Nurse prescribers < Influencers contents | Print this page Nurse prescribers For over 50 years, UK pharma companies have directed most of their marketing efforts at the prescribing physician. There are around 20,000 nurse prescribers at the moment, but this is against the old Nurse Prescribers’ Formulary (NPF). For some companies the Nurse Prescribers’ Extended Formulary (NPEF) is very relevant, as it means their products (prescription only medicines (POM) and pharmacy medicines (P)) are now available to be prescribed by independent nurse prescribers. With growing numbers of independent nurse prescribers and more dependent (or supplementary) nurse and pharmacist prescribers to swell the ranks of non-medic prescribers, it may be necessary for NHS influencers (working with head office staff) to include these new customers in their local business planning activities. NHS influencers may wish to explore in more detail what local initiatives are in place and who the key stakeholders/influencers are. NHS influencers should be aware that there is essentially no formulary in supplementary (dependent) prescribing by nurses and pharmacists and that the key will be the clinical management plan agreed with the independent prescriber. Asthma, diabetes, high blood pressure, mental illness and arthritis have all been cited as suitable conditions for supplementary prescribing. See the DH’s supplementary prescribing section for more details. In late 2002, the DH announced full details on supplementary prescribing by nurses and pharmacists, following patient diagnosis by a doctor. New courses for nurse prescribing began in the middle of 2003 and training for pharmacists began in early 2004. The aim was to have 1,000 pharmacists trained by the end of 2004 (including 100 community pharmacists) in addition to 10,000 nurses — however these figures are now likely to be hugely over optimistic. Further guidance continues to be issued on the implementation of supplementary prescribing by nurses and pharmacists in England. The DH supplementary prescribing website has draft templates for clinical management plans (CMPs) and a useful set of PowerPoint slides covering the general background. CMPs are important, as they will be the foundation stone of supplementary prescribing. Before such prescribing can take place, there will have to be an agreed CMP in place related to a named patient. The CMP will either make reference to a specific medicine or class of medicine as well as the circumstances in which the supplementary prescriber can vary the dosage, frequency and formulation of the specific medicines. But some nurse leaders remain disappointed by the scheme. ‘What’s new?’, they say, after all nurses have been regularly prescribing for some time by going through the ‘charade’ of getting a doctor to sign a prescription with little input into the decision about what the patient should receive. If supplementary prescribing is just formalising this then little progress is being made. And the DH’s plans do not go far enough. Nurses should have access to all drugs and the formulary for independent nurse prescribing must be extended, says the Royal College of Nursing. Supplementary prescribing could be expected to reduce the significant number of prescribing mistakes made by hospital doctors, according to Anthea Clegg, chair of the Association for Nurse Prescribing. ‘With supplementary prescribing, two practitioners debate and discuss what is best for the patient, so it would be a good way of reducing errors’, she has suggested. NHS influencers might like to know that the DH gives further information on the training of nurse prescribers, and further clarification on who is eligible. The notes also highlight those nurses (nurse consultants, nurse practitioners, clinical specialist nurses) who should have priority and why. There appears to be a growing interest within the industry on patient group directions (PGDs). NHS influencers should note that a flow chart ‘To PGD or not to PGD?’ has been published. See also www.groupprotocols.org.uk. Note the guide emphasises that 'the majority of clinical care should still be provided on an individual, patient-specific basis.' Also note that the Medicines and Healthcare Products Regulatory Agency (MHRA) has consulted on extending patient group directions to allied health professionals such as dieticians and occupational therapists — see www.mhra.gov.uk. PGDs appear to be evolving and it seems that they are rapidly moving away from the original idea of written directions relating to the supply and administration of named medicines to their supply and/or administration. The Nursing Times often features articles on nurse prescribing and for NHS influencers particularly interested in this area, this may be yet another essential read. Articles have included ‘Assessing the data’ — which is about prescribing competencies and finding evidence-based material from independent sources. Reference is made to material from pharmaceutical representatives. ‘Research has shown that nurses have used other, potentially less reliable, sources of information, in particular that from pharmaceutical representatives, although they did not seem to be aware of the potential bias in such materials… Nurse prescribers should always be aware that a drug company’s aim is to promote its products. Moreover the company may have funded its clinical trials.’ The article also talks about the need for critical appraisal of any trial results and the need to network with pharmacists. Other articles have discussed the practice nurse’s influence on GPs’ prescribing, that these nurses continue to be increasingly involved in influencing doctor’s prescribing decisions and included suggestions that these practice nurses should be included within the new nursing prescribing proposals in areas like asthma, diabetes and family planning. Clearly there is an awful lot happening around nurse prescribing and a lot more developments to take place through 2005/06. Companies need to be clear on what their non-medical prescriber strategy is.
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