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The Government's skill mix drive is endangering patients and putting GPs at medicolegal risk, two new studies suggest.

Inadequate training courses for supplementary prescribers are 'failing to fill the hiatus in scientific knowledge in order for nurses to prescribe medication from the nurse prescribing formulary', the first study concludes.

A second study, due to be published in the BMJ, linked pharmacist medication reviews to a rise in the number of hospitalisations in the elderly.

The GMC and medical defence bodies warned GPs were legally responsible for ensuring all health professionals in their practice were capable of carrying out their tasks and could be liable for a nurse's error.

The three-month prescribing course failed to provide nurses with skills in physical assessment, diagnostic reasoning and medicines management, according to the first study, in the latest edition of Nurse

Education Today.

Study author Dr Maggi Banning, principal lecturer in adult nursing at Canterbury Christ Church University College, said nurses needed updated training and GPs were often left in the dark over how to manage nurse prescribing.

Dr Chaand Nagpaul, a member of the GPC prescribing sub-committee, said nurse prescribers had reduced workload for GPs but urged caution on increasing their prescribing responsibilities.

'I think the complexity of prescribing has been underestimated in nurse training. This whole area does need to be looked at again,' he added.

The second study, presented at the Society for Social Medicine conference earlier this month, found patients who received pharmacist home-based medication reviews after hospital discharge were significantly more likely to be readmitted.

The study of 824 elderly patients found 232 readmissions in the review group and 170 in controls.

The researchers criticised the Government's tendency to roll out policies without proper testing.

GP Dr Sohail Butt, care of the elderly lead for North Surrey PCT, said: 'It may be that pharmacists working in isolation may not be as good [at medication reviews] as someone with a more holistic view.'

Dr Peter Elliott, prescribing lead for Redbridge PCT, said elderly medicine checks were 'a nightmare' and 'bright ideas' were being rushed into practice.

By Rob Finch

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