Matt Griffiths: The UK pioneered nurse prescribing, but are we making it count?
Many nurses who can prescribe do so infrequently, or not at all. A review of the nurse prescribers’ formulary may help to overcome one of the barriers
The UK pioneered prescribing by nurses, yet many nurses who can prescribe do so infrequently. A review of the nurse prescribers’ formulary may help to overcome one of the barriers
Latest figures from the Nursing and Midwifery Council (NMC) show that as of September last year there were 77,067 nurse prescribers in the UK.
Yet many nurses trained to prescribe do so infrequently or not all. What are the barriers to nurse prescribing, and how can they be overcome?
Of the two groups of nurses who are qualified (see box), community practitioner nurse prescribers are using their powers less than previously, while nurse independent/supplementary prescribers (NISPs) are using their qualifications much more.
Community practitioner nurse prescribers are frustrated that the Nurse Prescribers’ Formulary at their disposal does not meet their needs.
Review of the formulary
Many of the items in this formulary, such as dressings and catheters, do not need to be prescribed in secondary care and are simply taken out of stock cupboards.
Of the medicines that are included, many are in the ‘general sales list’ or ‘pharmacy’ categories, which means they can be purchased over the counter, or staff are permitted to administer them using homely remedies protocols and patient group directions.
The good news is that the Nurse Prescribers’ Formulary is currently being reviewed by Cardiff University nurse prescribing expert Molly Courtenay, along with the British National Formulary’s nurse prescribing sub-committee, to ensure it better meets the needs of those qualified to use it.
Not the only barrier
The limitations of the formulary are not the only barrier to nurse prescribing, however. Anecdotally, many nurses who undertook training as part of their district nursing or health visiting qualification did not necessarily want to become prescribers and are now reluctant to use their powers.
By contrast, practitioners who wanted to become NISPs had to apply to do the V300 course and be employed in roles that would involve using the qualification. Given that they made a positive choice to undertake the vast amount of study required, motivation was there in abundance.
I am not saying that all community practitioner nurse prescribers lacked motivation, but making a course compulsory inevitably means that some of the cohort feel less positive about it than others.
Knowledge of medicines
In 2017, the NMC carried out a public consultation on its plans for a radical overhaul of pre-registration nurse education. Running parallel to this was a consultation on prescribing for nursing students, which included a proposal to allow nurses to undertake the community practitioner prescribing programme immediately after registering.
An NMC Council meeting in January, where initial feedback from the consultation was discussed, heard that around 65% of the 706 people who responded to the consultation disagreed with newly qualified nurses being eligible for this programme before completing preceptorship.
But allowing newly qualified nurses to undertake prescriber training would strengthen their knowledge base around medicines, and I fully support this change.
Pioneered in UK
The formulary as it stands is extremely limited, so the risk is low, and up to one in five community practitioner nurse prescribers go on to become NISPs. The more of them we have the better.
While we wait for the NMC to conclude its deliberations we should remember with pride that the UK pioneered prescribing by nurses.
It bears repeating that we must all remember to use this skill with great care and never forget our overarching responsibility for the patient’s holistic care, which remains our priority.
Two kinds of nurse prescribers
Community practitioner nurse prescribers There are around 38,389 of them in the UK, and they will have successfully completed a V100 or V150 course. They may prescribe only from the Nurse Prescribers’ Formulary, which comprises appliances, dressings, pharmacy (P), general sales list (GSL) and 13 prescription-only medicines (POMs).
Nurse independent/supplementary prescribers They total around 38,678 in the UK, and will have successfully completed a V300 course. They may prescribe any medicine provided they are competent to do so. This includes medicines and products listed in the British National Formulary, unlicensed medicines and most controlled drugs.
Supplementary prescribing requires a clinical management plan to be drawn up in advance and agreed with a doctor or dentist, so is mostly used by nurses working in complex care areas such as chemotherapy. It is also an excellent way of safely prescribing when moving clinical areas or returning to practice after a career break.
Matt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University