1. Background

A Competency Framework for all Prescribers sets out what good prescribing looks like. It describes the demonstrable knowledge, skills, characteristics, qualities and behaviours central to a safe and effective performance in a prescribing role. Its implementation and maintenance are important in informing and improving practice, development, standard of care and safety (for both the prescriber and patient).

The competency framework is for all regulators, professional bodies, education providers, prescribing professions (independent prescribers, community practitioner nurse prescribers and supplementary prescribers) and patients/carers to use. It’s a generic framework for all prescribers and can be used by any prescriber at any point in their career regardless of their professional background or setting. However, it must be contextualised to reflect different areas of practice, levels of expertise and settings.

‘A single prescribing competency framework’¹ was published by the National Prescribing Centre/National Institute for Health and Care Excellence (NICE) in May 2012. Since 2016, the Royal College of Pharmacy (RCPharm) has managed the update of the competency framework on behalf of all the prescribing professions in the UK. In collaboration with a multi-disciplinary group with representatives from professional regulators, professional organisations, prescribers from all prescribing professions, lay representatives and other relevant and interested stakeholder groups from across the UK, RCPharm first published ‘A competency framework for all prescribers’ in July 2016².

This literature review looks at the key changes since its publication in 2016. Since the 2016 publication, there have been amendments to The Human Medicines Regulations in 2018 introducing independent prescribing by paramedics³. In addition, publications such as the RCPharm ‘A Competency Framework for Designated Prescribing Practitioners’ in 2019⁴. and the General Pharmaceutical (GPhC) ‘Standards for the education and training of pharmacist independent prescribers’ in January 2019⁵ have shaped the approach to prescribing within the UK since the publication of the competency framework. During the development of the RCPharm ‘A Competency Framework for Designated Prescribing Practitioners’ in 2019, the project board and steering group provided specific advice that the ‘Competency Framework for all Prescribers’ was still broadly fit for purpose; however, a light refresh to the competencies would be needed.

1.1.Aim

A literature review of the ‘Competency Framework for all Prescribers’ has been undertaken to ensure the competency framework is still current, relevant, fit for purpose and continues to cover the key competencies required for prescribers.

This review is aimed at:

• Identifying any new legislation, competencies or standards linked to non-medical and medical prescribing since it was last published in 2016.
• Identifying any relevant research that has utilised the competency framework for professional development to identify any potential areas of improvement or gaps relating to the use of the competency framework.

This review does not include guidance for designated prescribing practitioners as this is covered elsewhere in the RCPharm ‘Competency Framework for Designated Prescribing Practitioners’.

2. Method

2.1 Search strategy

Medline Complete, Biomedical Ref Collection, and PubMed, were searched using the keywords:

safe OR patient oriented OR e-prescribing OR medication error OR shared decision making OR de-prescribing AND “competenc*; prescr* AND competen*; non medical OR independent OR medical AND prescriber; regulation OR standards OR competency frameworks OR professional development OR continuing professional development OR accreditation AND independent OR non medical and prescrib*

The search was limited to articles published in English from July 2016 to November 2020 and search fields to keyword, title, abstract.

A grey literature search for standards, competencies and competency frameworks published since 2016 was also performed in NHS evidence and UK healthcare regulatory body websites (General Medical Council, Nursing and Midwifery Council, General Pharmaceutical Council, General Optical Council, Pharmaceutical Society of Northern Ireland, and Health and Care Professionals Council).

2.2 Study design

All study designs were considered for review. Studies with interventions involving standards, competencies continuing professional development or competency frameworks for non-medical or medical prescribers were included.

The review focused on studies from Europe, Canada, USA, Australia and New Zealand.

The target population was non-medical prescribers and prescribers.

Studies were excluded if competencies were for undergraduate students.

2.3 Results

The search strategy generated 1854 abstracts. Following refinement based on the inclusion and exclusion criteria and removal of duplicates, 18 research papers were selected for the final review.

A range of papers and studies were used; five of the papers were journal articles^7,8,9,17,19, three were surveys^11,18,25, two were systematic reviews^12,23, one was a review¹⁰, one was a cohort study¹⁶, one was a scoping review²², one was a consensus study¹³, one was an interprofessional analysis²⁴, one was a report²⁰, one was a dataset analysis¹⁵, and one was a documentary analysis¹⁴.

Four studies^22,23,24,25 looked at barriers to prescribing and potential gaps,

Seven^{7,8,9,10,11,12,13} studies looked at how the competency framework was used for professional development or where it applied the principles of the competency framework.

Seven^{14,15,16,17,18,19,20} studies looked at identifying gaps regarding prescribing which were not directly related to the competency framework.

This can support us in identifying the continual need for the competency framework and any potential areas of improvement or gaps relating to the use of the competency framework. These cover the secondary objective of the paper.

