The Pharmaceutical Journal
Vol 268 No 7194 p521-527
20 April 2002

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Medicines Control Agency (www.mca.gov.uk)

Consultation starts on supplementary prescribing by pharmacists and nurses

Pharmacists could be writing prescriptions next year if proposals published this week are implemented. The start of a consultation period on supplementary prescribing by pharmacists and nurses was announced by the Government on 16 April.

The consultation document, MLX 284, produced by the Department of Health and the Medicines Control Agency, sets out proposals for supplementary prescribing by nurses and pharmacists and proposed amendments to the Prescription Only Medicines (Human Use) Order 1997. It says that the proposals are intended to enhance patient care by providing quicker and more efficient access to health care through an increased and flexible use of pharmacists' and nurses' skills.

The proposed changes would allow prescription-only medicines to be prescribed by a supplementary prescriber as part of an agreed clinical management plan for individual patients. Supplementary prescribers would be responsible for monitoring and assessing a patient's progress, and prescribing medicines (including altering doses) within the limits of an agreed management plan. Supplementary prescribers would have to accept clinical responsibility and professional accountability for their prescribing decisions and practice.

The proposed prerequisites for supplementary prescribing are:

1. An individual clinical management plan for a named patient and specific condition must be written and agreed in consultation with the patient.
2. The plan must specify the range of medicines that can be prescribed for a named patient and the range and circumstances within which dose, frequency and formulation of the specified range of medicines can be varied.
3. Both independent and supplementary prescribers must share access to the same common patient record.

It is not proposed to restrict the range of medicines that can be prescribed, with the exception of not allowing prescribing of Controlled Drugs and unlicensed medicines outside paediatric care. In addition to POMs, it is proposed that supplementary prescribers should be able to prescribe pharmacy and general sale list medicines. It is expected that supplementary prescribing will be of most benefit for managing non-acute conditions such as asthma and diabetes and for prescribing long-term treatments such as anticoagulants and hormone replacement therapy. Pharmacists wishing to become supplementary prescribers will have to undertake training and become accredited.

The consultation document suggests that prescribing and dispensing responsibilities should be kept separate.

Speaking at a Pharmacy Management seminar in London on 17 April, Professor Clare Mackie, head of centre for partnerships in medicines for health, Robert Gordon University, Aberdeen, pointed out that skill mix in community pharmacy was an area that needed consideration. If dispensing was devolved to technicians in standard operating procedures, would responsibility lie with the pharmacist who wrote the SOP and did this mean that prescribing was a separate function, she asked.

In more general terms, Professor Mackie said: "The benefits of supplementary prescribing come when a dose has to be altered, such as during a flare-up of disease." Patients who would benefit most from supplementary prescribing were those who take a number of medicines who were likely to be reviewed more frequently under a system of supplementary prescribing than repeat prescribing. For this reason she believed that pharmacists should prescribe in a general manner rather than specialising in one or two disease areas.

Outlining the proposals, Health Minister Lord Hunt said: "Pharmacists are an untapped resource for the National Health Service. There are around 20,000 pharmacists practising in the community and in hospitals in England and by harnessing their skills we can deliver rapid access to medicines and improved patient care."

The implementation of parts of the Health and Social Care Act 2001 on 1 April will enable the introduction of different types of prescriber and the extension of prescribing responsibilities to other health professions, including pharmacists, via amendments to section 58 of the Medicines Act 1968.

Although the proposals are being circulated throughout the United Kingdom, the Department of Health says that the extent to which supplementary prescribing is adopted is a matter for each devolved administration. A trial of pharmacist prescribing is already under way in Scotland (PJ, 23 February, p238).

Public consultation on supplementary prescribing ends in July. The Government envisages that training of nurses will begin later this year, training of pharmacists early in 2003 and supplementary prescribing (initially by nurses) will be introduced in 2002.

The consultation document is available on the MCA website (www.mca.gov.uk). Comments should be addressed to Anne Ryan, 16-142, MCA, Market Towers, 1 Nine Elms Lane, London SW8 5NQ (e-mail anne.ryan@mca.gsi.gov.uk).