearly, giving you different patients (eg, for language, age, capacity, physical and sensory
adequate information; impairments)
not being vague)
9. Helping you to take 1.21 Negotiate a shared understanding of the issue and its management with the
control… (exploring with patient, so that they are empowered to take responsibility and look after their
you what you can do to 1.25 own healthand provide ongoing support for new behaviours and actions to be
Advocate
improve your health taken by the patient, including those involving taking risks and fear of failure
yourself; encouraging
rather than ‘lecturing’
you)
10. Making a plan of 1.13 Share information and discuss options in an open, honest and unbiased manner
action with you… to support the patient in assessing the risks versus benefits in relation to
(discussing the options, medicines- taking and making changes to lifestyle
involving you in 1.21 Negotiate a shared understanding of the issue and its management with the
decisions as much as patient, so that they are empowered to take responsibility and look after their
you want to be involved; own health
1.26 Before concluding any consultation, determine whether the patient has sufficient
not ignoring your views) information for their needs or whether they require further explanation, by
providing them with further opportunities to ask questions
1.27 Demonstrate techniques to manage the conclusion of the consultation effectively,
providing a safety net, while agreeing and summarising the plan appropriately
in a timely manner

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FAQs about the PSQ

What do I do if the patient is visually impaired?

There is a larger print version of the questionnaire available for those who are visually impaired on
the assessment section of Canvas. Alternatively, the practice receptionist or care worker could
read out the statements on the PSQ to the patient and record their responses.
What do I do if the patient can’t read?
The receptionist, a care worker or a family member could read out the statements on the PSQ to the
patient and record their responses.
What do I do if the patient can’t speak English?
Where possible use a translator or a family member to translate. In areas where there is a large
non-English speaking community, you might want to get the questionnaire translated into different
languages but you need to be careful that the meaning of the words isn’t changed. CPPE does
not provide the questionnaire in different languages.
What do I do if the patient doesn’t have capacity to make decisions and the consultation is
with a family member or care worker?
A family member or care worker can complete the questionnaire based on their experience of the
consultation. If you do a lot of work in care homes, you might work with care workers on a regular
basis but do not ask the same care worker to complete the PSQ on more than two occasions.

Example reflective essay – general practice

I started to use the PSQs in my practice during late summer, when I had been in post about a
year. 31 PSQs were returned. Here is the [link] to my collated PSQ feedback spreadsheet.
My mean scores ranged from 5.9 to 6.45, the latter being the mean score for the overall
consultation. My median score was 6 for all questions and my actual scores ranged from 4 to 7. I
was very pleased with these results. As a person I believe I am warm, friendly and respectful. This
is clearly reflected in my score for Q1.
Conversely I don’t think it comes naturally to me to carry out the behaviours described in Q2 –Q6.
Through lots of role playing during my prescribing course and CPPE learning events and actual
patient consultations, I have tried hard to develop these skills, using techniques such as ICE
(ideas, concerns, expectations) and by learning that empathy is not about saying “I understand
how you are feeling” but by saying (for example) “That must have been very difficult for you”. It
was encouraging to see that my scores were excellent for these questions. I have also completed
the CPPE Consultation skills assessment and written about and reflected on different consultation
frameworks (eg, Calgary–Cambridge), during my prescribing course.

I have decided to focus on the three questions where my median scores were the lowest.

Q4: Being interested in you as a whole person, mean score 5.9 – this was my lowest mean score.
Although this is not a bad score, I was a little disappointed with it. I have really made an effort to
get to know my patients. I can recall many consultations where I have had conversations about the
patients’ lives. In fact, this is sometimes what makes my consultations overrun! There may be an
element of the patients and meeting for the first time and so I’m getting to know them from scratch.
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There are very few patients I have seen more than once so far.

I have reviewed the key consultation skills behaviours from Consultation skills for pharmacy
practice: practice standards for England, which have been mapped to this question. On reflection, I
think that I am perhaps too focused on the clinical aspects of the consultation and what guidelines
say, rather than giving greater attention to the psychological and social aspects.

Q10: Making a plan of action with you, mean score 6.03 – this was the only question where
someone scored me as 4, my lowest score. I have given this a great deal of thought after reviewing
the practice standards mapped to it. I believe I am good at discussing options, sharing information
and discussing risks vs. benefits. I often use patient decision aids, provide leaflets, ask the patient
if they have any questions and give them an opportunity to go away and think about the options.
Where I think I fall down is summarising the plan. My appointments are 20 minutes long and I
cover a lot of ground with the patient. It must be difficult for them to take it all in and remember the
important parts. I realise I haven’t always wrapped up the consultation with a summary, something
I’ve observed other clinicians doing, even after a ten-minute consultation. In the last few weeks I’ve
been making a conscious effort to do this and have found it actually helps me too! There have
been occasions where I’ve said “So we discussed this and agreed to do x and y. Was there
anything else?” and the patient has said “Oh yes, what about z?”

Q9: Helping you to take control, mean score 6.06 – I believe that I sometimes have a tendency to
lecture the patient rather than letting them come up with solutions themselves. I’m actually
surprised I scored as highly as I did! So many of my consultations involve trying to get patients to
lose weight, eat more healthily, reduce their sugar/cholesterol levels, stop/reduce alcohol/smoking.
I know that I do tend to tell patients how to do something rather than taking the approach “What do
you think you could do to lower your sugar level?” I did do a brief motivational interviewing course,
but I think a full health coaching course might benefit me.

In summary, patients seem very satisfied with how I deal with them and I am very encouraged by
this. There is room for improvement with all of the elements of the questionnaire. My top priorities
for my action plan are 1) to make a conscious effort to summarise consultations, 2) to practise
coaching patients to come up with solutions themselves, 3) to get to know my patients better,
especially what they are thinking, feeling and what their social circumstances are.

Reflective essay marking and feedback

Congratulations! You have passed this assessment and your feedback can be found below.

Assessment criteria demonstrated:

• You have shown evidence that you have completed the PSQ.
• You have shown evidence that you have reflected on the patient feedback and
identified your strengths.
• You have shown evidence that you have reflected on the patient feedback and
identified your development areas.
• You have shown evidence that you have used the Consultation skills for pharmacy
practice standards for England to support your development.

