Nurse prescribers as safe as GPs
• From Jenny Aston, nurse practitioner, Thetford, Norfolk
I write in response to the story 'Nurse prescribing "a threat to safety"' (News, October 5). This may have been an eye-catching headline but it is very far from the truth.
As a highly experienced advanced nurse practitioner and nurse independent prescriber, I would like to know how many of the GPs surveyed actually know anything about nurse prescribing. I would suggest that those who have commented are ignorant of the facts. When nurses train as prescribers, a large part of their training is down to the GP or doctor who mentors them for six months. Nurses who are accepted on the course are required to be in a job where they are in a position to prescribe with support. They are also required to be able to study at degree level and have an underpinning level of knowledge.
I totally agree that there may be a risk if nurses are sent on prescribing courses when they do not have existing skills to assess, diagnose and treat patients. However, the reality is that most nurse prescribers are as safe as doctors and work within their competence levels. What I do now is actually safer because I am not asking a GP to simply sign a prescription for a patient I have assessed and diagnosed. I do think it high time that the BMA and the RCGP spoke directly to some experienced nurse prescribers and nurse practitioners to gain a greater understanding of what we do.
• From Jan Gower, nurse practitioner, Warboys, Cambridgeshire
I find myself reading yet another onslaught on non-medical prescribing that is neither substantiated nor
true. An alarmist response such as this does nothing
to foster good working relations between doctors
and nurses and least of all helps the patients we are
here to serve.
Yes, nurses are able to prescribe after following essentially a six-month course, but all nurses who undertake such training have to be experienced in their field of work in order to be accepted onto the course. How many GPs sign off the prescription that the practice nurse has generated without any thought to what is on the script or having seen the patient? This occurs all the time.
It was for this reason as an experienced nurse practitioner in primary care that I undertook the course – to validate the prescribing decisions I was already making and to be accountable and responsible for them. So GPs such as Dr Olly O'Toole need not worry – it will be me and not my GP that they sue (that is why I have indemnity insurance with the RCN).
Although I have access to the whole BNF, I am never likely to use it. I will only ever use it in those areas in which I am competent and expert.
As a haematology sister it was acceptable for me to tell the first-day house officer
what to prescribe and it is acceptable for me to take on those out-of-hours tasks that GPs no longer want... but prescribe? Oh no!
Pulse is correct to comment that GPs would fail to cope with GMS without their practice nurses – I am fortunate that I work with supportive broad-minded GPs – but I am aware that I prescribe a lot less antibiotics than them and am less likely to prescribe a centrally acting weight reducing drug for someone who needs weight management.
• From Dr John Leigh, Washington, Tyne and Wear
I was somewhat surprised to read that the RCGP had warned that expansion of prescribing rights to non-doctors had gone too far and it had demanded stronger regulation of non-doctor prescribing. You report Professor Mayur Lakhani, chair of the RCGP, as saying 'we share the concerns of doctors quoted as being worried by the extension of prescribing'.
I wonder if this is the same RCGP whose vice chairman has been intimately concerned with the development of non-doctor prescribing by medical care practitioners (bogus doctors) in this country.
• More on this issue, page 38