Why non medical prescribing

Independent prescribing rights were extended in to include other groups of registered nurses [ 5 ]. Nurse independent supplementary prescribers NISPs are able to independently prescribe any medicine including controlled drugs and unlicensed medicines [ 6 ] and can also prescribe any medicine as a supplementary prescriber [ 1 ].

Pharmacists were given supplementary prescribing rights in and later legislative changes also enabled this group the same independent prescribing rights as nurses [ 7 ]. More recently optometrists, and allied health professionals AHPs i. There are approximately 33, community practitioner prescribers, 23, NISPs, pharmacist independent supplementary prescribers PISPs , and several hundred AHPs and optometrist, working across the UK, with prescribing capability [ 9 ].

The numbers are set to rise with the extension of prescribing rights to other non-medical healthcare professional groups [ 11 ]. Stakeholders are generally satisfied with NMP [ 12 — 15 ] and report that it increases the accessibility and flexibility of services [ 16 , 17 ]. A number of benefits for NMPs themselves have also been reported including greater autonomy and increased job satisfaction, more time with patients and the ability to provide a complete episode of care, increased self-confidence, and time savings [ 18 — 21 ].

There are however, wide variations in the numbers of prescribers both within and across organisations [ 22 ] and barriers to NMP have been reported including restrictions of local arrangements such as inability to access prescription pads , inability to computer generate prescriptions, lack of peer support, organisational and policy restrictions, and difficulties in fulfilling continuing professional development needs [ 23 ].

Inconsistencies in the clinical governance systems within which NMPs work have also been identified [ 15 ] and such inconsistencies can influence prescribing activity and its on-going use. The profile and prescribing practices of NISPs [ 23 ] and the prescribing activity of nurse and pharmacist independent prescribers [ 24 ] have been explored in two national surveys.

Additionally, a number of small studies have explored the impact and effectiveness of community practitioner prescribers [ 25 ]. Each SHA had the responsibility to manage the local NHS across large geographical areas that encompass numerous health care organisations including primary care trusts PCTs , acute trusts, mental health trusts and general practices.

The specific objectives were to identify:. The non-medical healthcare professionals qualified to prescribe medicines i. The mode of prescribing used by these healthcare professionals, the frequency with which they prescribe, and the different ways in which the prescribing qualification is used. SurveyMonkey—a tool for creating web surveys—was used to develop an on-line questionnaire see Additional file 1.

The questionnaire, informed by previous work undertaken by the researchers [ 15 , 23 , 26 ], was divided into 4 sections. Questions were mainly fixed choice with room for open ended comment. Section 1 collected general demographic information including job title, county in which the participant worked, employer, highest academic qualification, care setting and number of NMPs in the team. Section 3 comprised questions about prescribing practice.

Questions included the method of prescribing currently used and the number of items prescribed, the different ways in which the prescribing qualification was used i.

The final section focused on clinical governance. Participants were asked to indicate from a list of 11 statements their experience of the clinical governance systems in place within their organisation.

Participants were also asked whether or not they had received support from their NMP lead. As part of safety and clinical governance arrangements, the NMP lead is responsible for the maintenance of a current database containing the details of NMPs within their organisation.

Each of these leads were contacted by the researchers and asked if they would supply the email addresses of all NMPs listed on their database. Number of Trusts across the Strategic Health Authority who provided email contact list.

Forty leads, responsible for 44 trusts, responded. Although 38 were able to provide a current electronic database of NMPs, two were unable to do so. These two leads emailed the NMPs for whom they were responsible, and requested that they made contact with the researchers in order to participate in the survey.

An email containing an invitation letter, outlining the purpose of the study, and the link to the on-line questionnaire was sent to each NMP with an email address. Delivery receipts were requested.

One thousand five hundred and eighty five emails were acknowledged as delivered. Participants were sent three follow-up reminder emails. Data collection took place between November and February Ethical approval for the study was provided by the University of Surrey.

The study was deemed a service evaluation by Cambridgeshire 4 Research Ethics Committee. Descriptive statistics were used to describe the demographic nature of the sample. Analysis of variance ANOVA was used to explore whether the number of items prescribed differed according to individual demographic variables such as job title, employer, care setting, and time since qualifying as prescriber. General linear modelling GLM , a popular generalisation of the linear regression model [ 27 ], was also used to explore whether demographic variables i.

Chi-square was used to explore the difference between demographic variables and the level of support received before, during and after the prescribing programme.

Content analysis was used to analyse free text comments. The demographic data of the sample are presented in Table 1. Participants were from all six counties across the SHA, with Of those who reported their job title, Thirty six 4.

Degrees or higher degrees were held by Five hundred and ninety Five hundred and seventy eight A further 58 6. One hundred and thirty three This included 59 Using ANOVA it was evident that the number of items prescribed using independent prescribing was affected by the prescribing qualification.

The range of therapy areas for which participants prescribed are shown in Figure 3. Areas where the greatest number of NISPs prescribed were pain , Participants reported that they used the prescribing qualification in a variety of ways see Figure 4. The extent to which to safety and clinical governance systems are in place and job title. Table 3 provides a summary of the extent to which participants reported that safety and clinical governance systems were in place.

Only Using GLM it was evident that the extent to which safety and clinical governance systems were in place was significantly affected by job title, employer, and care setting, and prescribing qualification.

Significantly fewer clinical governance systems were reported by community nurses and those with the community practitioner qualification see Figure 7.

Support received from the non-medical prescribing lead on an individual basis. The level of support participants received from their NMP lead before, during and after the prescribing programme is shown in Figure 7.