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• You have shown evidence that you have developed an action plan to improve your
practice.

Assessment criteria not demonstrated: N/A

Examples of good practice in the essay

You’ve reflected well on your PSQ feedback and you have really thought about what it
means for your practice. It’s also good to see that you have already implemented some
actions and reflected on the impact of those. You have used the consultation skills
practice standards to help you to identify how you can improve, eg, paying greater
attention to the psychological and social aspects of the consultation. I am interested to
know more about what you intend to do to achieve this.

Recommendations for what you can do next

You have identified priority areas for improvement for your action plan, eg, a health
coaching course. Making your action plan SMART (specific, measurable, achievable,
relevant and timed) would enable you to keep track of your progress. I would recommend
reading the section on health coaching in the CPPE Consultation skills for pharmacy
practice distance-learning pack and reflecting more on how you can apply motivational
interviewing techniques in your consultations.

You also identified that time management in clinics is an area that you could improve on but this
didn’t feature your action plan. Efficient use of time can make all the difference to you, your patients
and the practice. Have you considered using a time management diary over a two-week period and
recording, eg, the number of patients you saw in clinic and the number and percentage of
consultations that overran? List the main reasons for overrunning. This might help you identify more
effective strategies for time management in clinics.

Example reflective essay – care homes

I undertake medication review in care homes using a STOPP/START toolkit to deprescribe
inappropriate medicines and initiate suitable treatment where clinically indicated. Approximately 70
percent of the residents have dementia and I must conduct my consultations with carers or
relatives where the resident is lacking capacity and insight into their medical conditions and
medications. The carer or relative may have their own agenda when discussing the resident and I
must take this into consideration when making holistic, clinical decisions that affect the resident
and their quality of life.
I have had 30 PSQ returns from care home residents, or carers/nurses. The survey distribution and
collation were facilitated by my employer over a six to eight-week period. I only asked relatives,
carers or nurses to complete one questionnaire per visit for one resident to reduce bias across my
care home population. I have included a link to the spreadsheet with my collated PSQ scores
[Link].

All the questions received a favourable return, with scores of good, very good, excellent or
outstanding, except for the question, ‘Did the pharmacist explain things clearly to you?’, which
received responses of fair to good.

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Overall, I am very pleased with the results that I have achieved. My strongest scores were ‘Did the
pharmacist really listen to you?’ and ‘Did the pharmacist make you feel at ease?’ Most care homes
have various visiting healthcare professionals and providers addressing different needs and this can
be unsettling for the resident.

For me it has been critical to make the patient feel at ease. I have observed of carers and nurses
and consciously changed my style when communicating with residents. It’s a challenge when
residents are hard of hearing or have impairments with speech. I now endeavour to speak more
slowly and clearly using the tone of my voice to be loud but not sound aggressive. I have also
become more self-aware of my body language and now generally sit down in a resident’s room or
crouch down to their level rather than standing up in an authoritative stance.

My weakest score was ‘Did the pharmacist explain things clearly to you?’ It can be difficult to
explain things clearly when residents have dementia. I incorporate my learning from CPPE
Consultation skills training and make sure that I recap regularly at various points during the
consultation to ensure that the resident/carer understands what is happening with regards to their
medical condition and plan of care and ensure that the resident/carer is happy with the decisions
made during the consultation.

I received a score of good for ‘Did the pharmacist let you tell your own story?’ and ‘Did the
pharmacist help you to take control’. I think the common theme here is about empowering residents
more and then checking their understanding of mutual goals. I have been mindful that I struggle to
do this and perhaps I have an incorrect perception of older people in care homes being more
willing to relinquish self-care and independence. Consequently, rather than empowering them I
have at times created an action plan either independently or with the carers.

Person-centred care means empowering and educating the patient, so that they can make
informed decisions about their own healthcare choices and interventions. I have started to look at
resident care plans before a consultation. These plans contain information about a resident’s
background such as previous occupation, childhood and adult life and this may help to facilitate a
better understanding of the individual person. One example of application of this approach was
following a review of a resident with dementia who was exhibiting sun downing effects. The home
were reluctant for the clinician to initiate anxiolytic drugs and wanted to try a non-pharmacological
intervention. I read the resident’s care plan and then sat with the resident in her room to have a
general chat around her health and goals. I spoke to her about what she enjoyed, what she missed
about home, not overly focusing on her health and medicines. What became very apparent was
that some level of control over her world was crucially important to her. I then spoke with the
mental health outreach team and asked for their input on techniques that may support this lady.

Together with the support of the home, we formulated ideas to minimise her agitation in the
afternoon. This included laying the tables in the dining area, getting dressed for tea, clearing up
after dinner. This small intervention worked really well and has helped me to think much more
holistically about the residents who I review. It has also encouraged me to work more closely with
other outside agencies to seek support and expertise.

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Getting feedback from staff and residents about my consultation skills has been really beneficial to
develop my skill set and become a better healthcare professional. The results of the PSQ have
given me a realisation of my abilities in my clinical role. The feedback demonstrates that I am
providing a very good service and that further work on clinical areas and communication will
improve my professional confidence and allow me to embrace this new role as it develops further.

It is crucial that I continue to develop my skills and revisit the learning from CPPE Consultation skills training
now that I have more opportunity for practical application. I have also identified that I struggle with
conversations when residents are really sick eg, end of life care and breaking bad news. This is included in
my action plan for development. I am going to try and keep a communication diary for myself so I can write
when I have had difficult conversations with residents/ staff and what I could have done to improve.

Reflective essay marking and feedback

Assessment criteria demonstrated:
• You have shown evidence that you have completed the PSQ.
• You have shown evidence that you have reflected on the patient feedback and
identified your strengths.
• You have shown evidence that you have reflected on the patient feedback and
identified your development areas.
• You have shown evidence that you have developed an action plan to improve your practice.

Assessment criteria NOT demonstrated:

• You have not shown evidence that you have used the Consultation skills for pharmacy
practice standards for England to support your development.

