The number of healthcare practitioners in Northern Ireland who are eligible to prescribe continues to increase each year. In addition to the more traditional medical prescribers, appropriately qualified nurses and pharmacists have been able to prescribe independently since 1997.
Additional professional groups such as optometrists, physiotherapists, chiropodists, podiatrists, radiographers, dietitians and paramedics may undertake further professional training to qualify as non-medical prescribers (NMPs). Traditionally, prescribers have worked in either primary or secondary care and mechanisms to facilitate prescribing are largely reflective of these two environments.
The aims of non-medical prescribing are:
- to improve patients’ access to treatment and advice;
- to make more effective use of the skills and expertise of groups of professions;
- to improve patient choice and convenience;
- to contribute to more flexible team working across health and social care in Northern Ireland.
The development of non-medical prescribing within the health service enables suitably trained healthcare professionals to enhance their roles and effectively use their skills to improve patient care in a range of settings, for example:
- management of long term conditions
- medicines management / medication review
- emergency care / urgent care / unscheduled care
- mental health services
- services for non-registered patients e.g. homeless
- palliative care
- provision of specialist garments
Types of non-medical prescribing
- Independent prescribing
This is prescribing by a practitioner responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing. Different professional groups may hold different prescribing rights, for example:
- Some nurses and pharmacists with specific independent prescribing qualifications are able to prescribe any medicine for any medical condition within their competence, including any controlled drug in Schedule 2,3,4 or 5 of the MDR 2002 Regulations, as amended, (except Diamorphine, Dipipanone or Cocaine for the treatment of addiction)
- Optometrist Independent Prescribers can prescribe any licensed medicine for ocular conditions affecting the eye and surrounding tissue, but cannot prescribe any controlled drugs.
- Physiotherapists and podiatrists or chiropodists can prescribe any licensed medicine provided it falls within their individual area of competence and respective scope of practice as independent prescribers, but can only prescribe from a limited range of controlled drugs.
- Supplementary prescribing
Supplementary prescribers may prescribe any medicine (including controlled drugs), within the framework of a patient-specific clinical management plan, which has been agreed with a doctor.
Nurses, midwives, pharmacists, physiotherapists, chiropodists or podiatrists, paramedics, radiographers, dietitians and optometrists may train and register as a supplementary prescriber.
- Prescribing by Community Practitioners from the Nurse Prescribers’ Formulary for Community Practitioners
Community practitioners, formerly known as District Nurses and Health Visitors, are able to prescribe independently from a limited formulary comprising a limited range of medicines, dressings and appliances suitable for use in community settings.
- Independent prescribing
Future of Non-Medical Prescribing
New Models of Prescribing (NMOP) aims to make it easier for patients to get their urgent medicines without delay and from the most appropriate healthcare professional. Some prescribers working in Trusts can now write prescriptions for patients that can then be dispensed by community pharmacists rather than waiting for a GP to write the prescription following an outpatient appointment for example:
- Physiotherapist prescribers working in Southern and South Eastern Trusts are able to prescribe directly to patient where there is an urgent need or if it is a specialised item/medication. This was useful when physiotherapists were able to prescribe urgent prescriptions to manage COPD exacerbations or to provide specialist lymphoedema garments to patient in a more timely manner.
- Previous evidence shows that therapy for the management of Heart Failure is sometimes started but not optimised. Optimisation requires dose titration and monitoring, which is complicated. Up to now, the majority of that work was carried out by the patient’s GP. Heart Failure nurses working in the Western and Northern Trusts with a Non-medical Prescribing qualification are now able to prescribe directly to the patient when there is an urgent need or during the titrating medication phases of the illness. This helps in reducing delays in accessing urgent medicines, expedites optimisation and increases patient satisfaction.
NMOP will continue to identify further opportunities for NMPs and ensure they are enabled to play a greater role in all aspects of service delivery and maximise their prescribing capability.