There are three areas which should be managed with a service involving independent prescribing;

• The quality of the service

• The standards of practice

• Performance.

The quality of service

This refers to the execution of the service from the perspective of the consumer and customer. For private services,consumer and customer will probably be the same person. For NHS services, the NHS is the customer and the person receiving it will be the consumer.

The quality of the service might be measured by simple customer or patient satisfaction surveys. Surveys might be single questions (Were you happy with the quality of the services you received today?). Alternatively, you might break down the service to identify specific areas such as appointment availability; ease of making an appointment; communication with the pharmacist; the quality of the consulting room; and overall satisfaction. Don’t overburden the consumer with too many questions as this, in itself, will detract from the quality of the service.

The service specification for an NHS service may require specific feedback as part of the contract. This will be useful information to use to manage the service and the performance of the independent prescriber.

Standards of practice

In a similar way to all services in the pharmacy, there will be standards for any service involving independent prescribing. The SOP should be followed when delivering the service. As the manager of a pharmacy, you need to be able to demonstrate compliance with the SOP and that you have a robust process for demonstrating it. While this is important to ensure quality and safety, it is also important action for protection against litigation. The process that is followed should be audited against the SOP regularly. This can be used to provide feedback to the IP.

There are also other areas that should be monitored and managed to deliver high standards of practice. This might include the maintenance of diagnostic and monitoring equipment used as part of the patient assessment process and ensuring that records of this are kept. Visual assessment of the consulting room, ensuring it is kept clean and ordered is a simple measure to maintain standards. The management of risks, such as the disposal of contaminated items, blood or urine samples and sharps, is another basic standard that can be visually assessed.

The quality of patient records and communications with doctors and other healthcare professionals, are an important part of almost all services. These can be reviewed to ensure that they meet expected standards and to provide feedback to the prescriber. However, this does present some ethical issues. Notes and communications will contain patient information which is confidential. The review of these by a registered healthcare professional, for the purpose of managing the quality of the service, would be seen as acceptable as they are bound by their ethical obligations for confidentiality. Review of these by a manager, who is not a registered healthcare professional, would not be acceptable. 

Performance

IPs can also be managed using the type of performance metrics that we might use for other services. This might include:

• Availability to deliver the service

• Time taken to complete the appointment

• Number of services completed

• Number of NHS services claimed. 

For NHS services it is important to reconcile the number of services completed with the number of services claimed. A failure to claim for the services provided will result in the double whammy of lost income and incurred costs or lost stock.