Examples of good practice in the essay:

• You have identified your strengths and reflected on what you have done in your practice
that has led to these scores, eg, your approach to putting the residents at ease, listening to
them and showing interest in the whole person, especially in a challenging environment.
You have also reflected on your lowest scores, possible reasons for these scores and you
have considered how you are addressing these issues showing a person-centred
approach. This in turn has brought about a change in your practice and provision of more
holistic care to residents.

Recommendations for what you can do next:

• Although you have identified key areas for your PDP, this could be improved through the use
of SMART objectives, eg, what specifically do you want to achieve? When will you achieve
this? How will you measure this? You have not used the Consultation skills for pharmacy
practice standards for England and I would recommend that you reflect on these standards
and identify how the standards can to support you to develop in the areas where you had
lower scores. The CPPE Consultation skills (advanced) gateway page:
www.cppe.ac.uk/gateway/consultadv has a wide range of resources to help you further
develop your consultation skills, eg, consulting with older people, consulting with people
living with dementia and consulting with people with mental health problems.

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Patient Satisfaction Questionnaire template

Pharmacy professional’s name:

Hello
We are asking you to complete this questionnaire today because you will be having a consultation
with a pharmacist or pharmacy technician.

Pharmacy professionals are now members of the multidisciplinary team in general practice and care
homes and work alongside other healthcare professionals such as doctors and nurses. Pharmacy
professionals have a valuable role to play in helping you to get the best out of your medicines and
making sure that you use your medicines safely and effectively.

Pharmacy professionals are experts in medicines, but no one knows better than you how you
respond to the medicines you’re prescribed, how you feel about taking them and how helpful they
are for you. So it’s important that you and the pharmacy professional are able to discuss your
needs and wishes fully and reach decisions together.

Your views about your consultation with the pharmacist or pharmacy technician today are essential
in helping to improve their skills. So we’d be very grateful if you would complete this questionnaire
after your consultation today. It will only take a couple of minutes to complete and it’s anonymous
so the pharmacy professional will not be able to identify your individual responses.

Returning your questionnaire:

• If your consultation was at the GP surgery, please put the completed form in the box in reception.
• If your consultation was at a care home, please return your completed questionnaire to
the care home manager or their deputy.
• If the pharmacy professional visited you at home, they will give you an envelope to
put the questionnaire in. (You can seal the envelope and the pharmacy
professional will return it to their employer. Or, if you prefer to complete the
questionnaire later, the pharmacy professional can provide a stamped-addressed
envelope.)
• If you received this electronically please return the completed questionnaire as requested
by the sender.

Thank you for your help.

Name of GP, practice manager or care home manager:

Name of practice or care home:

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PSQ form
The form presented here shows you the form that patients will use to provide feedback on your
consultations. You cannot type into this form.

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Section 6 – Consultation skills direct observation of practice

The consultation skills assessment (direct observation) is one of the Module 5 assessments for
pharmacy professionals undertaking the Primary care pharmacy education pathway. Your assessor
(must be a GP for pharmacists but can be a senior pharmacist for a pharmacy technician) will
directly observe your practice and use the Medicines Related Consultation Assessment Tool (MR-
CAT) form to assess your consultations.

The MR-CAT can be used to assess pharmacy professionals’ consultation skills when undertaking
any patient consultations such as clinical medication reviews, chronic disease reviews, level 3
medicines reconciliation or helping a patient use their medicines. It can be based on a face-to-face,
video or telephone consultation. The emphasis of the assessment is on the communication aspects
of the consultation and shared decision making. The consultation observation tool (COT) might be
more suitable for assessing consultations in acute settings that require diagnostic techniques
and/or clinical examinations and GPs may wish to use this tool to assess pharmacists undertaking
these roles, but this is not one of the formal pathway assessments. Clinical examination and
procedural skills are assessed using the clinical examination and procedural skills assessment
record (CEPSAR).

Your consultation skills will be assessed in your workplace on two different consultations using the
MR-CAT as the framework for assessment. You will need to demonstrate your competence for both
consultations. We recommend that you choose different types of patients for your consultation skills
assessments where possible to demonstrate the breadth of your practice. After your first MR-CAT
assessment it is good practice to allow time for reflection on your strengths and development areas
before your second MR-CAT assessment.

Your assessor will usually be your clinical supervisor or they can delegate this assessment to
another GP. Your assessor will directly observe your practice or they might ask you to make a
video or audio recording of a consultation which they will assess retrospectively. See pages 82–
84 for information on the use of video recordings.

Patient consent
See pages 82–84 for the stepwise process for communicating with a patient or care home resident
and asking for consent.

Preparing for your consultation skills assessment

The Consultation skills: what good practice looks like e-learning:
www.cppe.ac.uk/programmes/l/wgll-e-01 is a useful resource to help you prepare for your
consultation skills assessment. In particular, we would recommend Section 2 – The patient-centred
approach: Demonstrating key skills. You should complete the Consultation skills e-assessment
before undertaking this assessment. In passing the Consultation skills e-assessment, you will have
demonstrated your knowledge of consultation skills and your ability to distinguish between good
practice and practice that requires further development (‘knows’ and ‘knows how’ stages of Miller’s
pyramid on page 5). The consultation skills direct observation builds on this and enables you to
demonstrate what you can actually do in practice; the ‘does’ stage of Miller’s pyramid.

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Read through this section of the assessment handbook and the MR-CAT form carefully and
familiarise yourself with the assessment criteria.
Use the MR-CAT form (pages 75–79) and the examples of good consultation practice (pages 80–
82) as tools to reflect on your consultations prior to undertaking your assessments. You will need to
share the information about this assessment and the MR-CAT form with your GP clinical
supervisor, and agree a time when your assessments will take place.

