References
Barriers and enablers to nurse prescribing in primary care

Abstract
Non-medical prescribing has seen rapid growth in recent years in the United Kingdom. It has been shown to be beneficial to patients and healthcare services. There are advantages for practitioners who choose to take on this extended role, however, some nurse independent prescribers only use their prescribing qualification in a limited way and others not at all. This literature review will consider the barriers and enablers for nurse prescribers who work in primary care. Five papers were selected from a database search of Ovid Medline, PubMed, Cinahl, and Google Scholar: two meta-syntheses, one systematic review, a national cross-sectional survey and a qualitative study using semi-structured interviews. The results showed that key areas of continuing professional development, support, and organisational factors could affect prescribing in either a positive or negative way and that these areas were often interrelated. There was little difference in these issues between primary care and the acute sector. Ensuring access to continuing professional development, the provision of ongoing clinical and managerial support and improvement to infrastructure along with further research are recommended to ensure nurse independent prescribers advance and fully utilise their prescribing qualification and that this vital service continues to develop and expand.
From its inception in the early 1990s, non-medical prescribing (NMP) has grown and developed at a rapid rate in the UK. It has evolved from an initially small number of community nurses and health visitors, prescribing from a limited formulary, to the current situation where a significant and growing number of nurse independent prescribers (NIPs), pharmacists and an increasing range of allied health care professionals (AHCP) are permitted extensive prescribing rights that are only limited by their scope of expertise. The UK is viewed as a world leader in NMP because of the short training programme, extensive roll-out and lack of prescribing restrictions (Smith et al, 2014; Nuttall, 2017). The rise of NMP has been driven by the need to improve patient care and access to medicines, make better use of the skills of health professionals, and to promote more flexible working in the health service (Department of Health and Social Care, 2012). NMP has been beneficial to the healthcare system, patients and prescribers through up-skilling the workforce (Darvishpour et al, 2014). Research indicates that NIPs are both safe and well-evaluated by medical colleagues and patients (Graham-Clarke et al, 2018).
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