Demand for medication is increasing: 105.8 million prescriptions are issued annually in the community alone, and the number of people over 85s is set to double in the next 10 years, many of whom require multiple medications (Holloway and Henry, 2014). Given that there is a deficit of 18 million healthcare workers worldwide and a predicted UK shortfall of 350 000 by 2030, with a third due to retire by 2030 (Beech et al, 2019), the implications for ensuring access to medicines are profound. New approaches that overcome inadequacies of traditional doctor-led systems of care are urgently required.
Extending prescribing rights to nurses, pharmacists and allied health professions (Department of Health (DH), 2009; 2008) has been the focus of United Kingdom (UK) policy drive to ensure access to medicines by making better use of existing skills and innovation in service delivery (NHS England, 2017; 2020; Graham-Clarke et al, 2017). The UK continues to be the pioneer of developments in non-medical prescribing, with over 91 000 nurses, pharmacists, physiotherapists, podiatrists, optometrists, therapeutic radiographers, dietitians and paramedics now qualified to prescribe medicines.
Although non-medical prescribing (NMP) provides organisations with the ability to improve productivity and quality of patient care, there are ongoing concerns surrounding levels of support, governance structures and barriers caused by organisational and policy restrictions that can affect the implementation of the prescribing role (Graham-Clarke et al, 2017). A survey by Courtenay et al (2012) for example, found up to a third of prescribers were not using their qualification in practice. Although some of this may be due to NMPs moving into roles that do not require them to use their prescribing qualification, with NMP education costing up to £3.5K per individual (Assoication for Prescribers, 2019) there is a potential loss of investment to patients, the wider NHS and the individual themselves if the prescribing role is not fully implemented (Edwards et al, 2020).
Non-medical prescribing leads are responsible for ensuring effective implementation of the prescribing role. However, this role has been hampered by a lack of regional support following the abolition of the ten Strategic Health Authorities (SHAs) in England (Turner, 2019), and a lack of up to date guidance regarding the role and responsibilities of NMP leads in practice, with many reporting little or no preparation, a lack of clarity and little or no designated time for the role (Lim et al, 2013; Courtenay et al, 2011).
More recently NMP leads and Higher Education Institute (HEI) course providers have expressed concerns about managing the complexity of the increased number of professional groups, recent regulatory changes and ensuring applicants meet NMP course requirements (Association of Prescribers, 2019; 2020). Reducing the requirement for post-registration experience for nurses from three to one year has for example, increased accessibility of nurse independent/supplementary prescribing training (Nursing and Midwifery Council (NMC), 2006; 2018). Additional regulatory changes have also allowed suitably qualified NMPs to undertake the role of practice assessor (NMC, 2018; Health and Care Professions Council (HCPC), 2019; General Pharmaceutical Council, 2019), a role that previously could only be undertaken by a medical doctor or dentist, known as ‘designated medical practitioner’ (DMP). While these changes have been designed to remove barriers and support the development of the workforce, it is important to note that each regulator and the professional group has individual requirements and legal frameworks that underpin practice (NMC, 2018; HCPC 2019).
Through independent prescribing, nurses and pharmacists can prescribe from the full range of licensed and unlicensed medicines, with the exception of some controlled drugs for addiction treatment (NMC, 2018; General Pharmaceutical Council, 2019) within their scope of practice, whereas only certain controlled drugs can be prescribed by physiotherapists, and podiatrists. By comparison, dietitians, can only use supplementary prescribing, where an initial diagnosis is by a doctor and a clinical management plan, detailing medicines that can be prescribed, must be agreed between the supplementary prescriber, doctor and patient (HCPC, 2019).
While it is reassuring to know that NMP leads and higher education course providers take the selection of candidates seriously, the burden association with this part of the role, as well ensuring consistency in the information provided could be reduced by using the ‘Preparing to Prescribe’ toolkit, a relatively new and freely available resource (Carey et al, 2020). Preparing to prescribe is a Surrey Implementation toolkit™ that ensures those who are interested in undertaking prescribing training receive consistent pre-course information, and provides resources for healthcare professionals, non-medical prescribing leads, service and provider organisations, commissioners, and Universities to support the implementation of non-medical prescribing in practice.
The ‘Preparing to Prescribe’ toolkit consists of trigger questions, signposting and links to current guidance and is designed to support those who wish to become a NMP. By working with their organisation and making appropriate plans, those who undertake NMP training will be better placed to ensure effective implementation of the prescribing role in practice.
Since its initial launch in 2017, over 900 people have visited the toolkit. Feedback from NMP leads suggests that they are increasingly asking potential applicants to complete the toolkit to check if they meet the basic entry criteria, before progressing to an application (Association of Prescribers, 2019). NMP course providers feedback indicates that they think it is a useful addition to pre-course information that can be accessed by potential students, with a number of providers additionally reporting they have added the weblink to their admissions procedures (Association of Prescribers, 2020). Similarly, healthcare professionals thinking about NMP training report that they found the tool kit user friendly and liked the fact that they could check they met the criteria before submitting an application to their organisation (Association of Prescribers, 2019).
Non-medical prescribing is likely to become increasingly important for services to overcome predicted workforce deficits and inadequacies with traditional doctor-led care in order to maintain patient access to prescription medicines. ‘Preparing to Prescribe’ can help optimise individuals and organisations readiness, helping the full potential of the prescribing role to be realised.