Assessment criteria
The MR-CAT is a global assessment tool that focuses on five areas of the consultation:
1. INTRODUCTION – How well did the pharmacy professional introduce the
consultation and build rapport/a therapeutic relationship?
2. GATHERING INFORMATION AND IDENTIFYING PROBLEMS – How well did the
pharmacy professional identify the patient’s medicines and/or health needs?
3. SHARED DECISION MAKING – How well did the pharmacy professional engage
the patient in establishing and taking ownership of a management plan?
4. CLOSURE – How well did the pharmacy professional negotiate an effective closure to the
consultation including discussing safety-netting strategies?
5. CONSULTATION BEHAVIOURS – Overall summary of consultation behaviours
that forms the structure of the consultation, power versus partnership and
therapeutic relationship.

The assessor will rate your consultations on a three-point scale for each of the five areas. The scale is
as follows:
• Needs further development
• Competent
• Excellent

The MR-CAT is a user-friendly assessment tool. It includes descriptors of competent and excellent
consultation skills for each of the five areas of the consultation. There are also descriptors where the
pharmacy professional needs further development. These descriptors ensure fairness and
consistency of assessment. A copy of the MR-CAT assessment tool, which includes the descriptors
for all five areas of the consultation, can be found on pages 75–79.

There are a number of behaviours included in each descriptor so your assessor will need to use
his/her judgement to decide whether your consultation behaviours are competent, excellent or
whether you need further development for each of the five areas.
Having assessed each of the five areas, your assessor will use his/her judgement to make an
overall assessment of the consultation and decide whether your overall performance was excellent,
competent or needs further development.
You will need to be assessed as competent overall to pass this assessment.
Your assessor may decide that you are competent overall, even if he/she assesses you as needing
further development for one or two of the five areas. In this situation, they will give you clear feedback
on how you can improve your consultation skills behaviours in these areas. If your assessor’s overall
assessment is that you are not yet competent and need further development, you will need to repeat
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the assessment. You will need to agree an appropriate time period for repeating your assessment
with your assessor.
In all cases, your assessor will also comment on your strengths and areas for development and you
should use this feedback to reflect on your practice and further improve your consultations. Your
assessor should give you written feedback as well as verbal feedback.
You will need to record the dates that you passed each consultation skills direct observation
assessment on the Module 5 assessment activity series – Activities 4 and 5.

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Medicines Related Consultation Assessment Tool (MR-CAT)

The form is presented here to show you the criteria the assessor will be using. You cannot type into this
form.

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Reflecting on your practice to prepare for your assessment

The MR-CAT is a global assessment of each of the key five areas of the consultation. We have
listed examples of good consultation practice for each of the five areas of the consultation in the
table on the next page. We have linked these key skills and behaviours to the Consultation skills for
pharmacy practice: practice standards for England:
www.consultationskillsforpharmacy.com/pathways6.asp?P=2
This does not form part of your assessment, but we have provided this information to help you
reflect on your strengths and development needs before and after your assessment. We
recommend that you use the examples of good consultation practice as a self-assessment tool to
prepare for your consultation skills direct observation of practice assessment.
See table on the next page.

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Examples of good consultation practice

1) INTRODUCTION – How well did you introduce the consultation and build rapport/a therapeutic
relationship?

Examples of good consultation practice Standard Yes / No

Set the scene of the consultation professionally; introduce yourself by name and role to the 1.10
patient (and any other people present in the consultation)
Confirm patient’s identity and address how they would like to be called 1.10

Discuss purpose and structure of the consultation from your own perspective 1.10

Achieve meaningful consent where relevant 1.70

Invite patient to share their agenda and discuss any medicines or health-related issue that 1.11
may be on their mind
Balance the patient’s agenda with your own agenda then negotiate a shared agenda 1.11

2) GATHERING INFORMATION AND IDENTIFYING PROBLEMS – How well did you identify the
patient’s medicines and/or health needs?

Examples of good consultation practice Standard Yes / No

Document a full history from the patient of their medicines or any public health issues 1.80
discussed
Elicit patient’s understanding of his/her condition 1.19

Use appropriate questioning techniques and listening skills to assess the patient’s 1.19
knowledge and understanding of their medicines 1.17
Establish and deal sensitively with the patient’s concerns 1.23

Explore social history and other factors which influence medicines taking and health 1.15
1.29
1.30
3.20
Explore patients attitudes towards taking medicines and assess adherence in a non- 1.22
judgemental way 1.24
Identify and agree the priorities for the patient’s issues using summarising 1.21
1.24

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3) SHARED DECISION MAKING – How well did you engage the patient in establishing and taking
ownership of a management plan?

Examples of good consultation practice Standard Yes / No

Share information and discuss options in an open, honest and unbiased way 1.13
2.40
Establish what information would be helpful to the patient in terms of medicines taking and 1.13
health and provide education accordingly 1.26
3.10
Involve patient in designing a management plan (shared decision making) 1.21
2.50
Check patient understanding of the plan 1.20

Check patient’s agreement to the plan and identify any points they are unsure of or not 1.24
comfortable with
Refer appropriately to other healthcare professional(s) 1.50
2.30

4) CLOSURE – How well did you negotiate an effective closure to the consultation including
discussing safety-netting strategies?

Examples of good consultation practice Standard Yes / No

Manage the conclusion of the consultation effectively including a safety net (explain what 1.27
to do if patient has difficulties in following the plan and inform them of whom to contact)
Provide a further appointment or contact point 1.27

Establish if the patient has enough information and offer opportunity to ask further 1.26
questions

5) CONSULTATION BEHAVIOURS – Overall summary of consultation behaviours which forms the

structure of the consultation, power versus partnership and therapeutic relationship

Examples of good consultation practice Standard Yes / No

Listen actively, acknowledging non-verbal cues and without interrupting 1.16

Use appropriate questioning techniques using open and closed questions to gain 1.19
maximum benefit from the discussion
Demonstrate respect for the patient’s perspective and appropriate empathy and /or 1.17
compassion 1.23
1.31
1.32
Communicate positively and adapt your communication to meet the needs of the individual 1.12
(language, people who do not have the mental capacity to make their own decisions about 1.14
their care and treatment, age of person, physical and sensory impairments etc.)
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Accept the patient as a partner in the consultation, eg, show respect, not judgemental or 1.17
patronising 1.22
Adopt a structured and logical approach to the consultation 1.20

Summarise the discussion at appropriate time points before moving on to the next issue 1.20
1.26
1.27
Manage time effectively (get the best from the consultation within the time available) 1.4

Stepwise processes in general practice and care homes

Stepwise process for communicating with a patient and asking for consent, and the use of
video recordings or recorded telephone conversations in general practice
1. You and your assessor will decide whether the assessment will be a direct observation of
the consultation, a video recording, or a recorded telephone consultation. See the box
below for more information on the use of video and audio recordings.
Using video recordings
If you decide to use video, you must follow the General Medical Council guidance on Making and using
visual and audio recordings of patients: www.gmc-
uk.org/static/documents/content/Making_and_using_visual_and_audio_recordings_of_patients.
pdf and your practice’s local procedures to ensure confidentiality of data and patient consent.

