The Pharmaceutical Journal Vol 267 No 7169 p533
13 October 2001

Action on pharmacist prescribing

The Royal Pharmaceutical Society is to send a letter to the Medicines Control Agency stating that a strong argument for the prescribing of prescription only medicines by pharmacists arises from an MCA proposal for extending nurse prescribing. (See also October Council meeting.)

The decision to send the letter was made by the Practice Committee when it considered the MCA proposal during its meeting on 18 September. The committee noted that the MCA proposal, contained in a consultation letter (MLX 273) of 19 July entitled “Extended prescribing of prescription only medicines by independent nurse prescribers” (PJ, 28 July, p111), would considerably increase the range of POMs available for nurse prescribing and would extend prescribing rights to any first-level registered nurse who has had a limited amount of additional training.

Currently nurses may prescribe only from a limited list of POMs and only if they hold a district nurse or health visitor qualification and are recorded in a register held by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC).

The Society’s letter points out that, if the length and type of training proposed is considered to impart competence to prescribe, then pharmacists, with their training, should also have the same list available to them.

In a separate letter, directly responding to the proposals as they affect nurses, the Society particularly emphasises the requirement for competency, the practical difficulties of prescribing and the need for training to include risk management and multiple pathology.

Commenting on the consultation document’s definition of nurses who are eligible to prescribe, the response begins with a reminder that the Crown review of the prescribing, supply and administration of medicines identified a number of principles contributing to patient safety and improved health outcomes. Among these were that prescribing should be restricted to those who were competent to assess all relevant aspects of the patient’s clinical condition, to decide on an appropriate programme of clinical management and to take responsibility for prescribing and related decisions.

In a comment on the prescribing resources that might be made available to nurses, the response says that, although the use of the British National Formulary might seem appropriate, considerable changes would need to be made to accommodate nurse prescribing. For example, it would be necessary to identify the conditions for which a nurse could prescribe a given medicine and those for which nurse prescribing would be inappropriate. Furthermore, the BNF was currently written for physicians and pharmacists, who interpreted the information in the light of their extensive education and training. Modification might be needed to take nurse education into account.

Commenting generally on range of antibiotics included in the list of POMs available to prescribing nurses, the Society’s response reminds the MCA of the Crown report’s specific warning, on grounds of public health, that antibacterial antibiotics should not normally be available to new groups of prescribers because of the risk of increased prescribing leading to the development of resistant organisms.

Concluding with some general comments, the response notes that all nurses who complete the training would be able to prescribe privately, even if they are not entitled to prescribe within the National Health Service. This raises the question of what level of clinical supervision would be available and what framework of regulation would be in place outside the NHS.

The response also points out that pharmacist could face difficulties in identifying the areas in which individual nurses had been authorised to prescribe and the formularies available to them. It asks whether in practice there would be a need for constant references to a UKCC register of specialists.

Certificates of attendance The Education Committee agreed that the Society should produce a template for a certificate of attendance at continuing education events. The template would be made available to Society branches and other groups.

At its previous meeting, the committee had recognised that many pharmacists, especially those who were members or associates of the College of Pharmacy Practice, had a wish for some form of attendance certificate for continuing education events. Committee member Sheila Chantler had subsequently drafted a pro forma certificate incorporating the learning objectives for the meeting and a number of self-reflection and self-evaluation questions. This had been considered by the continuing professional development advisory group, which had suggested some improvements, before submission to the committee.

Pharmacy school intake The Education Committee was pleased to receive information suggesting that most, if not all, of the United Kingdom schools of pharmacy had reached or exceeded their intake targets for pharmacy degree courses starting this autumn. However, it seemed probable that for some schools the mean A-level scores of entrants from secondary education would this year be somewhat lower than the mean scores in recent past years.

The committee’s information came from informal reports from members of the committee involved with schools of pharmacy.

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