National evaluation report endorses pharmacist and nurse prescribing

Nurse and pharmacist independent prescribing in England, “is becoming a well-integrated and established means of managing a patient’s condition and giving him/her access to medicines”, according to an independent report commissioned by the Department of Health from Southampton and Keele universities.

The study, which is the first national evaluation of nurse and pharmacist prescribing since the formulary was opened up in 2006, also found that:

  • nurse and pharmacist prescribing is safe and clinically appropriate, with some evidence that prescribing could sometimes be more cost-effective or consistent with national guidelines, and that assessment and diagnostic skills could be an area for improvement.
  • most Trusts have core non-medical prescribing clinical governance and management strategies.
  • independent prescribing by nurses and pharmacists was viewed positively by patients.
  • 2-3% of nurses and pharmacists are qualified independent prescribers and the majority of those were actually prescribing.
  • educational programmes are largely satisfactory and suitable.
  • roughly 50% of Trusts said they had a written plan or strategy for non-medical prescribing; its development has mostly been driven by individuals so far and not been used for redesigning services.
  • other healthcare professionals mostly see non-medical prescribing as a positive development.
  • nurse and pharmacist prescribing is more common in primary and secondary care but is taking place in both settings. Nurses are prescribing for a number of long-term and acute conditions whereas pharmacists prescribe mostly for long-term conditions, including cardiovascular ones.

Looking to future expansion and development, issues may include:

  • preparing non-medical prescribers to prescribe across conditions, in the care of people with co-morbidities.
  • more Trusts need to develop a strategic approach to non-medical prescribing.
  • Primary Care Trusts were less likely to have systems in place for dealing with poor performance of non-medical prescribers than secondary ones; most Trusts had no system of covering absence by non-medical prescribers; and most did not use patient feedback systems.
  • education and training about assessment and diagnostic skills.
  • some doctors still appear to lack understanding about non-medical prescribing.

As non-medical prescribing expands further, some of these strategic and infrastructural issues could become important priorities.