Key points to remember are listed below:

• video recordings can only be made using the practice’s equipment and must not be made on
personal mobile devices
• videos must be stored safely and securely to protect patient confidentiality and must not leave
the premises
• patients must give written consent before the consultation is recorded and your practice should
have a consent form that you can use.

2. CPPE has provided notices and a patient information leaflet to inform the patient that the
pharmacy professional’s consultations are being observed. You can find these on the
assessment section of Canvas.
There are different notices for direct observation and video or audio recordings. The practice should print
copies of the relevant notices and patient information leaflets, and copies of the consent form if video or
audio recordings are being made. All practices that use video to record consultations will have consent
forms.
3. The notices should be prominently displayed in the following locations:
• at the reception desk
• close to electronic check-in to direct patients to reception
• on the door of the consultation room where the observation or video recording is taking place
(fail-safe)
• sent to the patients via post or electronically in the case of virtual video/telephone consultations.
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4. The receptionist should hand out or send the relevant patient information leaflet (and consent form for
video or audio recording) to patients, and the patient should be asked to read the patient information
leaflet and confirm their decision as to whether this wish to consent.
5. If the patient gives verbal consent:

Direct observation
• The pharmacy professional should be informed that the patient has given verbal consent.
• When the patient arrives in the consulting room and/or virtual environment, the
pharmacy professional should:
o introduce the assessor
o check that the patient has been informed
o check that the patient has consented – the patient can change their mind at any time
o explain the assessor’s role.

Video
• The patient should be asked to read, sign and return the consent form.
• The pharmacy professional should be informed that the patient has given verbal
consent and signed the consent form.
• When the patient arrives in the consulting room or virtual environment the pharmacy
professional should:
o check that the patient has been informed
o check that the patient has consented – the patient can change his/her mind at any time
o explain the process of video recording.

6. If the patient does not wish to consent, the receptionist should inform the pharmacy
professional and the assessor will leave the room/the video will not be recorded. The
consultation will then go ahead as normal, with no observer.

Stepwise process for communicating with a care home resident and asking for consent in
care homes

1. You will need to liaise with your care home manager or deputy prior to the consultation in order
to gain consent from residents. Care home residents must be asked for consent before the
consultation. They should be fully informed of what is involved, verbally and in writing, utilising
information from the MR-CAT Patient Information Leaflet, which you can find on Canvas.
2. Consent can be given by another person if the resident does not have the mental capacity to
make their own decisions about their care and treatment. The person giving consent may be a
family member, friend, advocate or care worker.
3. The consultation should not be observed unless the care home resident has given consent or
another person has given consent on their behalf. It is not acceptable to ask for consent
retrospectively.
4. Care home residents, or the person giving consent on their behalf, must be informed that it is
their choice whether to allow the observer to be present or not, and their decision won’t affect
treatment in any way. If the observer is not allowed to be present and the consultation is
needed then it should continue without being part of the direct observation of practice.
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5. The care home manager or a deputy will let the pharmacy professional know whether the
resident has given consent for the consultation to be observed or another person has given
consent on the resident’s behalf.
6. If the resident gives consent, or another person gives consent on their behalf, the care home
manager or deputy should complete the section on consent of the Medicines Related
Consultation Assessment Tool (MR-CAT) and give this to the pharmacy professional prior to
the consultation.

Using video recordings for consultations in a care home is not appropriate.

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Section 7 – Portfolio
A well-constructed portfolio should demonstrate how you work effectively as a pharmacy
professional in primary care and provide evidence of your impact in your role.

You will record your portfolio on Canvas. To support you in using the Canvas online platform we will
be running a live interactive Canvas online induction for all new learners at the beginning of each
cohort. An introduction to setting up your ePortfolio will take place in your Canvas online induction. If
you are unable to attend the live Canvas induction, you can watch a video:
https://cppe.instructure.com/courses/118/pages/programme-overview-and-compulsory-
induction-webinars

You will create the following folders in your portfolio:

• Evidence of impact in role
• Assessments
• Personal development plan (PDP)

More information on what to include in each of these folders is provided below.

You can choose to create additional folders, eg, some pharmacy professionals have told us that
they want to record their tasks from the Primary care essentials e-course in their portfolio so you
could create a separate folder for this.

We have provided the following templates for you to record your portfolio entries (you can find
copies in the assessment section of Canvas):
• ‘Evidence of impact in role’ template
• Reflection on MSF and action plan
• PDP template
• CEPSAR case studies template

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‘Evidence of impact in role’ template

You will use the ‘evidence of impact (EOI) in role’ form to record entries for this section of your portfolio. The
template is presented here to show you the forms that you will need to complete to record your EOI entries.
You cannot type into this form.

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The EOI entry should, as the title suggests, focus on what impact the piece of work or learning had on
patients/care home residents/colleagues/the pharmacy professional/the service as a whole. When writing
your EOI in role entries, think about the different aspects of your role, eg, clinical work, safety work,
strategic work, networking, leadership, etc, and try to ensure that your entries represent everything that you
do in practice. Your entries should demonstrate the breadth of your role; therefore, you must not write more
than one entry for any one topic.

A good EOI entry will include the following:

• a description of what you did (what)
• a description of why you did it (why)
• information on how you used your expert knowledge and skills (how)
• an explanation of how you worked with the multiprofessional team to achieve results (who)
• a description of the benefits to service users and patients (so what).

