Brief History

Community nurses have been prescribing across Scotland since 1996. These nurses were required to possess either a District Nursing or Health Visiting qualification. This course comprised of 2 days attendance preceded by a period of open learning within approved Higher Education Institutes. Across Scotland there are approximately 3000 nurse prescribers within this category. This nurse prescribing course will continue to be a core component of the District Nursing and Public Health Nursing courses.  These nurses will continue to prescribe from a limited formulary.

Extending Nurse Prescribing

The key principle underlying nurse prescribing is that patient safety is paramount, although it is intended to provide patients with quicker and more efficient access to medicines, and to make the best use of nurses’ skills.  The extension of nurse prescribing allows access to this development to more nurses and to a wider range of medicines, to cover four broad areas of practice:

·        Minor aliments

·        Minor injuries

·        Health promotion

·        Palliative care

Under the extended scheme, nurse’s who had successfully completed the training will be able to prescribe all General Sales List (GSL), Pharmacy only medicines (P) and approximately 140 Prescription only Medicines (PoMs).

The Scottish Executive Health Department has published and distributed widely 'Extending Independent Nurse Prescribing within NHSScotland: A Guide for Implementation'. This important document can now be downloaded from their website (www.scotland.gov.uk/library5/health/einp.pdf).

The Scottish Executive Health Department also has a specific website regarding nurse prescribing which contains feedback from the nurse prescribing roadshows that took place last year. Many of the questions raised have since been answered, go to www.show.scot.nhs.uk/sehd/nurseprescribing for further information.

Training

The new course involves 25 study days within an approved Higher Education Institution and 12 days working in their area of practice being supervised by a prescribing medical practitioner (these 12 days relate to the nurses time, not the Doctors).  The course can be completed within a minimum period of three months and a maximum of six months.  Higher Education Institutions have been developing the course to meet the competence laid down by the UKCC (now the Nursing and Midwifery Council).  Each Higher Education Institution must be approved by NHS Education for Scotland (NES) previously NBS.  For more details go to www.nes.scot.nhs.uk.

Many of the Higher Education Institutions have now started delivering the extended nurse prescribing course.  Further information can be accessed from NES.

Eligibility of Nurses and Midwives

This decision must be taken on an individual basis to reflect local needs and circumstances.  No nurse shall be required to undertake training unless he/she wishes to do so.

Legal criteria include:

• Ability to study at Level 3 (degree level)
• At least 3 years post-registration clinical nursing experience: nominees will usually be ‘E’ grade or above
• A medical practitioner willing to contribute to and supervise the nurse’s 12 days learning in practice
• The support of their employer

Three key principles that should be used to prioritise potential applicants are:

• Patient safety
• Maximum benefit to patients in terms of quicker and more efficient access to medicines for patients
• Better use of nurses’ skills

Funding for Extended Nurse Prescribing Course

The Scottish Executive Health Department is funding the cost of the course to support this important nurse development.  This will be allocated on the basis or named lists of nurses Trust’ have prioritised for training (recently increased to £1000 per nurse).  Central funding currently includes a contribution to other costs, in addition to the course fees.

Formulary Supplies

·        Nurse Prescribing Formulary (NPF) – every 2 years

·        BNF – 6 monthly

·        Scottish Drug Tariff – 6 monthly

 Supplementary Prescribing

This area of development has been out for consultation and has been approved for implementation across the UK.  Guidance for supplementary prescribing is presently being developed.

What is Supplementary Prescribing?

‘A voluntary prescribing partnership between an independent prescriber (doctor or dentist) and a supplementary prescriber (nurse or pharmacist), to implement an agreed patient-specific clinical management plan with the patient’s agreement.’ (DoH, 2002)

Supplementary prescribing will allow suitably trained nurses and midwifes (and pharmacists) to prescribe within the parameters of a clinical management plan implemented by the patients medical officer, the nurse may alter the dosages, formulation, frequency of named medication e.g. nurse- led lithium clinics, warfarin clinics, asthma and diabetic management.

Supplementary Prescribers will be able to prescribe:

·        All General Sales List medicines, Pharmacy medicines, appliances and devices, foods and other borderline substances approved by the Advisory Committee on Borderline Substances

·        All Prescription Only Medicines with the current exception of controlled drugs (Home Office agreement is being presently sought)

·        Medicines for use outside of their licensed indication (i.e. ‘off label’ prescribing), ‘black triangle’ drugs and drugs marked ‘less suitable for prescribing’ in the BNF

Additional Competencies

The Nursing and Midwifery Council have made additions to the competencies identified for extended nurse prescribers see:

www.nmc-uk.org/cms/content/Employers/NMC%20circular%202502.pdf). 

NES have asked HEI to include these into the present Extended Nurse Prescribing course.  This will mean that all Extended Nurse Prescribers will also be supplementary prescribers on the successful completion of the approved course.

Patient Group Direction (PGD)

Patient Group Directions are written instructions for the supply or administration of medicines to groups of individuals who may not be identified before presentation for treatment.  PGD must contain specific information that complies with legislation and health professionals that may supply or administer medicines under a PGD must be individually named and this must be recorded within each Trust.