NON-MEDICAL PRESCRIBING APPLICATION GUIDANCE NOTES (V300 Independent/Supplementary prescribing) NURSE / MIDWIFE APPLICANT GUIDANCE Applicants must provide evidence that they meet the NMC’s criteria for eligibility to undertake a nurse independent/supplementary prescribing programme. The criteria are: You must be a registered nurse, midwife and/or specialist community public health nurse You must have at least three years’ experience as a practising nurse, midwife or specialist community public health nurse and be deemed competent by your employer to undertake the programme. Of these three years, the year immediately preceding application to the programme must have been in the clinical field in which you intend to prescribe, e.g mental health. Part-time workers must have practised for a sufficient period to be deemed competent by their employer You must provide evidence of your ability to study at the level you wish to study at. If you are applying for under-graduate degree (level 6) you will be required to present your original nursing diploma and if you are applying to undertake the programme at Master’s level (level 7), you are required to have either an under-graduate degree or be able to present evidence of recent degree level modular study. Contact the Professional Development Centre for further details. In addition, you will need to have written confirmation from: Your employer of their support for you to undertake the preparation programme. A designated medical practitioner who meets eligibility criteria for medical supervision of nonmedical prescribers and who has agreed to provide the required term of supervised practice. Your NMP trust lead (not applicable to nurses working outside of a healthcare trust) The university that a place can be offered to you, following successful interview and drugs calculation pre-assessment test completion. Responsibilities of Employer The NMC requires employers to undertake an appraisal of an applicant’s suitability to prescribe before the applicant applies for a place. Employers must also have the necessary clinical governance infrastructure in place including a Disclosure and Barring Service check to enable the registrant to prescribe once they are qualified to do so. 1 Where the applicant is not undertaking a module to prepare them in diagnosis and physical assessment alongside the independent/supplementary prescribing programme, then the employer is responsible for confirming that: The applicant has been assessed as competent to take a history, undertake a clinical assessment, and diagnose, before being put forward; There is clinical need within the applicant’s role to justify prescribing; The applicant has sufficient knowledge to apply prescribing principles taught on the programme of preparation to their own area and field of practice; The applicant must be able to demonstrate appropriate numeracy skills. Employers should not put applicants forward if they haven’t demonstrated the ability to diagnose in their area of speciality. It should be possible to identify whether an applicant has these skills through Continuing Professional Development (CPD) reviews within the work place setting. The University of Lincoln must be satisfied that any applicant to the programme of preparation has the ability to study at the appropriate level. In addition, the university must provide the designated medical practitioner (DMP) with a suitable competence framework to assess learning in practice and is responsible for ensuring that the DMP meets the eligibility criteria. The application form asks whether an applicant has applied and commenced a programme of preparation previously. Where this is the case, the reason for not completing must be stated along with the year it was undertaken and the institution. This will allow a decision to be made by the employer in collaboration with the university as to whether it is appropriate for them to re-apply. Prescribing for children and young people The NMC ‘Standards of proficiency for nurse and midwife prescribers’ were published in May 2006. This document states that: ‘Only nurses with relevant knowledge, competence, skills and experience in nursing children should prescribe for children. This is particularly important in primary care (e.g. out of hours, walk-in-clinics and general practice settings). Anyone prescribing for a child in these situations must be able to demonstrate competence to prescribe for children and refer to another prescriber when working outside their area of expertise or level of competence’ (NMC. 2006, page 7). ‘It is the responsibility of the employer to ensure that the registrant is able to apply the prescribing principles to their own area of practice’ (NMC.2006, page 6). All nurse/midwife independent/supplementary prescribing programmes must incorporate an additional learning outcome to ensure that on successful completion of the programme, they can take an appropriate history, undertake a clinical assessment and make an appropriate diagnosis, having considered the legal, cognitive, emotional and physical differences between children and adults. In addition the assessment must demonstrate the registrant’s ‘recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates, children and young people.’ (NMC. 2006, page 6). In keeping with the existing standards of proficiency for nurse/midwife prescribers the assessment should take place within the context of their work setting. 2 If there is any doubt about the ability of the applicant to demonstrate knowledge, skill and competence in the areas described above, further training in relevant aspects of the legal, cognitive, emotional and physical differences between children and adults and in taking an appropriate history, undertaking a clinical assessment and making an appropriate diagnosis for a child, should be undertaken prior to them completing a prescribing course. A medical practitioner who is experienced and competent in prescribing for children should confirm the demonstration of competence. If an applicant who is already a prescriber moves into a new role which requires them to prescribe for children for the first time, or after a break in practice, it would be considered good practice for them to have a period of preceptorship and they may require additional education and supervision in relation to assessment, diagnosis and prescribing for children (NMC Circular 22/2007). PHARMACIST APPLICANT GUIDANCE The GPhC requires that pharmacists applying to undertake an independent prescribing programme must: Be a registered pharmacist with the GPhC or the Pharmaceutical Council of Northern Ireland (PSNI); Have at least two years appropriate patient-orientated experience in a UK hospital, community or primary care setting following their pre-registration year. Applicants must have identified an area of clinical practice in which to develop their prescribing skills and have up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to their intended area of prescribing practice. They must also demonstrate how they reflect on their own performance and take responsibility for their own CPD. General Pharmaceutical Council [On-Line] Entry Requirements http://www.pharmacyregulation.org/education/pharmacist-independent-prescriber/entry-requirements [Accessed 28.06.13] ELIGIBILITY GUIDANCE FOR DESIGNATED MEDICAL PRACTITIONERS The curricula for preparing nurse and pharmacist prescribers include no less than 12 days of learning in practice. This period of learning in practice is to be directed by a DMP who will also be responsible for assessing whether the learning outcomes have been met and whether the registrant has provided sufficient evidence to demonstrate clinical competency in prescribing. The outcomes and competencies will be identified by the University of Lincoln. Eligibility criteria for becoming a DMP: The DMP must be a registered medical practitioner who: 3 Has normally had at least three years recent clinical experience for a group of patient/clients in the relevant field of practice; Is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post-graduate Training in General Practice Certificate or is a specialist registrar, clinical assistant or a consultant within a NHS Trust or other NHS employer; Has the support of the employing organisation or GP practice to act as the DMP who will provide supervision, support and opportunities to develop competence in prescribing practice; Has some experience or training in teaching and/or supervising in practice; Normally works with the registrant. If this is not possible (such as in nurse-led services or community pharmacy), arrangements can be agreed for another doctor to take on the role of the DMP, provided the above criteria are met and the learning in practice relates to the clinical area in which the registrant will ultimately be carrying out their prescribing role. Competencies for designated medical practitioners Before taking on the role of DMP the doctor, and the organisation, should consider the competencies needed to effectively undertake this role. The following broad, core competency areas for GP’s considering undertaking the role of DMP are as follows: the ability to create an environment for learning ; personal characteristics; teaching knowledge; teaching skills. What is a designated medical practitioner expected to do? The DMP has a crucial role in educating and assessing student Non-Medical Prescribers (NMPs). This involves: Establishing a learning contract with the registrant; Planning a learning programme which will provide the opportunity for the registrant to meet their learning objectives and gain competency in prescribing; Facilitating learning by encouraging critical thinking and reflection; Providing dedicated time and opportunities for the registrant to observe how the DMP conducts a consultation/interview with patient/clients and/or parents/carers and the development of a management plan; Allowing opportunities for the registrant to carry out consultations and suggest clinical management and prescribing options, which are then discussed with the DMP; Helping to ensure that the registrant integrates theory with practice; 4 Taking opportunities to allow in-depth discussion and analysis of clinical management using a random case analysis approach, when patient/client care and prescribing behaviour can be examined further; Assessing and verifying that, by the end of the course, the registrant is competent to assume the prescribing role. 5