When writing your EOI entry, make sure that you cover all of the points above and include a clear
description of the impact of your work, including, if possible, some objective evidence of this
benefit. A common pitfall when writing EOI entries is to provide a very detailed description of what
you did, but very little description or evidence of what difference it made.

EOI entries are not intended to be a record of cases which involve a single patient, because this is
assessed using the case-based discussion (CbD). However, sometimes the starting point for an
EOI entry could be due to an interaction with an individual patient. In these situations, it is not
necessary to provide a lot of clinical detail about the original patient. Instead, you should focus
your entry on how you applied the learning from the patient to a wider cohort of patients or at a
strategic level. For example, you undertook a medication review with a patient who was not taking
his statins due to negative media reports about statin side effects. You had a conversation with the
patient about the benefits of taking statins and provided information about potential advantages
and disadvantages to help promote shared decision making. This consultation led you to reflect on
whether there are other patients who are not taking statins for similar reasons. You decided to run
a search for patients with statins on repeat which have not been issued in six months, and then
invited them for a medication review to discuss their statin prescription. This would demonstrate a
much bigger impact than focusing the entry on one patient.

You can also upload supplementary evidence to your portfolio, eg, you might write an entry about
your role in reviewing a local policy, how you trained your colleagues in relation to the policy, an
audit that you completed to check compliance with the policy, etc. Supplementary evidence would
be a copy of the policy, a copy of the presentation and a copy of the audit report.

You will aim for 18 (15 for pharmacy technicians) portfolio entries over the duration of the pathway
(minimum ten pieces of evidence during the pathway). While this works out as approximately one
entry per month, we recognise that you will need some time to settle into your role before you are
able to demonstrate impact, so you might write fewer entries at the start of the 18-month pathway.

However, we would encourage you to start writing your EOI in role entries as early as possible and
to keep working on them throughout the pathway, to avoid leaving them all until the end of the
pathway. You will be expected to bring your EOI in role entries to the tutorials for discussion with
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your peers, and to give and receive feedback.

There are some examples of EOI entries, and feedback on these entries, on Canvas:
https://cppe.instructure.com/courses/118/pages/evidence-of-impact-entry-examples-and-
feedback

Please note: these examples are of varying quality, so it is really important for you to read the
feedback as well as the example to understand what improvements could be made. The table on
the next page lists some examples of topics that pharmacy professionals could write their portfolio
entries about. This is not intended to be an exhaustive list.

Well-written entries provide good evidence of your role development as you progress
through the pathway. Therefore, your employer may wish to see your portfolio entries
during the pathway as part of your ongoing personal development review process.

In addition to demonstrating role progression for the pathway, your EOI entries can be used to
demonstrate the value that you bring to your PCN. They can also provide valuable evidence to use
at your appraisal or at interviews, if you are looking for a promotion or changing roles; to
demonstrate to your employer your ability to take on additional responsibilities; or to develop a
business case to grow the pharmacy team and recruit more pharmacy professionals. Examples
might include:
• how you are supporting practices to meet targets, eg, Investment and Impact fund (IIF),
Quality and Outcomes Framework (QOF) or other local PCN targets
• how you are supporting person-centred care, patient safety, reducing hospital admissions
and reducing waste
• how you are demonstrating leadership
• how you are supporting and developing the multidisciplinary team by training and
managing others, sharing learning or resources, delegating or referring appropriately
• how you are advancing your personal goals and aspirations, eg, having a passion for a
particular clinical area that leads to running clinics or taking on more complex patients.

Your EOI entries can also provide evidence of how you are demonstrating the GPhC standards for
pharmacy professionals, and examples from your EOI entries can be used for revalidation. In
addition, if you are a pharmacist and want to apply for RPS credentialing as an advanced
practitioner after you have completed the pathway, your EOI entries will provide high-quality
evidence for your RPS portfolio.

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Examples of topics for portfolio entries for pharmacy professionals working in primary care

• Provide leadership on person-centred medicines optimisation.

• Have a leadership role in supporting further integration of general practice with the wider
healthcare teams (including community and hospital pharmacy) to help improve patient
outcomes, ensure better access to healthcare and help manage general practice workload.
• Take a central role in the clinical aspects of shared care protocols, liaising with specialist
pharmacists where appropriate.
• Take the lead in ensuring the PCN/practice complies with Care Quality Commission (CQC)
medicines management standards and support the PCN/practice to prepare for a CQC visit.
• Patient safety – using computer searches to identify groups of patients at high risk of harm from
medicines, including patient-related and/or medicines-related risks. Undertake high-risk drug
monitoring. Implement changes to medicines that result from Medicines and Healthcare
products Regulation Agency (MHRA) alerts, product withdrawal, and other local and national
guidance.
• Repeat prescribing – writing and implementing repeat prescribing policies for the PCN.
Managing the repeat prescribing re-authorisation process and ensuring patients have
appropriate monitoring tests in place when required.
• Contribute to the development and implementation of new services, and undertake audits and
quality improvement (QI) projects.
• Ensure policies and procedures are in place to reconcile medicines following discharge from
hospitals, intermediate care and into care homes.
• Identify and provide leadership on areas of prescribing requiring improvement, including
antimicrobial stewardship to reduce inappropriate antibiotic prescribing, reducing medicines
waste, monitoring prescribing against local formularies and medicines switches.
• Prevention of medicines-related hospital attendance or admissions – review the use of
medicines most commonly associated with unplanned hospital admissions and readmissions
through audit and individual patient reviews. Put in place changes to reduce the prescribing of
these medicines to high-risk patient groups.
• Provide education and training for practice and care home staff.
• Working with the multidisciplinary team, community pharmacy and patient participation groups.
• Work with care home staff to improve safety of medicines ordering and administration.
• Leadership role in COVID-19 vaccination clinics.