The grey literature covers the primary objective of the paper and looked to identify any new, updated or future competency frameworks (independent of the competency framework for all prescribers), prescribing safety standards and legislation. It also looked at updates to original resources used in the previous literature review conducted in October 2015⁶. It also identified where the competency framework for all prescribers was used in the development of new frameworks or models.

3. Discussion

3.1 Research studies

In relation to the use of the competency framework and its principles

One journal article⁷ looks at the need for the competency framework and its use by doctors. It concluded the competency framework is needed as it underpins safe and effective prescribing. It considers people with co-morbidities, complex polypharmacy, and keeping up to date with new and emerging medicines, including their pharmacokinetics, pharmacodynamics and monitoring requirements. The paper did not highlight any gaps in the competency framework, but it did highlight the need to explore how the competency framework could be embedded in medical practice. It identified potential uses of the competency framework in medical practice alongside existing tools and curricula (e.g. teaching undergraduates by mapping against the RCPharm curriculum in clinical pharmacology and prescribing for medical students, supporting foundation doctors alongside use of the prescribing safety assessment, or for continuing professional development alongside use of the generic professional capabilities for all doctors).

Another journal article⁸ shows how The Nursing and Midwifery Council (NMC) has adopted the competency framework as its prescribing standards for the nursing profession. However, it did not identify any gaps or provide any recommendations for the competency framework.

One journal article⁹ looks at the use of the competency framework by all prescribers in all settings. It mainly highlights educational, organisational and individual uses. For example, universities use the competency framework as a basis for their curricula for their prescribing programmes (independent and supplementary and for all prescribing professions), students are mainly required to use the competency framework to build a portfolio of evidence of how they meet the competencies of a safe and effective prescriber and to identify individual learning. Employing organisations have used the competency framework for governance processes, to define levels of prescribers, to support development and recruit new prescribers. Employers have also used the competency framework as a tool for employees to demonstrate continuous competence through audits, submission of evidence of competence and updates to personal formularies. Individual prescribers use it for many reasons, including identifying ongoing learning and development needs and submitting evidence of competence for employment or professional bodies to maintain registration. The paper then goes on to suggest how the competency framework can be used to support revalidation and continual professional development through self-reflection and provides examples of how to reflect. It identified that the update of the competency framework should include contributions from all prescribing professions and levels to make it evidence-based. It should also consider the publication of the RCPharm ‘A Designated Prescribing Practitioner Competency Framework’⁴ and include the important role of mentoring and supporting other prescribers on their prescribing journey. Also, the understanding that designated prescribing practitioners will need to demonstrate competence against both competency frameworks. Limitations include limited examples of use from those who contributed to the development of the competency framework. Further examples of use would be needed to see how all prescribing professions use it in practice.

A review¹⁰ of legislation, policy documents and information from professional and regulatory organisations, and education providers identified that pharmacist prescribers in New Zealand base their framework on earlier versions of the competency framework for all prescribers. They do not mention any gaps in the RCPharm competency framework. However, they do mention the need for consistency in educational programmes and prescribing competencies for all non-medical prescribers (NMPs) in New Zealand, as in the UK. Limitations of this paper include the location being limited to New Zealand only and the framework being used by pharmacist prescribers only.

This survey study¹¹ recognises that the competency framework considers identifying and reporting suspected adverse drug reactions (ADRs) to The Medicines and Healthcare products Regulatory Agency Yellow Card Scheme as good practice. Although it did not identify any gaps in the RCPharm competency framework, it did mention the need to reinforce identifying and reporting ADRs in practice by healthcare professionals. This could include medical devices. Our survey is of course a snapshot of NMPs and has inherent limitations. Limitations include a small sample size from certain cohorts and locations (being limited to the North West of England only) and, finally, a lack of data regarding yellow cards submitted by non-medical prescribers. Although this is a wider technical issue outside the control of this study, it does limit the impact of the findings. Finally, it would have been informative to have a measure of the volume of prescribing rather than just frequency. Such data would have enabled analysis of the association between prescribing volume and reported outcomes.

This systematic review¹² looked at whether McLellan et al.’s theory of expertise development model (“the model”) is applicable to independent prescribers. It mentions that assessing competencies, like designated medical practitioners (DMPs) do for NMPs using the competency framework, is an “insufficient measure of professional aptitude because it breaks a complex skill into individual exercises to be assessed”. The study suggests competencies should be combined with real-life work-based experience to become experts in their fields and not just competent. The study also mentions concerns about NMPs’ diagnostic, physical examination skills and pharmacological knowledge, as well as their development of expertise. It recommended NMPs keep up to date with evidence-based practice, continually self-reflect and develop, and adapt to uncertainty. Limitations include only looking at the development of pharmacist and nurse independent prescribers. However, it is important to understand that the competency framework describes the knowledge, skill, behaviour, activity or outcome that prescribers should demonstrate to be a safe and effective prescriber. It does not provide recommendations on how the prescriber should demonstrate, as it sits outside the scope of the competency framework. Also, the competency framework is not intended to be viewed as a curriculum but rather the basis on which one can be built.

