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Report shows ‘limitations’ of independent nurse and pharmacist prescribing

By Alisdair Stirling

Nurse and pharmacist independent prescribing is generally safe, but not always cost-effective or in line with Government guidelines says a major new Department of Health evaluation.

The first detailed evaluation of the controversial scheme, introduced in 2006 to allow nurses and pharmacists to prescribe independently of doctors, found that a quarter of the respondents to the consultation commented on the 'potential limitations' in the depth or breadth of nurses and pharmacists assessment and diagnostic skills.

But in spite of these criticisms, the report said that independent prescribing by nurses and pharmacists was generally 'safe and clinically appropriate', and even suggested that non-medical prescribing could be expanded to prescribe across a wider range of conditions in patients with co-morbidities.

The report, by a team of researchers from the Universities of Southampton and Keele, found: 'There was some indication that assessment and diagnostic skills associated with prescribing could be improved, and some medicines prescribed may not be the most cost effective and/or consistent with national guidelines on prescribing.'

It continued: 'The recurring theme across all therapeutic areas is the consistency of prescribing patterns within a practice.'

'Established local prescribing policy appears to dominate over national guidance, resulting in brand loyalty for the combination inhalers, or a titred approach to dosing at odds with NICE recommendations, as in the 10 and 20mg doses of simvastatin.'

'We recommend that attention needs to continue to be given to nurses' and pharmacists' assessment and diagnostic skills which underpin their independent prescribing role', the report concluded.

'Key issues for further expansion of non-medical prescribing may include preparing nurses and pharmacists to prescribe across conditions for patients with comorbidities,' the report goes on to say.

Professor Tony Avery, professor of primary care at the University of Nottingham and a member of the report's advisory committee said a new GMC-funded study he is taking part in suggested that limited independent nurse prescribing could be safer for patients.

'It suggests it's better than to have the nurse hovering outside the GP's door to get them to sign a prescription. That that can interfere with the GP's thought processes when they should be logging the previous consultation and writing up records.'

And he questioned the recommendation to train non-doctors to prescribe for patients with co-morbidities: 'I spend most of my time as a GP with very complex patients on complicated medication regimes, and it's always a significant intellectual challenge working out the risks and benefits.'

'There's a distinction to made between nurses and pharmacists. Pharmacists have a broader training and could perhaps work on more complex prescribing reviews, but nurses haven't got the broad therapeutic training of GPs so I'm not sure whether nurses doing highly complex prescribing is right.'

'That's what we're trained for and it's getting more and more complex all the time.'

Report shows 'limitations' of independent nurse and pharmacist prescribing


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