The Government has started consultations on a major expansion to nurse prescribing
which could lead to an additional 10,000 nurses being allowed to prescribe for
chronic diseases, such as asthma and diabetes, for minor ailments, for palliative
care and to help people give up smoking. The proposal includes five options
for expanding the Nurse Prescribers Formulary (NPF).
The Government’s aim is to have amended the relevant Medicines Act and
National Health Service Act Regulations and the Prescription Only Medicines
(POM) Order by September, 2001.
A principal question to which the consultation seeks an answer is whether the
NPF should continue as a single formulary or should it be divided into a number
of different formularies for different classes of nurse prescribers. Five options
are set out.
The Department favours retention of a single formulary because it would be difficult
for pharmacists and the Prescription Pricing Authority to know what individual
nurses were entitled to prescribe. It would prefer to rely on nurses, like medical
and dental practitioners, to make right judgments about what they were competent
to prescribe. Nurses would be allowed to write private, as well as NHS, prescriptions.
Option 1 The first proposed option would entail no change to the current system in which there is a single formulary and it is for manufacturers to apply to the NPF subcommittee for products to be included, and to apply to the Medicines Control Agency for a POM Order amendment to allow nurse prescribing if the product concerned is a POM. This system is regarded by the Department as slow and unlikely to lead to a full range of prescribing options for specific conditions.
Option 2 All general sale list items and pharmacy medicines would become nurse prescribable other than those on the NHS blacklist or selected list. Prescription medicines would continue to be transferred after manufacturers’ applications. This would expand the range of prescribable items immediately, but POM changes would remain subject to a lengthy process.
Option 3 The third option is to include in the NPF GSL and P medicines as for option 2, plus a specified range of POMs to treat certain chronic conditions, such as asthma, diabetes and hypertension.
Option 4 This would include in the NPF P and GSL medicines as for options 2 and 3, along with all POMs excluding Controlled Drugs, unless individual POMs were deemed unsuitable for nurse prescribing. This would mean that all new medicines would be immediately prescribable by nurses unless or until deemed unsuitable.
Option 5 The final option is to include in the NPF all medicines except those on the NHS blacklist or selected list and most CDs but including opioid CDs for use in palliative care.
As well as views on the five option, the Department also wants to hear views
on precribing by nurses other than in accordance with licensed indications,
on nurse prescribing of unlicensed products and on which nurses should be allowed
to train to prescribe and what form training should take.
The consultation paper is available on the internet at www.doh.gov.uk/nurseprescribing.
The consultation process closes on January 10.