Knowledge vs competence: who signs off medication competency in your care service?

There’s a quiet assumption in a lot of adult social care services that’s worth challenging. A member of staff attends medicines training, passes a test and receives a certificate, so they must be competent to give medicines.

It’s an understandable assumption, but it isn’t right. When it surfaces during an inspection, or after a medication error, it can leave a registered manager exposed.

Three different things

In my experience, services often blur three separate stages:

The first two are often bought in from a training provider. The third can draw on outside help, and NICE even suggests providers consider an accredited learning provider so staff can be assessed by an external assessor. But the responsibility for confirming competence, and for deciding who may give medicines in your service, stays with you.

What the guidance says

NICE’s guideline on managing medicines in care homes (SC1) states that providers must make sure designated staff give medicines only when they have had the necessary training and are assessed as competent. Staff who don’t have the skills to give medicines, even after completing the training, must not be allowed to. SC1 also recommends an annual review of each staff member’s knowledge, skills and competencies, and more frequent review after a medicines-related safety incident.

For medicines support in people’s own homes, NICE guideline NG67 asks providers to make sure care workers are assessed as competent to give the medicines support asked of them, including assessment through direct observation, with an annual review.

CQC’s Regulation 12 (safe care and treatment) sets the same expectation: providers must make sure staff have the qualifications, competence, skills and experience to keep people safe.

Competence depends on context. A trainer can explain what good looks like. Whether someone is safe on your Tuesday morning medicines round is a judgement for the people who run that round.

A care worker might score highly on a knowledge test and still struggle with your eMAR system, your monitored dosage packaging, a resident who needs medicines given covertly, or the interruptions of a busy lunchtime round. Only someone who can see them in that setting can judge that.

What a provider’s competency process should include

When I review services, the strongest competency arrangements have a few things in common:

Where training and knowledge checks fit

None of this makes training less important. Competence can’t be built on shaky knowledge, and a good knowledge assessment shows a manager exactly where someone’s understanding is weak before they are observed. That makes it a useful filter and a useful piece of evidence.

It’s evidence of understanding, though. Present it to an inspector as evidence of competence and you invite an obvious question: “And how did you confirm they can do it safely here?”

We’ve designed our own Medication Knowledge & Understanding Assessment around exactly this distinction. It’s an individual check of understanding after training, completed online through a personal link with an 80% pass mark. Practical workplace competency assessment and sign-off stay with the care provider.

A simple test for your service

If you want to know whether your service has this right, ask yourself three questions:

1. For any member of staff giving medicines today, could you show an inspector when they were last assessed as competent, and by whom?
2. Does your process say what happens after a medication error, including reassessment?
3. Would your staff describe their training certificate as “permission to give medicines”? If so, that’s the culture worth changing.

Training providers, myself included, should be clear about where our role ends. And providers can be confident that the final and most important judgement belongs to them: is this person safe to give medicines to the people we support?