Non-Medical Prescribing
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
Over recent years there has been an ongoing programme to expand the number of non‐medical health care professions who may prescribe drugs as independent or supplementary prescribers. Non‐medical prescribing aims to improve patient care, choice and access to ensure that an increasing number of healthcare professionals can contribute to the transformation agenda through the ability to prescribe medication.
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 with respect to the range of medicines that they can prescribe, 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 as listed in the Misuse of Drugs Regulations 2002
- 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 Further information can be obtained at The Misuse of Drugs (Amendment) Regulations (Northern Ireland) 2019 No. 208 (legislation.gov.uk)
- Paramedic and therapeutic radiographer independent prescribers are now able to prescribe some specific controlled drugs. Further information relating to what controlled drugs this professional group of NMPs can prescribe can be accessed at The Misuse of Drugs (Amendment No.2) Regulations (Northern Ireland) 2023 (legislation.gov.uk)
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 Nurses
Community nurses, 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.
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. Further information can be found here.