This consensus study¹³ identified that the competency framework lacked detail on the patient assessment skills needed by pharmacist prescribers. However, limitations of this study included only focusing on pharmacist prescribers in Scotland and for a specialist area of systemic anti-cancer therapy. Further studies would need to cover other prescribing professions and their needs for patient assessment skills. The current competency framework does cover patient assessment; however, due to the generic nature, it would need to be contextualised. It does not contain statements that relate to specialist areas of prescribing as this is outside of its scope. Use of further or existing specialised guidance and frameworks regarding detail of patient assessment required for the prescribing setting alongside the competency framework should be encouraged.

Identifying gaps regarding prescribing (not directly related to the competency framework)

A documentary analysis (14) looked at what would make a model high-level prescriber in practice, irrespective of professional background. Limitations of the analysis were mainly the use of a small sample size. However, they identified four core requirements of a model prescriber being: knowledgeable, safe, good communicators and contemporary. The study identified gaps in the competency framework, including use of specific general practice guidelines, type of deprescribing, personal formulary use, and looking at medicines as groups rather than individually. Other gaps for consideration include prescribing safe quantities, determining a genuine need for a prescription, keeping the patient informed throughout treatment, building rapport and communication skills, and accountability for clinical decisions. Limitations of this study include a small sample size of relevant documents from outside the UK, and for dental practice, most of the documents were UK-based. However, it is important to remember the generic nature of the competency framework. It’s encouraged to use the competency framework alongside other available supporting resources to support how to implement the competency framework in practice, for example, for sector-specific guidelines, polypharmacy, de-prescribing and personal formulary.

Some studies looked at the best way of assessing prescribing competencies, and ways to demonstrate and maintain competencies to improve prescribing. Examples included developing a personal formulary¹⁵ or self-regulated learning-enhanced video feedback¹⁶ or the Prescribing Safety Assessment (PSA)¹⁷, practice-based assessment (SDEP)¹⁸, random case analysis, audit, and feedback of prescribing practice¹⁹. This journal article²⁰ identifies that many of the competencies in the competency framework also feature in the PSA. It suggests looking at future ways other prescribing professionals can use the PSA. However, how to achieve competencies would sit outside the scope of the competency framework. It could be useful to look at the various tools available in future guidance to use alongside the competency framework to improve prescribing practice (e.g. supervision, observation of practice, clinical assessment skills, portfolios, workplace competency-based assessments, questionnaires, case -based discussions, personal formularies, and patient and peer feedback).

Many of the papers that were excluded due to the exclusion criteria (i.e. those involving undergraduate medical students and medical school curricula) could be considered for further reviews. This recommendation is in line with the UK Chief Pharmaceutical Officers, General Pharmaceutical Council and Pharmaceutical Society NI reforms for pharmacist prescribers in the UK in July 2020, which propose pharmacists become prescribers at the end of their foundation year (which will replace the current pre-registration year)²¹. Future literature reviews will need to consider studies involving students and undergraduates, in line with the proposed changes. They would also need to consider other prescribing tools used by other professions, such as the prescribing safety assessment in future reviews.

Barriers to prescribing

Barriers to prescribing and ways to address them were a common theme in some of the papers identified in the search^22,23,24,25. Although not directly related to the competencies, the barriers identified may affect the uptake and use of the competency framework. Barriers identified include organisational and resourcing issues (workload, funding, reimbursement and employer or colleague support), and lack of prescriber competence, confidence, training (e.g. diagnostic knowledge and skills and clinical reasoning), and lack of awareness and understanding of the role by others. This journal article²² suggested developing policy pathways, targeted training, raising prescriber recognition and identifying funding and resourcing to address barriers. Other recommendations included better role integration and acceptance by patients and colleagues²⁵. None of the papers identified any gaps in the competency framework, although these would sit outside the scope of the competency framework. Limitations of some of these studies include small sample sizes and barriers encountered mainly by nurses and pharmacists, with one of the studies based in New Zealand. Further research would be required to identify if similar themes occur within other non-medical prescribing professionals, in different settings, and ways to overcome them.

3.2 Grey literature

The grey literature search helped identify new or updated competency frameworks, standards or legislation linked to non-medical and medical prescribing since the publication of the competency framework in 2016, which may impact the update of the competency framework.

Legislation

Amendments to the Human Medicines Regulations (2012) in 2018³ allowed paramedics to practise as independent and supplementary prescribers in the UK. This is a significant change that would need to be included in the review and update of the competency framework.

