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CAMHS won't see you now

Are nurse prescribers safe?

From Dr Anila Reddy Ex-clinical governance lead in nurse-led clinic, London

Your coverage of safety concerns over nurse prescribing has provoked indignant responses from nurse prescribers and some of their teachers. While I am sympathetic to their feelings of hurt and their perception that doctors are prejudiced against them, I would like to make a few important points.

There is no proper system in place to ensure that all nurse practitioners are of a set standard. This is wrong. There is no nurse practitioner register and no standardised requirement for minimum courses or experience.

There are nurses seeing patients who have neither done the 38-day prescribing course nor the RCN-recommended nurse practitioner course nor a masters degree.

I would also question the judgment of anyone who suggests they have learned all the relevant pharmacology and therapeutics of all the drugs in the BNF in 38 days.

I and many doctors are not prejudiced against nurse prescribers and welcome their help, but we are perplexed and rightly concerned as advocates for patients about the nursing profession's lack of regulation of their new roles.

I would say to all responsible nurse practitioners: don't pretend patients are being protected by the nursing code of practice. Patients are at risk of misdiagnosis and wrong treatments by nurses who have not done an accredited training course.

• From J. Martin FarrarNurse practitionerRoyal Infirmary of Edinburgh

It is unsurprising doctors are against extended nurse prescribing powers, but this is not for safety reasons but because their power base has slowly been eroded over the last few years.

The evolution of nurse practitioners and other health care practitioners has dispelled the myths surrounding the perceived omnipotence of the medical profession.

Practising within their area of expertise, nurse practitioners are able to provide care equal and in many cases better than their medical colleagues. Despite practising autonomously and treating hundreds of thousands of patients annually, fears surrounding a wave of negligence claims have never materialised.

It takes four years to train a graduate nurse. In my trust nurse prescribers require a minimum three years' clinical experience before commencing the degree level nurse prescribing course.

Students are required to submit a portfolio of essays, pass an exam and be signed off on 29 different competencies. This takes six months.

On my reckoning that is a minimum seven-and-a-half years, compared with the five-six years to be a junior doctor with very little clinical exposureMany factors have recently conspired to create the health care provision we now have; not least the new GMS contract and reduced doctors' hours that have left a yawning gap in the service.

Nurses, as always, have stepped into the breach.

What is important is how doctors, nurses and other health care professionals can work together to meet local patient needs.

• From Alan Moore, group manager at a medical centre, Ellesmere Port, Cheshire

I write with reference to the letter in Pulse (23 November) from a nurse practitioner complaining that doctors do not value the experience and training of their nurses and that their attitude is 'negative, derogatory and with sarcastic undertones'.

While the nursing profession is pushing its boundaries outwards and taking on roles traditionally carried out by doctors, on the other side of the equation registered nurses are being negative, derogatory and sarcastic about health care assistants extending their role into registered nurses' heavily protected domains.

The experience of having health care assistants in general practice is showing that the range of tasks that a well-trained, managed and competent assistant can do – supported by the defence unions – is expanding all the time and the biggest obstacle is always the attitude of the nursing profession.

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