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Independents' Day

GPs overruled on nurse prescribing

The Government gave the green light to a radical expansion in non-medical prescribing despite the overwhelming opposition of medical groups, writes Gareth Iacobucci.

Documents obtained by Pulse under the Freedom of Information Act reveal the extent of disquiet among doctors about the move to provide access to the whole BNF.

In consultation responses, not a single one of 16 medical bodies supported the plan to provide pharmacists with access to the whole formulary for all medical conditions.

The British Pain Society was the only one of 14 medical bodies listed as supporting the same arrangements for nurse prescribers.

By contrast, the move – which became law in May – was strongly supported by non-

medical bodies. Of the 250

respondents supporting the pharmacist prescriber arrangements, 90 per cent were either pharmacists or NHS bodies.

In the nurse consultation, more than half of 613 respondents supported full BNF access, but 85 per cent of these were nurse or NHS bodies.

The RCGP said in its response that 'safety remained a fundamental issue'. It expressed concerns about 'the complexities of the diagnostic process, possible commercial influences in community pharmacy and the need for a single shared health record'.

It favoured no or very limited changes, allowing only 'a potentially small number of well-known medicines to be applied to a broader number of medical conditions'.

The British Association of Perinatal Medicine specifically opposed nurse prescribing, saying: 'It would be uncertain who would decide which medicines were inappropriate.'

There were also concerns expressed by some patient groups. Roger Goss, co-director of the patient support group Patient Concern, said the group was 'very cautious' about the new regulations.

He said: 'Drug errors are a hazardous thing for patients, particularly those on many drugs. The elderly and vulnerable want access to their GP, and not to be brushed off.'

Dr Peter Elliot, a GP in South Woodford and prescribing lead for Redbridge PCT, said medical interests should be represented more strongly in these types of consultations.

He said: 'GPs spend years training, and then nurses and pharmacists are expected to learn after a short course.'

A Department of Health spokesperson insisted the recommendations took all consultation responses into account, 'including those from doctors'.

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