Standards and prescribing guidelines

Most of the content within the standards mentioned is already covered in the current competency framework. The following provides information on new or updated standards and prescribing guidelines and gaps identified for consideration in the update of the competency framework.

Since 1 September 2019, the Health and Care Professions Council (HCPC) has adopted the 2016 version of the competency framework as their ‘Standards for all prescribers’²⁶.

Since 28 January 2019, the Nursing and Midwifery Council (NMC) has adopted the 2016 version of the competency framework as their ‘Standards of competency for prescribing practice’²⁷, which replaced their 2006 ‘Standards of proficiency for nurse and midwife prescribers’²⁷. It also published ‘Standards for prescribing programmes’²⁷ on 17 May 2018, and ‘Standards framework for nursing and midwifery education’²⁷ and ‘Standards for student supervision and assessment’²⁷ on 28 January 2019. These refer to and relate to the new standards for prescribers. The NMC Code ‘Professional standards of practice and behaviour for nurses and midwives’²⁸ was also updated on 10 October 2018 to reflect new responsibilities for the regulation of nursing associates. The rest of the code remains unchanged from the previous 2015 version and the changes do not affect the competency framework.

In January 2019, the General Pharmaceutical Council (GPhC) published new ‘Standards for the education and training of pharmacist independent prescribers’⁵. The key themes in these standards are person-centred care, professionalism, professional knowledge and skills, and collaboration. Relevant topics related to prescribing to consider incorporating into the updated competency framework include: recognising the psychological and physical impact of prescribing decisions, legislation on equality and human rights, respecting diversity and cultural differences, consultation skills, understanding the role of others in multi-disciplinary teams, remote prescribing, handling and sharing confidential information, raising concerns on inappropriate or unsafe prescribing, scope of practice, working collaboratively, and safeguarding vulnerable people. In addition, GPhC also updated its ‘Standards for pharmacy professionals in May 2017’²⁹, which focuses more on professionalism, including person-centred care, working in partnership with others, communicating effectively, maintaining, developing and using professional knowledge and skills, exercising professional judgement, respecting and maintaining privacy and confidentiality, raising concerns, and leadership. These topics can all be considered when updating the competency framework.

The General Medical Council (GMC) has not updated its ‘Good practice in prescribing and managing medicines and devices’³⁰ since it was published on 25 February 2013. Neither has it updated its standards on ‘Outcomes for provisionally registered doctors with a licence to practise’³¹ since July 2015. However, standards for education, training and curricula such as ‘Promoting excellence’³¹ came into effect from 1 January 2016, and ‘Excellence by design’³¹ on 22 May 2017. They cover how undergraduate and postgraduate medical education should be delivered and mention prescribing.

In April 2018, the British Medical Association (BMA)³² published guidance on ‘Prescribing in general practice’. Relevant topics related to prescribing to consider incorporating into the updated competency framework include cost-saving exercises, prescribing appropriate quantities/intervals, medicines shortages, responsibility for reissuing repeats, prescribing incentive schemes, and prescribing aids. These can be considered when reviewing and updating the competency framework.

In April 2018, Royal College of General Practitioners (RCGP) published ‘Online consultations in general practice: the questions to ask’³³. It provides considerations on the risks of remote prescribing which may be considered within the update of the competency framework.

In April 2016, the General Optical Council (GOC) published ‘Standards of Practice for Optometrists and Dispensing Opticians’³⁴. Relevant topics related to prescribing to consider when reviewing the updated competency framework include communication skills, keeping knowledge and skills up to date, working within competency, working collaboratively, safeguarding, and using professional judgement. GOC also published ‘Standards for optical students’³⁴ in April 2016, which mention prescribing safely.

‘High level principles for good practice in remote consultations and prescribing’³⁵ was published on 8 November 2019 and co-authored by Academy of Medical Royal Colleges, Care Quality Commission. Faculty of Pain Medicine, General Dental Council, GMC, GOC, GPhC, Healthcare Improvement Scotland, Healthcare Inspectorate Wales, NMC, Pharmaceutical Society of Northern Ireland, RCPharm, Regulation and Quality Improvement Authority. This common set of principles sets out good practice expected of all healthcare professionals when providing consultations and prescribing medicines remotely. Remote prescribing and associated risks may need to be considered in the update of the new competency framework, including checking identity (of healthcare professionals and patients), identifying and protecting vulnerable patients, signposting appropriately, accessing medical records for verification of information, transfer of care, sharing information with others involved in the person’s care and keeping up to date with training.

Faculty of Sexual & Reproductive Healthcare (FSRH) and British Association for Sexual Health and HIV (BASHH) published ‘Standards for Online and Remote Providers of Sexual and Reproductive Health Services’³⁶ in January 2019: This standard refers prescribers to the current competency framework and highlights the risks associated with remote prescribing, which can also be considered during the review of the competency framework.

