Independent Prescribing Pharmacist (ADHD Service)

1. Check-in and Agenda Setting

• How are you feeling coming into this session (workload, wellbeing, capacity)?
• Any urgent prescribing or clinical governance issues to prioritise today?
• Follow-up from last session's action plan:

2. Prescribing Caseload Overview

• Current caseload size / mix (new titrations, stable maintenance, transitions from paediatric/shared care):
• Controlled drug (CD) prescribing volume since last session:
• Any private/independent prescribing activity to declare:
• Waiting list / access issues (titration delays, blood pressure/ECG capacity, pharmacy supply issues):

3. Case Discussion (repeat per case)

Patient identifier (initials/code only): __________ Age band: __________

Presentation and diagnostic basis (who diagnosed, using which tool/pathway — e.g., NICE NG87, QbTest, ASRS, Conners):

Prescribing decision under review:

☐ Initiation ☐ Titration ☐ Dose optimisation ☐ Switch (stimulant↔non-stimulant) ☐ Maintenance/repeat ☐ Deprescribing/discontinuation ☐ Shared care handback to GP

Clinical reasoning (why this medication/dose, licensing status, off-label use if applicable, alternatives considered):

Baseline and monitoring data (BP, HR, height/weight/BMI or growth centile, ECG/cardiology referral if indicated, sleep, appetite, mood, tics, family history of cardiac disease):

Comorbidities and interacting factors (autism, anxiety, depression, substance use, epilepsy, cardiac history, pregnancy/contraception, other medications and interactions):

Controlled drug governance (prescription validity, quantity/duration limits, FP10/private script requirements, safe custody advice given, diversion/misuse risk assessed):

☐ No concerns ☐ Concerns — details:

Risk assessment (misuse, diversion, driving/DVLA advice, occupational safety, safeguarding, overdose risk of prescribed quantity):

☐ None identified ☐ Present — details:

Shared care / communication (GP shared care agreement status, correspondence sent, other prescribers involved, care coordination):

What went well / what was challenging in this decision:

Reflective questions (What? So What? Now What? — or Gibbs' cycle):

• What was the clinical question and what did you decide?
• What evidence, guidance, or clinical reasoning underpinned the decision?
• What were you uncertain about, and how did you manage that uncertainty?
• Would a different prescriber reasonably have made the same decision?
• What will you do the same or differently next time?

Supervisor/DPP input and challenge:

Agreed action(s) for this case:

4. Functions of Supervision (Proctor's model, adapted for prescribing)

Normative (accountability, scope of practice, GPhC standards for prescribers, NMC/RPS competency framework, CD legislation, local formulary and shared care compliance, record-keeping standards):

Formative (learning needs — e.g., unlicensed/off-label prescribing rationale, complex titration, interpreting ECGs, cardiology referral thresholds, deprescribing, interface with paediatric services):

Restorative (emotional load of prescribing decisions, decision fatigue, pressure around access/waiting lists, impact of near misses):

5. Competency and Professional Development

Map to RPS Competency Framework for All Prescribers where relevant.

• CPD undertaken since last session:
• Revalidation/portfolio evidence generated by this session: ☐ Yes ☐ No
• Any scope-of-practice boundary reached (e.g., case requiring specialist psychiatry input, cardiology, paediatrics):

6. Governance, Incidents, and Escalation

• Prescribing errors, near misses, or discrepancies to discuss (dose, quantity, CD documentation):
• Yellow Card/MHRA reporting required this period: ☐ Yes ☐ No — details:
• Safeguarding concerns raised/actioned:
• Complaints or SI/incident review involvement:
• Items requiring escalation beyond this session (to whom, by when):

7. Wellbeing Check

• Current workload and prescribing volume manageable? ☐ Yes ☐ No — comment:
• Signs of stress, decision fatigue, or burnout:
• Support needed (peer support, DPP contact, workload adjustment, indemnity/insurance query):

8. Action Plan Summary

9. Session Sign-Off

Summary of key points:

Date and time of next session: __________________________

This record should be stored in line with local information governance policy, and is available for GPhC revalidation, appraisal, and annual prescribing competency review as required. Controlled drug prescribing discussed in this session should also be reflected in the organisation's CD governance/accountable officer processes where applicable.