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Nurse independent prescriber qualification has had little overall impact on prescribing

The proportion of primary care prescribing undertaken by nurses rose just 0.4% in the first five years after the introduction of nurse independent prescribing, researchers have reported.

The team from University of London looked at how nurse prescribing in primary care changed after the introduction of the nurse independent prescriber qualification in 2006, which enables qualified nurses to prescribe any licensed drug – including some controlled drugs – for any medical condition within their clinical competence.

The community practitioner nurse prescriber qualification, first introduced in 1992, enables nurses to prescribe only from a more limited list of medicines.

As reported in the journal BMC Health Services Research, the researchers found the proportion of items prescribed by nurses in primary care has risen only slightly since nurse independent prescribing came in, from 1.1% of all items in 2006 to 1.5% in 2010.

Overall, the number of nurses registered to prescribe rose by 18%, from 30,753 to 36,281.

In line with this, the number or nurses issuing prescriptions increased from 13,391 in 2006 to 15,841 in 2010.

However, this still meant the number as a proportion of all those qualified and authorised to prescribe remained static over the five-year period, at 43%.

It found that while nurse independent prescribers contributed most towards prescribing of emergency contraception, community practitioner nurse prescribers mainly contributed to prescriptions of dressings, stockings and incontinence appliances.

The team concluded: ‘The percentage of prescriptions written by nurses in primary care in England is very small in comparison to GPs and there has been little change in that over five years.’

‘Our findings suggest that nurse prescribing is used where it is seen to have relative advantage by all stakeholders, in particular where it supports efficiency in nursing practice and also health promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the prescribing role between nurses and general practitioners.’

BMC Health Services Research 2014

Readers' comments (19)

  • Have recently undertaken, I found the course extremely challenging in terms of pharmacology/ exams etc. One of our GP's said he did not think he could answer the exam questions!!! In my area most nurses use IP, out of interest how many nurses and GP's work within a supplementary prescribing context within general practice?

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  • Is supplementary prescribing underused in general practice? Long term conditions? Tripartite agreement patient .GP. and nurse.

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  • After working in GP for over 10 years, I think the biggest issue causing nurses not to take up IP is due to lack of practice recognition of this qualification which is not reflected in their pay!

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  • I think the biggest issue causing nurses not to take up IP is due to lack of practice recognition of this qualification which is not reflected in their pay!
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    For many practices it doesn't really decrease workload for the GP employers and they become vicariously liable for a very exposed area of medicine. We wouldn't want one of our nurses to undertake this because we're not convinced that the courses and training cover prescribing in anywhere near the depth required for safe prescribing.

    I know that this will generate howls of protest from the nurse prescribers (who may well be very safe) but, in our opinion, it still falls far short of the level of pharmacology and prescribing experience that a new GP registrar would have and the risks don't outweigh the benefits. Finally, I suspect a very large proportion of the nursing population wouldn't want the additional responsibility that goes with this role anyway.

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  • GP employers are vicariously liable for actions/ommissions of nurse employees regardless whether they prescribe or not. As none of your nurses have undertaken course, can assure you that there is plenty 'depth' complexitiy in terms of pharmacology/pharmacokinetics/safe prescribing. There is a body of evidence to suggest that NMP's are extremley safe/ competenent people and maintain exellent prescribing partnerships with their patients. - this is perhaps the most important point- and also how is nurse prescribing used in general practice - my point above - what about supplementary partnerships - PT/ GP/ Nurse would this facilitate better prescribing outcomes? in terms of PT ed/ concordance etc? GP/s PT/Nurses working together!!!

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  • Research consistently shows no difference in outcomes between Medical and non medical prescribing - whatever the anxieties are about training models.
    The funding for training of non medical prescribers has been affected by health economics so there has been a slow down in the number completing training which will influence these figures.

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  • "As none of your nurses have undertaken course, can assure you that there is plenty 'depth' complexitiy in terms of pharmacology/pharmacokinetics/safe prescribing"
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    That may be your assessment, but it isn't ours. We are well aware that we are variously responsible for all actions - what I am suggesting is that we, as employers, as not willing to be liable for this. That, as partner's is our decision. Equally, we can't see a large business benefit to this - other employers may take a different view.

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  • Nurses led long term condition management ?
    Advanced nurse practitioners managing on the day requests and minor ailments ?

    Both need prescribing skills to complete episodes of care and both are cost effective

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  • Nurse led LTC management doesn't need the ability to prescribe (it has worked for years and still does in most areas without this).

    Many practices are moving away from ANPs for untriaged care because it's often cost-equivalent to hire a salaried doctor (when adjusted for number of patients seen and the expanded role-set).

    Of course, different practices may take a different view but in business terms, the benefits to the practice are not necessarily well defined.

    Of course, in terms of professional development etc for the nurses concerned there may be other benefits - but I'm talking from an employer's perspective.

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  • There can be benefits for patients- still the most important point!
    For some, LTC clinics are mainly been driven by QoF, financial incentives templates and tick boxes, none of which requires a registered nurse! let alone a nurse prescriber. In my area, the patient is at the heart of everything we do.

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