The following standards and prescribing guidelines have not been updated since their publication.

• Health Education England and Centre for Pharmacy Postgraduate Education ‘Consultation skills for pharmacy practice: practice standards for England for all pharmacy professionals’ (March 2014)³⁷.
• Pharmaceutical Society of Northern Ireland (PSNI) ‘Standards and Guidance for Pharmacist Prescribing’ (April 2013)³⁸ and ‘Professional standards of conduct, ethics and performance for pharmacists in Northern Ireland’ (March 2016)³⁷.

New or updated competency frameworks

Some frameworks mentioned in the previous literature review (conducted in October 2015)⁶ have not been updated since the 2016 publication, for example:

• The Australian National Prescribing Service Prescribing Competencies Framework (2012)³⁹.
• The French competency framework ‘Référentiel métiers et compétences des médecins généralistes’, developed by the National College of Teaching General Practitioners⁴⁰.
• The Canadian CanMEDS 2015 Physician Competency Framework by The Royal College of Physicians and Surgeons of Canada⁴¹.
• Using Data and Technology to Transform Outcomes for Patients and Citizens A Framework for Action 2014 by the National Information Board and Department of Health and Social Care⁴².
• Canadian competency frameworks for registered nurses 2015 by Canadian Nurses Association⁴³.

The following frameworks have been updated; topics for review are also mentioned:

• GMC and Academy of Medical Royal Colleges ‘Generic professional capabilities framework’³¹ aimed at those developing postgraduate curricula was updated in May 2017. Topics for consideration for the update of the competency framework include practical and clinical skills, communication and interpersonal skills, dealing with complexity and uncertainty, using medical devices safely, infection control and communicable disease, leadership, patient safety and quality improvement, safeguarding vulnerable groups, education and training.
• The Prescribing Safely Canada Physician Prescribing Competencies⁴⁴ were updated in May 2018. The topics here are already covered by the current competency framework.
• Allied Health Professional Federation Outline Curriculum Framework for Education Programmes (Prescribing)⁴⁵ was updated in 2018 to include paramedic prescribers.

Specialist competency frameworks

Various new and existing specialist competency frameworks exist for those in specialist roles, for example, advanced practice, mental health, rheumatology and leadership. A list of identified competency frameworks can be found in Appendix 1 for reference. The specialist frameworks available demonstrate that the generic scope of the competency framework is appropriate and should remain. Prescribers should continue to contextualise the framework to suit their setting and practice and use existing specialist frameworks in conjunction with the ‘Competency Framework for all Prescribers’ rather than seek to include the content from specialist areas and specialist framework within it. However, this would be difficult to achieve and would fit better as separate frameworks.

4. Limitations

A limited number of databases were used for the literature search, and therefore a limited number of research studies on the use of the competency framework were identified. 

Research on the use of the competency framework and new or revised competency frameworks linked to prescribing since 2016 identified was limited and predominantly aimed at the medical, nursing or pharmacist profession. Also, there may not be many research drivers for its use to be reported in different settings. 

Other studies identified regarding prescribing competency and gaps identified mainly fit into the exclusion criteria involving undergraduate medical students.

5. Conclusion

In conclusion, common areas of competency exist irrespective of the type of prescriber involved, and the current competency framework is still relevant and robust. This indicates the continual need for a generic framework for all prescribers, which can be used alongside any other standards, professional guidance and frameworks.

This review identified that competency frameworks in other countries have not been updated since the 2016 competency framework. A comparison of the Competency Framework for all Prescribers against the competency frameworks in other countries from Canada, Australia, New Zealand, France, Northern Ireland, and Great Britain reveals that common areas of competency exist irrespective of the type of prescriber involved and that the current competency framework is still relevant and robust.

Key publications and changes that would impact updates of the competency framework include the RCPharm Competency Framework for Designated Prescribing Practitioners in 2019 and the legislation changes, which have allowed advanced paramedics to prescribe medicines to patients since April 2018. The existence of specialist frameworks, such as for leadership and mental health, shows that a generic framework is still needed. These frameworks have a more advisory status. However, NMC and HCPC have adopted our current competency framework as their prescribing standards, and they have more of a regulatory role. During the development of the RCPharm Competency Framework for Designated Prescribing Practitioners, the steering group also felt the competency framework was still broadly fit for purpose and only minor changes were needed.

There were no conflicts identified other than barriers to prescribing, and ways of demonstrating and assessing competencies, which sit outside the scope of the competency framework.

The grey literature, which looked at updated and new prescribing standards, curricula and guidance in the UK by other healthcare regulators or professional organisations, identified potential gaps and current key topics in our current competency framework which may need to be addressed during review.

