Governance and support crucial for non-medical prescribing

In the current climate of changes to the commissioning process, and tight budgets, how can we be sure that the potential benefits of non-medical prescribing are being realised? ‘Robust governance and support from healthcare organisations’ are essential if non-medical prescribers (NMPs) are to make the maximum contribution to patient care and services, according to a large questionnaire study of non-medical prescribing across one strategic health authority in England. There is a question mark over the future of supplementary prescribing too.

This is the first study to look at how the different types of non-medical prescribing – including community practitioner prescribing, nurse, pharmacist and allied health professional prescribing – have been implemented in different settings within one geographical area, explain the authors. Detailed information about what the prescribing practice of different types of NMPs is, and what their governance arrangements are, in one large area is useful for planning and policy-making.

The study team emailed 1869 NMPs for whom email addresses were obtained from non-medical prescribing leads: of the 1585 invitations that were delivered, 883 resulted in responses (55.7%). More than 90% were nurses, including some who were community practitioner prescribers (although fewer than expected), with some pharmacists and allied health professionals (AHPs) also replying. The survey results showed that practitioners with more prior experience in the prescribing area made greater use of the prescribing qualification and prescribed more frequently. Although most respondents had the one year of prior experience in the prescribing area that is specified by guidance, 10.5% did not; in addition, nearly one-quarter had not undertaken specialist education in their practice area before starting prescribing.

The great majority of nurse independent/supplementary prescribers (more than 90%) said they were currently prescribing; in contrast, about one-third of pharmacist and AHP prescribers and community practitioner prescribers said they did not, often because their role had changed. Community practitioners did still seem to be facing barriers to do with prescription pad and IT issues as well. Interestingly, however, the authors have identified a number of other medicine management activities undertaken by these groups of prescribers, for example recommending over-the-counter medicines to patients, and highlight the importance of capturing all these activities and their impact on patient outcomes and service efficiency, given the budgetary pressures and NHS reforms under which services are being redesigned.

So, as well as experience, what influences prescribing rates and what could be done to ensure that non-medical prescribing delivers on its promise? The study team found that the level of support from non-medical prescribing leads affected prescribing rates – except that mental health nurses had low prescribing rates but the most support, so other factors may be at work here. Supplementary prescribing was not used often, and its use often resulted from organisational restrictions on independent prescribing. The authors suggest that its time may be past, and that this should be a consideration as policy for prescribing for other professionals develops.

On governance, the picture was largely reassuring, although there were still difficulties with obtaining prescribing data, and monitoring and audit of activity. However, community practitioner prescribers had fewer governance systems, and this group also reported that lack of infrastructure, confidence, and access to continuing professional development prevented them from prescribing.

Where does non-medical prescribing go now? Study leader, Professor Molly Courtenay of the University of Surrey, is optimistic about the contribution it could make. “Current reform within the NHS is likely to lead to significant changes in the delivery of care. Given the pressure on budgets and the drive to increase quality and efficiency, non-medical prescribing can make an important contribution. NMPs are extremely well qualified, and have a wealth of clinical experience. Their ability to prescribe enables better use of the skills of the clinical workforce, increasing service capacity and efficiency, and improving the quality of patient care”, she said.

Courtenay M, Carey N and Stenner K. An overview of non medical prescribing across one strategic health authority: a questionnaire survey. BMC Health Serv Res 2012; 12: 138; published in provisional form online ahead of print.