Non-Medical Prescribing:
A Brief Introduction
June 2013
Paul Warburton
Senior Lecturer & NMP Coordinator
Edge Hill University
Ormskirk
Non-Medical Prescribing
The purpose of NMP
Who is eligible
Numbers
Benefits
Examples
Opportunities for commissioners & the NHS
Q’s
Medicines Act 1968
•
Controls the production and supply of medicinal products
•
Main purpose is to protect the public from harm i.e. to ensure as far as possible
that medicinal products are safe and efficacious
•
Identified practitioners that have the authority to prescribe – at that time Doctor,
Dentist, Vet; amended to enable NMPs to prescribe
•
Categorises medicinal products



General sales list
Pharmacy medicines
Prescription only medicines
GSL
P
POM
Eligible Non-Medical Prescribing Professions
Experienced*;
Nurses, Pharmacists and Allied Health Professionals (Physio’, Radiographers, podiatrists and
optometrists) are eligible to enter a programme of study.
Programme consists of 26 days learning plus 12 days in practice.
Universities approved by Professional Regulators to prepare Nurses (Nursing and
Midwifery Council (NMC)), Pharmacists (General Pharmaceutical Council (GPhC)) and Allied
Health Professionals (Health and Care Professions Council (HCPC))
Successful completion enables recording of qualification with professional
regulator
•Pharmacists a minimum of 2 years post registration experience,
Nurses & AHPs a minimum of 3 years
The year preceding the course working in the areas they intend to prescribe
Assessment Strategy

1hr examination – multiple choice and short answer question- based upon drug actions,
interactions and applied information and data.
Pass mark 80%

30 min examination - 4 Drug Calculations
Pass mark 100%

15 min Objective Structured Clinical Examination - including writing a Prescription
Pass Mark 80%

