Greater scrutiny of independent prescribing needed to ensure it works well, report says

Greater scrutiny of prescribing by nurses, pharmacists and other allied health professionals is needed, a report from the Nuffield Trust has suggested.

The review of implementation challenges in independent prescribing concluded there is ‘significant scope to improve the monitoring of prescribing practice’.

This could include extending the current monitoring of antibiotic prescribing in primary care, it said.

Improving the monitoring of workforce activity and prescribing patterns would provide ‘greater assurance that independent prescribing is working well’ and would support wider use of prescribing skills, it added.

There are already nearly 100,000 independent prescribers in the UK, representing almost a quarter of the prescribing workforce, the Nuffield Trust calculated.

Independent prescribers are envisaged to play an important role in shifting care from hospitals into community settings and in managing the growing population of people with long-term conditions, the report said.

While nurses currently form the largest profession, accounting for 69% of independent prescribers and with more than half of nurses in general practice actively prescribing, pharmacists are the fastest growing group.

Having developed in a piecemeal way across professions there are ‘inconsistencies in training and regulation of independent prescribers’, the report said.

With a new cohort of pharmacists who will be qualified independent prescribers at the point of registration – as of September – there will be a need for ‘robust supervision’ and continuing professional development.

A shortage of designated prescribing practitioners is a ‘significant barrier’ and will be a particular a challenge for pharmacists working in the community, the report added.

Overall, it raises concerns that current arrangements for funding, supervision and regulation ‘may not be fit for purpose’ as the independent workforce expands.

It found the training pipeline is fragile, funding to cover both training and the clinical oversight required for trainees is not assured and there is high competition for training places.

Integration of independent prescribing across settings will need to be part of the upcoming NHS 10 year workforce plan and funding for designated prescribing practitioners (DPPs) in community will need to be addressed, it concluded.

Nuffield Trust deputy director of research Sarah Scobie said: ‘We have an ageing population which is now living with more health issues, and the government hopes its ambitions to shift more care closer to home will tackle some of the problems this poses.

‘The NHS will need to harness the full potential of its fast-growing prescribing workforce to realise this change, but we have identified some worrying barriers.’

She called for the NHS workforce plan to clearly set out the role prescribers will play within neighbourhood teams based on local population needs.

‘Better monitoring of independent prescribing practice in all settings will also be crucial. Without this, the opportunities presented by the incoming wave of new pharmacist prescribers will sadly be missed.’