Assessments
You need to upload copies of the following assessments into your Canvas portfolio:
• Reflection on MSF and action plan x 2
• CEPSAR case studies x 2 (you will discuss these with your clinical supervisor)
• CEPSAR completed log/final sign-off (pages 37–39 of the CEPSAR logbook)
• CbD x 2 (upload completed assessment forms)
• MR-CAT x 2 (upload completed MR-CAT assessment forms)
• PSQ feedback spreadsheet/data from Google Forms/Microsoft Teams document
• Red Whale musculoskeletal (MSK) and chronic pain scenarios x 5 (pharmacists only)
• QI project abstract

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You don’t need to upload reflective essays or your MSF feedback report because your education supervisor
can access these via the CPPE website. If you want to include these assessments in your portfolio for
completeness, then you can choose to do so.

Assessments do not count towards your 10–18 pieces of evidence.

Personal development plan

Your PDP is a working document which you should keep updated throughout the pathway to plan and
manage your learning objectives. We would suggest formally updating your PDP at six and 12 months. As a
minimum, you will be required to upload one PDP from the start of the pathway and one PDP for the end of
the pathway to the PDP section of your portfolio. This PDP will be part of your submission for your
Statement of assessment and progression (SoAP).

Your PDP shows an education supervisor how you take responsibility for your learning, both in progressing
your personal goals and aspirations, how you are planning to use the learning from the pathway to develop
and grow knowledge, skills and behaviours, and how you have applied the learning to your role within the
practice. For example:
• How will you apply clinical assessment skills in your role?
• How will you set up SMR clinics and what do you need to do to achieve this goal?
• How do you plan to use your increased knowledge from Module 2 to take on more complex
patients?
• How would you like to advance your clinical knowledge in hypertension, such that you can manage
patients with this condition?
• How will you use your learning from the CQC to support your practice through a CQC inspection?

What gaps in knowledge, skill or behaviour did you identify in your learning needs analysis (LNA)? How do
you plan to fill those so that you can improve your LNA scores in three months, six months and 12 months,
so that you can see how you have developed from primary care entry level to intermediate and advanced
level roles? The progress column of each of your SMART objectives will show your ES how you have met
each of your personal challenges, and how you have taken on greater responsibility. The early SMART
objectives may look smaller and less significant when you look back at the end of the pathway, but they will
show you and your ES just how far you have come, and how you have used the pathway and in-house
practice support to progress and advance your role.

Sharing your portfolio with your education supervisor

Your education supervisor will use the information in your ePortfolio as one of the methods of measuring
your progress with your education pathway. You will need to share a link to your portfolio with your
education supervisor so that they can view it. On the Welcome to your ePortfolio page you will find a link
that enables you to share this with your education supervisor. Copy this link and paste it into the pathway
progress tracker: Module 1 assessments: Activity 6.

Your education supervisor may sample your portfolio before each group tutorial. They may ask you about
some of your ePortfolio entries at your group tutorial sessions, but do not expect them to provide detailed
feedback on your entries.

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Zipping up your files on your Canvas ePortfolio

You will not have access to your Canvas ePortfolio after the end of the pathway so you will need to export
your portfolio from Canvas and save it on your computer as a zip file. On the Welcome to your ePortfolio
page, click on the link that says Download the contents of this ePortfolio as a zip file. It may take a while to
download, but any files (PDFs or Word documents) are easily accessible. The pages created save as HTML
pages. You can download all the files you create in a zip file at any point throughout your pathway.

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Section 8 – Statement of assessment and progression

On completing the training pathway, you will receive a Statement of assessment and progression (SoAP),
which details the learning undertaken and confirms the assessments you have passed.

You are awarded a SoAP at the end of the pathway. Assessment is easy to measure – you have either
completed the required assessments or you haven’t. But progression can be harder to measure, as it
requires personal growth, application of knowledge and skills to practice, and it is a measurement of your
overall development in self and role, such as by observing your increased confidence and competence in
delivering person-centred care, as well as leadership within your multidisciplinary team. Your ES will use
your PDP and EOI to measure your role progression, on which they will give you positive and
developmental feedback in your SoAP.

You will submit your SoAP and portfolio for review at least one month before your pathway completion
deadline. Your education supervisor will review your SoAP and portfolio and provide feedback and
suggestions for further development.

When your education supervisor has completed the review, they will release your SoAP and you will be able
to access a PDF copy via the CPPE website.

You can use your SoAP and portfolio entries when applying for jobs to demonstrate your progression with
learning and assessment and evidence of how you have applied your learning to develop your role in
primary care. This SoAP is nationally recognised by NHS England and the British Medical Association as
evidence of training completed to any current or future employer.3

What is included in the SoAP?

Your SoAP will include the following information:
• your name and GPhC number
• your assessment record
• your learning record
• other learning
• your role statement
• links to your Canvas portfolio and PDP
• declarations.

Your SoAP will include information which has been downloaded from CPPE databases and
information that you record yourself via the Statement of assessment and progression activity
series on the CPPE website.

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Your name and GPhC number

Data is downloaded from the CPPE database into your SoAP.

Your modules (learning and assessment record)

This part of the SoAP will list all of the learning that you have completed for each module and all of the
assessments that you have completed for each module. Data is downloaded from the CPPE database into
your SoAP.

Other learning
You will record details of any other relevant learning that you have undertaken while you have been
enrolled on the Primary care pharmacy education pathway (maximum 1000 words).

Other learning may also include non-compulsory aspects of the pathway eg, optional online units from
Module 5, other learning from CPPE or other providers, formal qualifications, conferences and symposia
etc.

Your role statement

Your role statement summarises your roles and responsibilities as a pharmacy professional in primary
care.

Link to your Canvas portfolio

You will provide the link to your Canvas portfolio. Your portfolio entries provide evidence of your progress
with the Primary care pharmacy education pathway and evidence of the impact of your role. Your
education supervisor will review your portfolio and the information in your SoAP and provide written
feedback as part of the final review.
Link to your PDP
You will create a new personal development plan (PDP) at the end of the Primary care pharmacy
education pathway outlining plans for your future development in your role. You will focus on your
development plans for the 12 months immediately after the end of the pathway.
Declarations
Before you submit your SoAP for review, you will need to complete some declarations to confirm that:
• all sections of the SoAP are complete
• your role statement is an honest reflection of your roles in primary care
• your portfolio entries are an honest and accurate record of the impact of your role in primary care.

