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Huge explosion in nurse prescribing

By Richard Hoey

The full extent of the UK's nurse prescribing revolution is exposed by new data showing an explosion in nurse prescriptions for antidepressants, anti-biotics and cardiac medication.

Nurse independent prescribers are taking full advantage of their access to the entire drug formulary, with use of some medicines leaping by more than 200% in the year since prescribing regulations were changed.

Among the growing number of drugs prescribed by nurses are many whose use requires high-level clinical skills, such as venlafaxine, rosiglitazone, rimonabant and amiodarone.

The figures, obtained by Pulse under the Freedom of Information Act, reveal that overall numbers of nurse scripts have leapt by 49% in the year since independent prescribers were handed access to the entire BNF in May 2006.

But use of medicines requiring complex clinical judgment, including antibiotics and antidepressants, has increased far more rapidly. Use of ciprofloxacin is up 218%, paroxetine by 262% and rosiglitazone by 245%, according to the latest data, for May this year.

The figures came as an editorial in the BMJ called for prescribing to be built into advanced nurse training to deal with concerns over training quality.

There are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters in primary care, but training courses consist of only 26 days of theory and 12 days of mentored practice.

Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said he had ‘serious concerns' over the issue.

‘Nurses' knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent at differential diagnoses. Only a country with not enough doctors would go down this cheapy line.'

He identified particular concerns over nurses' use of the cardiac drugs amiodarone and digoxin, plus antibiotics, antivirals, calcium channel blockers and ACE inhibitors.

Professor Tony Avery, an author of the BMJ editorial who is conducting a review of nurse prescribing for the Department of Health, said the data raised some concerns, particularly over use of antibiotics.

Professor Avery, head of primary care at the University of Nottingham and a GP in the city, said: ‘We also found large increases in antibiotic prescribing and if they're not offset by decreases elsewhere, that's worrying. But it's still less than 1% of community prescribing.'

Dr George Rae, a member of the GPC prescribing subcommittee and a GP in Whitley Bay, Tyneside, expressed concerns over antidepressant prescribing and called for a full audit.

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