Prescribing Rights Nonmedical Qualified Practitioners

1
Prescribing Rights Non-medical Qualified
Practitioners

• Robert Hallworth, BSc., MRPharmS, ILTM
• Specialist Pharmaceutical Adviser Stockport
  Primary Care Trust

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Aim of session

• To provide an overview of developments in
  extended prescribing by non-medical healthcare
  professionals

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What are the currently available prescribing
mechanisms?
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Prescribing Mechanisms

• Patient Specific Directions
• Patient Group Directions
• Exemptions under Medicines legislation
• Extended Formulary Nurse Prescribing
• Supplementary Prescribing (nurses and pharmacists)

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Patient Group Directions (PGD)
Definition A written instruction for the
sale,supply and/or administration of named
medicines in an identified clinical situation. It
applies to groups of patients who may not be
individually identified before presenting for
treatment
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Who can supply medicines on a Patient Group
Direction?
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Patient Group Directions

• Nurses
• Midwives
• Health Visitors
• Paramedics
• Optometrists
• Chiropodists
• Radiographers
• Orthoptists
• Physiotherapists
• Pharmacists

• Dietitians
• Occupational Therapists
• Prosthetists
• Speech Therapists

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Patient Group Directions

• To PGD or not to PGD? that is the question
• www.npc.co.uk/npc_pubs.htm

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Independent Prescribing by Nurses

• District Nurses and Health Visitors - limited
  formulary, over 25,000 nurses (V100)
• Nurse Prescribers Formulary for District Nurses
  and Health Visitors
• Mainly appliances, dressings and a few medicines
• Extended Formulary Nurse Prescribers (V200)

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Nurse Prescribers Extended Formulary

• Currently four broad areas (80 conditions)
• Minor illness
• Minor injury
• Health promotion
• Palliative care
• Potential new category emergency care and first
  contact care
• Nurse Prescribers Extended Formulary
• All pharmacy and GSL medicines for these
  conditions
• 180 POMs / more POMs to be added

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Ability to Influence Decisions

• Consultation on the formulary currently led by
  the Department of Health
• Input from working groups, professional
  organisations
• Committee meets every 6 months

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What is Supplementary Prescribing?
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Definition
Supplementary Prescribing A voluntary
prescribing partnership between the independent
prescriber and a supplementary prescriber, to
implement an agreed patient-specific clinical
management plan with the patients agreement.
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Aim of Supplementary Prescribing

• To maximise benefit to patients and the NHS,
  through increased flexible use of workforce skills

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Supplementary Prescribing
Introduced through POM Order amendment and NHS
regulations in April 2003
Nurses (V300) and pharmacists
Will assist continuing care, rather than one-off
episode of care e.g. asthma, diabetes, other
chronic disease, mental health
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Criteria

• Independent prescriber must be a doctor makes
  diagnosis and reviews patient at pre-determined
  intervals
• Independent prescriber can at any time review the
  patients condition or resume full responsibility
  for the patients care
• Supplementary prescriber must be a Registered
  Nurse, Registered Midwife or Registered
  Pharmacist
• Written Clinical Management Plan specific to a
  named patient and the patients condition
• Good communication between the independent and
  supplementary prescriber
• Both prescribers need access to a common patient
  record

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Medicines

• Not proposed to restrict range of medicines,
  except
• Controlled Drugs (6 CDs available for palliative
  care for independent prescribers)
• Unlicensed medicines, with the exception of
  paediatric care

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Clinical Management Plan - Templates

• Patient specific
• State condition to be treated
• Start and review date
• Name of independent prescriber
• Name of supplementary prescriber
• Refer to the class or description of medicines to
  be prescribed

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Training and Preparation

• Taught element
• 26 days with some flexibility of delivery and
  APEL
• Practice-based
• 12 days (24 half days)
• Mentored by prescriber (DMP)
• (Face-to-face contact, but provision now also for
  some open and distance learning some e-learning
  now being developed)

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Funding for Training

• Course fees will be funded by DH and paid
  directly to education providers by Strategic
  Health Authority (SHA)
• There is no funding available for replacement
  costs needs to be covered by the organisation
• Also no funding for mentors may need other
  incentives
• Small amount of funding to SHA for provision of
  advice and support project management
• Agreed until 2006

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Selection District Nurses and Health Visitors

• Initially district nurses and health visitors
  higher grades
• Treatment room nurses as a result of starter
  pack initiative

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Selection Nurse Practitioners

• Allied to PMS bid
• Criteria diploma or degree / 3 years
  post-registration
• Meeting with practice
• What is a nurse practitioner? / Role and
  commitment / Mentoring

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Supplementary Prescribing
Supplementary Prescribing is to be extended to
some AHPs
Physiotherapists Podiatrists Radiographers
and Optometrists
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Current Position

• Nurses in training since January 2003
• 1300 nurse supplementary prescribers qualified
  already
• Pharmacists in training from September 2003
  first cohort qualified March 2004

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Research

• Department of Health has already commissioned
  evaluation of the extended / independent nurse
  prescribing
• Further research to follow when there are
  sufficient qualified supplementary prescribers

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Conclusions

• Mechanisms that will assist emergency care and
  one-off episodes of care
• PGDs for supply and administration of medicines
• Exemptions for sale and supply, under the
  Medicines Act
• Nurse Prescribers Extended Formulary
• Continuing care and chronic disease
  Supplementary prescribing