Remaining barriers to prescribing for practice nurses

Many services in primary care are now led by practice nurses working at an advanced level but not prescribing, either independently or as supplementary prescribers. What are the barriers as perceived by these nurses? Age, salary, support and training all emerged as factors in this questionnaire survey of practise nurses in one English county where prescriber numbers are low.

The authors make recommendations to improve the situation, including some central funding for course fees and expenses for practice nurses, study time and mentoring systems, a funded post of professional lead for practice nurses in each Primary Care Trust (PCT), a clear career pathway for practice nursing, and realistic financial incentives for professional development.

Of the 251 practice nurses in the county, 151 responded to the survey, most of whom were mature and experienced. About one-third will be reaching retirement age within 15 years, so GPs and PCTs will need to provide incentives to recruit and retain practice nurses.

More than 90% were managing at least one chronic condition but of these only 17% held a prescribing qualification and nearly half did not hold or intend to study for the prescribing qualification. Similarly, 37% of those providing first contact care for minor illnesses did not hold or intend to study for the prescribing qualification. The intention to train was strongly related to age, as might be expected.

Other factors included lack of support, time factors, anxiety about prescribing or the course, and lack of interest or opposition by GPs. There was a widespread view that respondents would receive little or no financial reward for doing the course. The authors point out that few GPs have adopted Agenda for Change, which would ensure parity with NHS colleagues.Â

Kelly A, Neale J and Rollings R. Barriers to extended nurse prescribing among practice nurses. Community Practitioner 2010; 83(1): 21-24.