This is the first study of NMP within one SHA which provides detailed information about the numbers and types of NMPs, their prescribing practice and clinical governance arrangements. It therefore provides an important overview of the development of NMP across a large geographical area of England. There are some limitations with the data set, in that email addresses of NMPs were not provided by NMP leads representing employees of six PCTs including community trusts and other provider services.

The high numbers of NISPs is unsurprising given the large nursing workforce in England, plus the fact that prescribing rights were granted to nurses first. Given the similar demographic profile of our sample to previous national evaluations of NMPs [ 23 , 24 ], we are confident that our findings present an accurate picture of this population. However, the proportion of community practitioner prescribers in our sample is lower than expected and is probably due to shortfalls in data provided by PCTs.

While there have been national surveys of NISPs and PIPs, there is a lack of similar data on community practitioners with which to compare. It should also be noted that the data is self-report data, and therefore information such as items prescribed per week, are likely to be an estimate. This reflects the organisation of the NHS in England and recent policy drives to provide care closer to home through services provided in the community [ 29 ].

Overall a third of NMPs worked in secondary care; which is similar to that reported previously [ 23 , 24 , 28 ]. This indicates that NMP is developing in line with policy intention that it would contribute to improving access and quality of care in a range of settings [ 1 ]. Overall, the level of education and experience that NMPs had was equivalent to previous surveys [ 23 , 24 , 28 ]. Importantly, those in our sample with more prior experience made greater use of the prescribing qualification and prescribed more frequently than those with lesser experience.

This highlights that experience helps to maximise use of the NMP role. Similarly, while most respondents had undertaken specialist education in their area of practice prior to undertaking prescribing, It has been found that nurses who acquire prior specialist knowledge are more likely to report that the prescribing course met their learning needs and prepared them to prescribe [ 30 , 31 ].

Patients have also been reported to have greater confidence in nurses who have more experience and specialist knowledge in their area of practice [ 32 , 33 ]. Skip to content. It is the Department's policy to extend prescribing responsibilities to a range of non-medical professions. The development of non-medical prescribing within the health service enables suitably trained healthcare professionals to enhance their roles and effectively use their skills and competencies to improve patient care in a range of settings involving:.

Currently nurses, pharmacists, optometrists, physiotherapists, chiropodists or podiatrists, radiographers and community practitioners may undertake further professional training to qualify as non-medical prescribers. Independent prescribers are responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing. Supplementary prescribers may prescribe any medicine including controlled drugs , within the framework of a patient-specific clinical management plan, which has been agreed with a doctor.

Nurses, pharmacists, physiotherapists, chiropodists or podiatrists, radiographers and optometrists may train and register as a supplementary prescriber. DoH: Proposals to introduce prescribing responsibilities for paramedics: stakeholder engagement. London: DoH. DoH: Allied health professions prescribing and medicines supply mechanisms scoping project report. British Journal of Community Nursing.

Article Google Scholar. Diabetic Medicine. British Journal of Dermatology. Palliative Medicine. Journal of Clinical Nursing. Courtenay M, Stenner K, Carey N: An exploration of the practices of nurse prescribers who care for people with diabetes: a case study. Journal of Nursing and Healthcare of Chronic Illness. Journal of Advanced Nursing. Stenner K, Courtenay M: Benefits of nurse prescribing for patients in pain: nurse's views.

Int J Pharm Pract. Diabetes Medicine. Journal of Psychiatric and Mental Health Nursing. Otway C: The development needs of nurse prescribers. Stenner K, Courtenay M: A qualitative study on the impact of legislation on the prescribing of controlled drugs by nurses. Nurse Prescribing. Nicholls J: Survey of organisational arrangements for non-medical prescribing - summary of results. Ritchie J, Spencer L: Qualitative data analysis for applied policy research.

Analysing qualitative data. Edited by: Bryman A. J Health Serv Res Policy. BJ Clin Pharm. Download references. We would like to thank all those who participated in this research. You can also search for this author in PubMed Google Scholar. Correspondence to Molly Courtenay. MC was responsible for the study conception and design.

NC performed the data collection and analysis. KS helped with the data analysis. All authors participated in the drafting of this manuscript and have approved the final manuscript. This article is published under license to BioMed Central Ltd.

Reprints and Permissions. Courtenay, M. Non medical prescribing leads views on their role and the implementation of non medical prescribing from a multi-organisational perspective. Download citation. Received : 14 December Accepted : 02 June Published : 02 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content.

Search all BMC articles Search. Download PDF. Abstract Background In the United Kingdom, non-medical prescribing NMP has been identified as one way to improve healthcare quality and efficiency.

Results The NMP lead role comprised of four main functions; communication, coordinating, clinical governance and support. Conclusions The significant contribution that NMP leads play in embedding NMP within organisations should be acknowledged by clearer national guidance for this role and its responsibilities.

Methods Design A qualitative design was selected, using semi-structured telephone interviews and framework analysis. Data collection A two-part interview schedule was developed based on previous work in the area [ 29 , 30 ] and comments from the project steering group.

Table 3 The extent to which NMP leads report safety and clinical governance systems are in place Full size table. Table 4 Barriers and Facilitators to non-medical prescribing Full size table. Discussion This study is the first to specifically explore the role of the NMP lead from a range of practice settings and consider the development of NMP from a multi-organisational perspective.

Conclusions The significant contribution that NMP leads play in embedding NMP within organisations should be acknowledged by clearer national guidance for the role, its responsibilities and workload. References 1. Article PubMed Google Scholar 5. DoH: Verbal Communication. London: DoH Google Scholar 9. Article Google Scholar Article PubMed Google Scholar Google Scholar View author publications. Additional information Competing interests The authors declare that they have no competing interests.

Authors' contributions MC was responsible for the study conception and design.