NHS trusts (hospitals) — nurse prescribers < Influencers contents | Print this page Increasing nursing prescribing levels Supplementary prescribing for nurses started in mid-2003 and pharmacists began a similar scheme at the beginning of 2004. The introduction of supplementary prescribing by nurses and pharmacists may drastically alter the pattern of care provision for many patients with long-term health conditions. NHS chief executives have been asked to ensure that action is taken forward within their acute trust/PCT as quickly as possible. The DoHhas also re-posted their guide for the implementation of supplementary prescribing. Extended formulary nurse prescribers DoH press release 2003/0179 pointed out that some 50 universities across the UK are running prescribing courses. But it seems likely that the government will not get anywhere near its target of 10,000 new nurse prescribers by 2004 (against the Nurse Prescribers’ Extended Formulary (NPEF)). A major obstacle for practice nurses has been getting time off work to attend lectures because GPs cannot spare them the costs of courses. As the NPEF begins to grow, have a look at the Department’s notes on primary care prescribing and budget setting (2003-06) which specifically adds independent nurse prescribers into the mix. See Primary care prescribing and budget-setting. Prescriptions issued by practice and community nurses have risen sharply in recent years from just over a million in 2000 to 2.5m in 2002. Nurse and pharmacist prescribing are likely to be amongst the top five NHS issues for pharmacos in 2004/5 and pharmacists, like nurses, need a new strategy from companies — from the sales force through NHS influencers and right through to marketing. The developments here clearly illustrate that change in this particular area is accelerating. NHS influencers need to be prepared. As companies continue to formulate their strategies, there is probably a lot they could do to help out. NHS influencers should note that there has been some criticism of the acceleration in extended nurse prescribing. Professor Alan Maynard from York University, a leading health economist, has said, ‘The rapid expansion of nurse prescribing is a social experiment that may seriously damage both the health of patients and the profits of the industry.’ Extending independent nurse prescribing within the NHS in England — a guide for implementation is the sister document to supplementary prescribing. This 80-page document has everything that NHS folk need to know about the area. Note that nurses are reminded that they must make their choice of medicinal product on the basis of clinical suitability and value for money alone and that personal gifts are prohibited apart from pens and pads. Both NPC competency frameworks for prescribing nurses and pharmacists have material around outside 'influences and influencers'. Also the NHS is reminded that in nominating for training any nurses whose posts are directly or indirectly funded by pharmaceutical and other companies whose products appear in the ENPF, 'necessary steps must be taken to ameliorate any conflicts of interest'. The chief nursing officer’s newsletter for January 2004 had a useful supplement on nurse prescribing. It said that more than 1,800 nurses were now qualified and registered to prescribe independently from the Nurse Prescribers’ Extended Formulary and of these many were trained as supplementary prescribers. The bulletin reviewed both kinds of prescribing — saying that the use of PGDs is not a form of prescribing — and that an additional 30 medicines will be added to the ENPF, including inhalers for acute asthma attacks and oral and implant contraceptives. There is also discussion on the funding of the initiative and the training undergone and linkage to the Medicines Partnership programme as well as various case studies and the use of PGDs at the 65 NHS walk-in centres. The CNO bulletin itself talks about nurse-led services, emergency nurse practitioners and the role of nurses in new GMS and PMS. See Prescribing: a supplement of the CNO bulletin on nurse prescribing The government has also been considering proposals to allow nurses working in settings where people need urgent treatment to prescribe oxygen, IV fluids, pain relief and antihypertensives. The DoH asked nurses working in critical care, A&E and ‘first contact roles’ in primary care to draw up a list of medications that they would like to administer without needing a doctor’s prescription under PGDs. There will also be further development of national templates for PGDs for treatments. Note the DoH page on independent nurse prescribing, which includes an update on central funds for training. Further
information >
Extending
the formulary The Home Office has considered proposals for independent nurse prescribers to be able to prescribe schedule two and three drugs — diamorphine, methodone, buprenorphine, etc — used particularly to treat heroin addiction as well as allowing nurses to supply controlled drugs under patient group directions. This would enable nurses in A&E and coronary care to supply diamorphine for cardiac pain and all nurses to supply benzodiazepines and OTC drugs containing low-dose opiates. As already mentioned, plans have also been announced to extend the scope of nurse prescribing to both the emergency treatment of asthma and diabetes; pain relief in midwifery practice and coronary care; the treatment of chlamydia, implantable contraceptives and the relief of symptoms of menopause. See Items prescribable by nurses through the Nurse Prescribers’ Extended Formulary. Finally, nurses
and pharmacists are set to learn prescribing skills side-by side
on a new course on supplementary prescribing being developed by
St Bart’s School of Nursing at City University and the School
of Pharmacy at the University of London.
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