3000 word prescribing case study
Pass mark 40%

A reflective Portfolio
Pass/ Fail

Practice based assessment – (Competencies)
Pass/ Fail
Students must successfully pass all components in order to achieve the 45 credits at Level 6 and
the recordable qualification.
The Aims of Non-Medical Prescribing
To:
•
•
•
•
Make more effective use of the skills and expertise of groups of professions
Improve patients’ access to treatment and advice
Improve patient choice and convenience
Contribute to more flexible team working across the NHS
”Extending Prescribing responsibilities is an important part of our commitment to
modernise the NHS. By expanding traditional prescribing roles, patients can more easily
access the medicines they need from an increased number of highly trained
professionals”
Patricia Hewitt
Secretary of State for Health, November 2005
Change: The only constant in the NHS
Drivers of Change
Numbers of registered NMPs – April 2012*
April 12
Numbers of registered non-medical prescribers
Community Practitioner Nurse Prescribers
25,958
Nurse Independent/Supplementary Prescribers
20,615
Pharmacist Independent/Supplementary Prescribers
1,598
Pharmacist Supplementary Prescribers
333
Optometrist Independent Prescribers
119
Physiotherapist Supplementary Prescribers
222
Podiatrist Supplementary Prescribers
152
Radiographer Supplementary Prescribers
31
Total
49,028
Source:
Department of Health, 2012
Number of items prescribed by non-medical prescribers
in primary care in England
In England, 2011 > 1.3 million items prescribed on FP10 per month
Source:
NHS Information Centre, 2012*
Number of items prescribed by NMP type
Jan - Mar 12
Oct - Dec 11
July - Sept 11
Apr - Jun 11
Jan - Mar 11
Oct - Dec 10
July - Sept 10
Apr - Jun 10
Jan - Mar 10
Oct - Dec 09
July - Sept 09
Apr - June 09
Jan - Mar 09
Oct - Dec 08
July - Sept 08
Apr - June 08
0
500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 4,000,000 4,500,000 5,000,000
Number of items prescribed
Community Practitioner Nurse Prescriber
Nurse Independent Prescriber
Pharmacists
Physiotherapists
Chiropodists/ Podiatrists
Practice unidentified supplementary
PCT unidentified supplementary
Source:
NHS Information Centre, 2012*
Non-medical prescribing by therapeutic area (2005-11)
2500000
2000000
1500000
1000000
500000
0
2005 / 2006
2006 / 2007
Appliances
Central Nervous System
Endocrine System
Infections
Respiratory System
Others
Source:
NHSBSA, 2012
2007 / 2008
2008 / 2009
2009 / 2010
2010 / 2011
Cardiovascular System
Dressings
Gastro-Intestinal System
Obstetrics,Gynae+Urinary Tract Disorders
Skin
Methods of Prescribing
Independent prescribing – Nurses (V300), Pharmacists
Prescribing by a practitioner, who is responsible and accountable for the
assessment of patients with undiagnosed or diagnosed conditions and for
decisions about the clinical management required, including prescribing.
(DH 2006)
Supplementary Prescribing – AHPs, Nurses (V300), Pharmacists
A voluntary partnership between an independent prescriber* and a
supplementary prescriber, to implement an agreed patient-specific Clinical
Management Plan with the patient’s agreement
*For the purposes of supplementary prescribing, the
independent prescriber is a doctor
Limits on Independent Prescribing?
Patient safety remains paramount
• Role and scope of prescribing agreed by employer
• Limits on prescribing role:
Legislation eg. CFNP very limited formulary,
Competence
Individual Formulary/ Trust Formulary
Trust Policy
• Even though they have the legal right to do so, no NMP will prescribe from the whole of
the BNF;
Individual professionals will only prescribe from a limited range of medicines within
their formulary, competence and area of clinical expertise
• Prescribers are accountable for their actions!
Examples of service delivery and redesign
• Allied Health Professional led services:
– Intensive care outreach, musculoskeletal review clinic, community children’s outreach,
podiatry services, consultant physiotherapist pain clinic, respiratory care……
• Pharmacist led Services:
– Care home medication review, medication review, mental health services, community
cardiovascular clinics, smoking cessation, post traumatic stress services, ward
prescribing, discharge ….
• Nurse led:
– Diabetes, heart failure, rheumatology, Hepatitis, drugs & alcohol, acute & community
mental health crisis, TB, scope clinics, walk-in centres, community matrons, ITU
outreach, community children’s services, tissue viability, DVT services, intermediate
care, palliative care, homeless outreach, acute pain services, parkinson’s disease, night
nurse practitioner …….
QIPP
Quality
Improvement
Productivity
Prevention
NMP enables many positive outcomes;
– Adherence to medications
– Service redesign
– Waste reduction
• NMPs able to complete episodes of care
• Reduced need for medic
– Improved outcomes
• Timely, appropriate intervention
– Patient satisfaction
• Improved access to appropriate
healthcare
- Cost effective
– Effective use of a highly skilled workforce
• Improved staff satisfaction
– Improved quality of care
NHS NW NMP Clinicians Audit
2012: > 19,000 Clinical interventions logged
Prevention of… events;
Health organisations are
continuously looking to
improve the experience and
quality of services offered
through innovative
approaches. Non-Medical
Prescribing enables
organisations to deliver
these approaches in addition
to required productivity
gains and wider public health
agenda.
http://www.prescribingforsuccess.co.uk/document_uploads/nmp-staff-stories/NMP_NHS_Staff_Stories.pdf
?!
Summary
NMP: An essential skill of the nurse, pharmacist and AHP of the future
Non-Medical Prescribers: Experienced, well qualified, senior, autonomous…..
•
Enable the completion of episodes of care by appropriate clinicians
•
Improve access to appropriate medications
•
Promote adherence to medications and patient safety
•
Enable service redesign and improvement
•
Promote efficient, effective and cost-effective health care
•
Enhance patient care and outcomes
‘excellence will save you money and excellence can always be found in the most highly
developed workforce.’ Non-medical prescribers can deliver excellence.
(Lilley 2012)
Questions?
"If I know the answer I'll tell you the answer, and if I don't, I'll just respond, cleverly.”
Rumsfeld D (2006)
Paul Warburton
Senior Lecturer & NMP Coordinator
Edge Hill University
Ormskirk
warburtp@edgehill.ac.uk
01695 657060
•
But think about this. Only nurses can do what only nurses can do. They can also do
what an HCA can do. And, they can also do a lot of what doctors do. Asthmatics,
diabetics, warfarin users, endoscopy-seekers and minor surgery-needers, intensive
care customers and theatre goers can all be looked after by nurses, prescribed for
by nurses, washed by nurses and fed by nurses. End-2-End Care.
•
Nurses have reinvented primary care and made GPs rich by harvesting most of the
QoF points for them. The scope of nursing influence on modern healthcare, in
hospital and outside and on family life has ballooned, blossomed and grown
beyond recognition.
It is a boardroom truth; excellence will save you money and excellence can
always be found in the most highly developed workforce. Nurses can deliver
excellence.
NPC May 2012