Topics for consideration include:

• Communication and consultation skills including identity checks.
• Dealing with complexity and uncertainty in prescribing.
• Drug switching (cost savings) and prescribing incentive schemes.
• Education and training.
• Equality and human rights legislation.
• Handling and sharing of confidential information.
• Infection control and communicable disease.
• Keeping knowledge and skills up to date.
• Leadership.
• Medicine shortages.
• Transfer of care.
• Responsibility and accountability for prescribing, for example, reissuing repeats and associated risks.
• Practical and clinical assessment skills.
• Access to medical records and using IT systems and prescribing decision support software appropriately.
• Signposting appropriately.
• Prescribing appropriate quantities and intervals.
• Psychological and physical impact of prescribing decisions.
• Raising concerns related to inappropriate or unsafe prescribing.
• Remote prescribing and associated risks.
• Respecting diversity and cultural differences.
• Safeguarding vulnerable groups.
• Taking responsibility for own learning and development, including self-reflecting and continual professional development.
• Using medical devices safely and reporting adverse events.
• Using professional judgement.
• Working collaboratively.
• Working within scope and competency.

6. References

6. References

1. National Prescribing Centre. A single competency framework for all prescribers. 2012. Available at:  https://www.webarchive.org.uk/wayback/archive/20140627111233/http:/www.npc.nhs.uk/ [Accessed 17 September 2026] (no longer available)
2. Royal College of Pharmacy. A Competency framework for all Prescribers. 2016 Available at: https://www.rcpharm.org/professional-standards/a-competency-framework-for-all-prescribers/ [Accessed 17 September 2026]
3. The Human Medicines (Amendment) Regulations 2018 (S.I. 2018/199. Available at: https://www.legislation.gov.uk/uksi/2018/199/contents/made  [Accessed 17 September 2026]
4. Royal College of Pharmacy. A Competency Framework for Designated Prescribing Practitioners. 2019 Available at: https://www.rcpharm.org/professional-standards/designated-prescribing-practitioner-competency-framework/ [Accessed 17 September 2026]
5. General Pharmaceutical (GPhC) Standards for the education and training of pharmacist independent prescribers. January 2019. Available at: https://www.pharmacyregulation.org/education/pharmacist-independent-prescriber. [Accessed 17 September 2026]
6. Literature review for A Competency Framework for all Prescribers [Internet]. Royal Pharmaceutical Society. 2015 (no longer available).
7. Picton C, Loughrey C, Webb A. The need for a prescribing competency framework to address the burden of complex polypharmacy among multiple long-term conditions. Clinical medicine (London, England) [Internet]. 2016 Oct [Accessed 17 September 2026];16(5):470–4. Available from: The need for a prescribing competency framework to address the burden of complex polypharmacy among multiple long-term conditions – ScienceDirect
8. Duncan D, Johnstone J. Prescriber ready – are you ready?. Nurse Prescribing [Internet]. 2018 [Accessed 1st November 2020];16(7):345-347. Available from: https://www.researchgate.net/publication/327201470_Prescriber_ready_-_are_you_ready
9. Hall K, Picton C. Analysing the Competency Framework for all Prescribers. Journal of Prescribing Practice [Internet]. 2020 [Accessed 17 September 2026];2(3):122-128. Available from: Analysing the Competency Framework for all Prescribers | Journal of Prescribing Practice
10. Raghunandan R, Tordoff J, Smith A. Non-medical prescribing in New Zealand: an overview of prescribing rights, service delivery models and training. Therapeutic advances in drug safety [Internet]. 2017 Nov [Accessed 17 September 2026];8(11):349–60. Available from: Examining non-medical prescribing trends in New Zealand: 2016–2020 | BMC Health Services Research | Springer Nature Link
11. Thompson A, Randall C, Howard J, Barker C, Bowden D, Mooney P, et al. Nonmedical prescriber experiences of training and competence to report adverse drug reactions in the UK. Journal of Clinical Pharmacy & Therapeutics [Internet]. 2019 Feb [Accessed 17 September 2026];44(1):78–83. Available from: Nonmedical prescriber experiences of training and competence to report adverse drug reactions in the UK – Thompson – 2019 – Journal of Clinical Pharmacy and Therapeutics – Wiley Online Library
12. Abuzour AS, Lewis PJ, Tully MP. Practice makes perfect: A systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom. Research in social & administrative pharmacy: RSAP [Internet]. 2018 Jan [Accessed 17 September 2026];14(1):6–17. Available from: Practice makes perfect: A systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom – ScienceDirect
