How much are primary care nurses prescribing?

How much do nurses in primary care in England prescribe, and what items are they prescribing? An analysis of the ePACT database of prescriptions up to 2010 led its authors to conclude that the “percentage of prescriptions written by nurses in primary care in England is very small in comparison to general practitioners and there has been little change in that over five years”.

There are also regional variations: in 8% of Primary Care Trusts (PCTs, as they were at the time of the study) independent nurse prescribers (INPs) employed in general practices recorded no prescriptions; at the other end of the spectrum, in one PCT area, INPs employed by general practices prescribed more than 5% of items.

The authors believe that this study presents prescribing data for the largest number of primary care nurse studied to this end so far: 30 753 (2006) to 36 281 (2010) primary care nurses. Over this period, the number of nurses with an independent prescribing qualification increased hugely, whereas there was a decrease in the number with the community practitioner nurse prescribing qualification. What is really striking in the data presented is that throughout this period, the percentage of nurses qualified to prescribe who issued two or more prescriptions a year remained static, at 43%. At the start of the period, nurses were prescribing 1.1% of ePACT items – by 2010 this had risen to 1.5%.

Penicillins were the items prescribed in the greatest volumes by INPs, followed by dressings; INPs prescribed many fewer items of emergency contraception but these formed a greater proportion of the total prescribed (just over 9%).

The authors conclude that independent prescribing has yet to be taken up as normal or usual practice for nurses with prescribing qualifications working in primary care. All the nurses in this study had been registered on the ePACT database as prescribers, so they had at least some level of employer support. Possible explanations discussed include lack of access to clinical supervisors or mentors, and more widespread ambivalence among these frontline staff than thought towards this initiative. The authors suggest that maybe nurse prescribing is most acceptable when it supports the efficient delivery of primarily nursing interventions.

Drennan VM, Grant RL and Harris R. Trends over time in prescribing by English primary care nurses: a secondary analysis of a national prescription database. BMC Health Serv Res 2014; 14:54 (epub ahead of print).