Learning from nurse prescribing

Some pharmacists may see nurse prescribing as a threat to their own aspirations to prescribe. But it is becoming clear that nurse prescribing offers pharmacy more of an opportunity than a threat. One lesson it provides is that progress requires careful planning, realistic goals and the support of other health professions. Nurse prescribing came out of the Cumberlege report in the 1980s, which recommended that appropriately trained community nurses and health visitors should be able to prescribe from a limited list of drugs and appliances. The aim was to save nurses having to make time-wasting trips back to the general medical practitioner's surgery to obtain prescriptions for products about which the nurse often knew more than the GP. Proposals for pharmacist prescribing will also need to have an aim that clearly results in a better and more efficient service for patients.

The logic of nurse prescribing may have been unassailable, but it took a long time for the vision to become a reality. The nursing profession wisely enlisted the support of bodies such as the Royal Pharmaceutical Society. Pharmacy too needs to ensure that it wins the support of other health professions that have a future in prescribing. Equally, it should offer them its own support. The need to forge mutually supportive links with all such professions is emphasised this week in an interview with Ms Beth Taylor, a pharmacist who serves on the National Health Service Modernisation Board (p255).

Another lesson from nurse prescribing is the realisation that nurses on the whole do not have any self-aggrandising prescribing ambitions — and nor should pharmacists. Those who think that prescribing will place them alongside doctors, raise their status in the eyes of patients and other professionals, and transform them into a "true" clinical profession are heading for disappointment. It is more realistic to see pharmacist prescribing simply as an element of medicines management that is not important in its own right.

Initially, pharmacist prescribing is likely to be implemented in hospital pharmacy, in specialised areas where clear benefits for patient care and treatment outcomes can be seen — areas such as anticoagulant therapy, parenteral nutrition and discharge medication. This is another lesson from the model of nurse prescribing, where implementation has tended towards specialist nurses prescribing within their particular areas of expertise.

Prescribing in community pharmacy is likely to be low on the agenda. Improved access to health care in the community is more likely to be implemented through patient group directions than pharmacist prescribing.

Incidentally, in a leading article two weeks ago (PJ, February 10, p173), we suggested that pharmacists in Scotland and Wales may be the first to become involved in prescribing. In fact, there is at present no reason to think that any part of Britain will have a lead on the rest.

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