13. Allison J, Fisher J, Souter C, Bennie M. What patient assessment skills are required by pharmacists prescribing systemic anti-cancer therapy? A consensus study. Journal of oncology pharmacy practice: official publication of the International Society of Oncology Pharmacy Practitioners [Internet]. 2019 Dec [Accessed 17 September 2026];25(8):1933–44. Available from: What patient assessment skills are required by pharmacists prescribing systemic anti-cancer therapy? A consensus study – Jennifer Allison, Julie Fisher, Caroline Souter, Marion Bennie, 2019
14. Omer U, Veysey M, Crampton P, Finn G. What makes a model prescriber? A documentary analysis. Medical teacher [Internet]. 2021 Feb [Accessed 17 September 2026];43(2):198–207. Available from: What makes a model prescriber? A documentary analysis: Medical Teacher: Vol 43 , No 2 – Get Access
15. Audi S, Burrage DR, Lonsdale DO, Pontefract S, Coleman JJ, Hitchings AW, et al. The “top 100” drugs and classes in England: an updated “starter formulary” for trainee prescribers. British journal of clinical pharmacology [Internet]. 2018 Nov [Accessed 17 September 2026];84(11):2562–71. Available from: The ‘top 100’ drugs and classes in England: an updated ‘starter formulary’ for trainee prescribers – PMC
16. Patel R, Green W, Shahzad MW, Church H, Sandars J. Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing. Medical Teacher [Internet]. 2020 Aug [Accessed 17 September 2026];42(8):886–95. Available from: Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing: Medical Teacher: Vol 42 , No 8 – Get Access
17. The Prescribing Safety Assessment. WHO Drug Information [Internet]. 2018 Jun [Accessed 17 September 2026];32(2):194–8. Available from: Medicines use: the prescribing safety assessment
18. Paterson RE, Redman SG, Unwin R, McElhinney E, Macphee M, Downer F. Non-medical prescribing assessment – An evaluation of a nationally agreed multi-method approach. Nurse education in practice [Internet]. 2016 Jan [Accessed 17 September 2026];16(1):280–6. Available from: Non-medical prescribing assessment – An evaluation of a nationally agreed multi method approach – ScienceDirect
19. Morgan S. Teaching rational prescribing to general practice registrars: A guide for supervisors. Australian family physician [Internet]. 2017 Mar [Accessed 17 September 2026];46(3):160–4. Available from: Teaching rational prescribing to general practice registrars: A guide for supervisors – PubMed
20. Maxwell SRJ, Coleman JJ, Bollington L, Taylor C, Webb DJ. Prescribing Safety Assessment 2016: Delivery of a national prescribing assessment to 7343 UK final-year medical students. British journal of clinical pharmacology [Internet]. 2017 Oct [Accessed 18 September 2026];83(10):2249–58. Available from: Prescribing Safety Assessment 2016: Delivery of a national prescribing assessment to 7343 UK final‐year medical students – PMC
21. Update: reforms to initial education and training of pharmacists | General Pharmaceutical Council [Internet]. Pharmacyregulation.org. 2021 . Available from: https://www.pharmacyregulation.org/news/update-reforms-initial-education-and-training-pharmacists [Accessed 17 September 2026]
22. Zhou M, Desborough J, Parkinson A, Douglas K, McDonald D, Boom K. Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences. International Journal of Pharmacy Practice [Internet]. 2019 Dec [Accessed 18 September 2026];27(6):479–89. Available from: Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences | International Journal of Pharmacy Practice | Oxford Academic
23. Graham-Clarke E, Rushton A, Noblet T, Marriott J. Facilitators and barriers to non-medical prescribing – A systematic review and thematic synthesis. PloS one [Internet]. 2018 Apr 30 [Accessed 18 September 2026];13(4):e0196471. Available from: Facilitators and barriers to non-medical prescribing – A systematic review and thematic synthesis – PubMed
24. Abuzour AS, Lewis PJ, Tully MP. Factors influencing secondary care pharmacist and nurse independent prescribers’ clinical reasoning: An interprofessional analysis. Journal of interprofessional care [Internet]. 2018 Mar [Accessed 18 September 2026];32(2):160–8. Available from: Factors influencing secondary care pharmacist and nurse independent prescribers’ clinical reasoning: An interprofessional analysis | Request PDF
25. Hindi AMK, Seston EM, Bell D, Steinke D, Willis S, Schafheutle EI. Independent prescribing in primary care: A survey of patients’, prescribers’ and colleagues’ perceptions and experiences. Health & social care in the community [Internet]. 2019 Jul [Accessed 18 September 2026];27(4):e459–70. Available from: (PDF) Independent prescribing in primary care:patients’, prescribers’ and colleagues’views
26. Standards for prescribing [Internet]. Health and Care Professions Council. 2019 [Accessed 17 September 2026]. Available from: https://www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing
27. Standards for prescribers [Internet]. The Nursing and Midwifery Council. 2019 [Accessed 17 September 2026]. Available from: https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/
28. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates [Internet]. The Nursing and Midwifery Council. 2018 [Accessed 17 September 2026]. Available from: https://www.nmc.org.uk/standards/code/
29. Standards for pharmacy professionals [Internet]. General Pharmaceutical Council. 2017 [Accessed 17 September 2026]. Available from: https://www.pharmacyregulation.org/standards/standards-for-pharmacy-professionals
30. Good practice in prescribing and managing medicines and devices [Internet]. General Medical Council. 2013 [Accessed 17 September 2026]. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices
31. Standards and outcomes [Internet]. General Medical Council. [Accessed 17 September 2026]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes
32. Prescribing in general practice [Internet]. British Medical Association. 2018 [Accessed 17 September 2026]. Available from: https://www.bma.org.uk/advice-and-support/gp-practices/prescribing/prescribing-in-general-practice
33. Online consultations in general practice: the questions to ask [Internet]. Royal College of General Practitioners. 2018 [Accessed 18 September 2026]. Available from: Online consultations in general practice: the questions to ask (pdf)
34. General Optical Council Standards [Internet]. General Optical Council [Accessed 18 September 2026]. Available from: Standards
35. High level principles for good practice in remote consultations and prescribing [Internet]. 2019 [Accessed 17 September 2026]. Available from: https://www.pharmacyregulation.org/news/principles-good-practice-issued-protect-patients-online-0
36. Standards for Online and Remote Providers of Sexual and Reproductive Health Services [Internet]. Faculty of Sexual & Reproductive Healthcare and British Association for Sexual Health and HIV. 2019. [Accessed 18 September 2026]. Available from: FSRH/BASHH Standards for Online and Remote Providers of SRH Services (Jan 2019) | CoSRH
37. Consultation skills for pharmacy practice: practice standards for England for all pharmacy professionals. [Internet]. Health Education England and Centre for Pharmacy Postgraduate Education. 2014. [Accessed 18 September 2026]. Available from: Pharmacy Consultation Skills: Practice Standards for England
38. Code of Ethics and Standards. [Internet]. Pharmaceutical Society NI.2016 [Accessed 18 September 2026]. Available from: https://www.psni.org.uk/psni/about/code-of-ethics-and-standards/
39. Prescribing Competencies Framework [Internet]. National Prescribing Service.2012 [Accessed 2 November 2020]. Available from: https://www.nps.org.au/prescribing-competencies-framework (no longer available)
40. Référentiel métiers et compétences des médecins généralistes. [Internet]. National College of Teaching General Practitioners. 2013 [Accessed 2 November 2020]. Available from: https://www.cnge.fr/les_productions_scientifiques/referentiels_metiers_et_competences/ (no longer available)
41. CanMEDS 2015 Physician Competency Framework [Internet]. The Royal College of Physicians and Surgeons of Canada. 2015 [Accessed 18 September 2026]. Available from: (PDF) CanMEDS 2015 Physician Competency Framework.
42. Using Data and Technology to Transform Outcomes for Patients and Citizens A Framework for Action [Internet]. National Information Board and Department of Health and Social Care 2020. 2014. [Accessed 17 September 2026]. Available from: https://www.gov.uk/government/publications/personalised-health-and-care-2020
43. Framework for Registered Nurse Prescribing in Canada [Internet]. Canadian Nurses Association. 2015 [Accessed 18 September 2026]. Available from: FRAMEWORK for the PRACTICE of REGISTERED NURSES in CANADA 2015 All Rights Reserved – DocsLib
44. Physician Prescribing Competencies [Internet] Prescribing Safely Canada. 2018. [Accessed 2 November 2020]. Available from https://rcportal.royalcollege.ca/mssites/prescribingsafely/EN/index.html (no longer available)
45. Outline Curriculum Framework for Education Programmes (Prescribing) [Internet]. Allied Health Professional Federation. 2018. Available from: http://www.ahpf.org.uk/AHP_Prescribing_Programme_Information.htm [Accessed 17 September 2026]

Appendix 1

Appendix 1

Some specialist competency frameworks include:

• Northern Ireland DHSSPSNI Advanced AHP Practice Framework – June 2019
• Royal Pharmaceutical Society Advanced Practice Framework – 2013
• Health Education England Musculoskeletal Core Capabilities Framework – 2019
• RCN A competency Framework for Rheumatology Nurses -March 2020
• NHS England Clinical leadership – a framework for action – February 2019
• HEE Prescribing Competency Implementation Guidance for Mental Health
• RCN National Curriculum and Competency Framework for Emergency Nursing (Level 1) – June 2017
• RCN National Curriculum and Competency Framework for Emergency Nursing (Level 2) – June 2017
• Faculty of Pain Medicine Guidance on Competencies for Paediatric Pain Medicine – March 2020