Submitting your SoAP for review

You will not be able to make changes to your SoAP after you have submitted it for review, so it is really
important that you check it before submitting it. By clicking on the submit button you are confirming the
declarations.

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Section 9 – Guidance on time needed to complete assessments

We have provided an estimate of the time that it will take for you to complete each
assessment, including preparation time. There is a table for each module listing the
assessments and estimated completion time. This will support you to plan your assessments
and to complete them on time.

Module 1 assessments
Assessment Time taken to complete
Statutory and mandatory Safeguarding training and assessment (as part of Time to complete depends on
employer induction and repeated every 3 years) local provider
Equality, diversity and human rights e-assessment (elfh) 15 minutes
CPPE Primary care essentials e-assessment 45 minutes
CPPE Consultation skills e-assessment 90 minutes
CPPE Care homes e-assessment 45 minutes
Total 3 hours and 15 minutes +
time for statutory and
mandatory training

Module 2 assessments
Assessment Time taken to complete
Case-based discussion (CbD) Total 3 hours:
CPPE CbD assessment tool. • Preparing for the assessment (reading
Assessed by pharmacist clinical mentor. assessment handbook and accessing
resources) – 1 hour
• Preparation of a case – 1 hour
• 30 minutes – presentation
• 30 minutes – feedback.
Multisource feedback (MSF) Total 3 hours:
Online questionnaire. • Preparing for the assessment (reading
Feedback provided by clinical and non-clinical staff assessment handbook and accessing
who work closely with the pharmacy professional. resources) – 1 hour
Portfolio entry on MSF feedback and professional • Sending out questionnaire – 15 minutes
discussion peers. • Reflection on MSF feedback and portfolio
entry – 1 hour
• Professional discussion with peers – up to 30
minutes
• PDP – 15 minutes.
Inhaler technique for health professionals Total 40 minutes:
CPPE e-assessment • Preparing for and completing the
assessment.

Total 6 hours and 40 minutes

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Module 3 assessment
Assessment Time taken to complete
Clinical examination and procedural skills Total will depend on how many clinical skills you need
assessment record (CEPSAR) to demonstrate (in agreement with your clinical
Direct observation of practice (DOP) by supervisor):
GPs, nurses, senior pharmacists in the • Preparing for the assessment (reading the CEPSAR
workplace. logbook) – 1 hour
Completion of clinical examination and • DOP – between 2.5 hours and 4 hours (you will also
procedural skills logbook. need time to learn the clinical skills and practice them
Two case studies and a professional before your DOPs)
discussion with your clinical supervisor. • Case studies – 1 hour to write and 30 minutes to
Reflective essay assessed by your CPPE discuss per case study
education supervisor. • Reflective essay – 1 hour to write.
Total 6.5 to 8 hours

Module 4 assessment
Assessment Time taken to complete
Quality improvement (QI) project Total 2 hours:
Creating an idea for a quality improvement • Research idea with your workplace – 1–2 hours
project in your area of practice. • Discussion on study day – (within study day time)
Discussion with your peers and then a • Presentation within group tutorial (within allocated
presentation of your idea within a group study time) and submission of abstract
tutorial. • Completion of project – this will be an ongoing part of
Upload copy of abstract to your portfolio. your role.
Total 2 hours

Module 5 assessments
Assessment Time taken to complete
Case-based discussion (CbD) Total 2.5 hours:
CPPE CbD assessment tool. • Preparing for the assessment (reading assessment
Assessed by pharmacist clinical mentor. handbook and accessing resources) – 30 minutes
• Preparation of a case – 1 hour
• 30 minutes – presentation
• 30 minutes – feedback.

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Multisource feedback (MSF) Total 2.5 hours:

Online questionnaire. • Preparing for the assessment (reading assessment
Feedback provided by clinical and non-clinical handbook and accessing resources) – 30 mins
staff who work closely with you. • Sending out questionnaire – 15 minutes
Portfolio entry on MSF feedback and • Reflection on MSF feedback and portfolio entry – 1
professional discussion with peers. hour
You complete your second MSF approximately • Professional discussion with peers – up to 30
six months after your first MSF to allow minutes
sufficient time to action development needs • PDP – 15 minutes.
identified in the first MSF.

Reflection on patient feedback Total 3.5 hours:

CPPE Patient Satisfaction Questionnaire. • Preparing for the assessment (reading assessment
(PSQ) Reflective essay of your learning from handbook and accessing resources) – 1 hour
feedback from the PSQ assessed by your • Planning logistics of assessment with practice
CPPE education supervisor. manager – 30 minutes
• Reflection on feedback in relation to consultation
skills standards – 1 hour
Reflective essay – 1 hour to write.

Consultation skills direct observation of Total 2.5 hours:

practice (DOP) • Preparing for the assessment (reading assessment
DOP by your clinical supervisor using the handbook and accessing resources) – 1 hour
Medicines Related Consultation Assessment• Planning logistics of assessment with practice
Tool (MR-CAT). manager – 30 minutes
Two consultations assessed by your clinical DOP and feedback from clinical supervisor – 30 minutes x
supervisor. 2.

Total 11 hours

Portfolio and Statement of assessment and progression

Assessment Time taken to complete
Portfolio Total 6 hours (20 minutes each)
18 (15 for pharmacy technicians) ‘evidence of
impact in role’ entries
(a minimum of 10 is required)
Statement of assessment and Total 2 hours:
progression • Role statement
• PDP
Total 8 hours

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References

1. Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine. 1990;65:

S63–S7.
2. Health Education England, CPPE. Consultation skills for pharmacy practice: practice standards for
England. March 2014. www.consultationskillsforpharmacy.com/docs/docc.pdf
3. NHS England. Network Contract Directed Enhanced Service: contract specification 2022/23 – PCN
requirements and entitlements. March 2022. https://www.england.nhs.uk/wp-
content/uploads/2022/03/B1357-Network-Contract-Directed-Enhanced-Service-contract-
specification-2022-23-primary-care-network-requireme.pdf

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Appendix 1 – PDP template

SMART How will I achieve Support needed – Timescale – by Progress

objective the objective? who or what? when?

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