The Pharmaceutical Journal
Vol 269 No 7228 p859
14 December 2002

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College of Mental Health Pharmacists/Industrial Pharmacists Group summary

Pharmacists better than nurses for prescribing role

One of the new initiatives that impacts on medicines used in psychiatric illnesses is the National Institute for Mental Health (NIMHE), which is based in the Modernisation Agency of the Department of Health, explained David Branford, director of pharmacy services, Derbyshire Mental Health Services Trust.

Its core activities are a Leeds-based central hub to provide leadership and co-ordination, eight development centres to share experiences and solutions to work practices for front-line teams, a standing programme of research and a national programme of work, creating new partnerships and action at national level to help staff deliver change locally. Despite NIMHE's stated aims to improve the quality of patients' lives, help implement change and develop, deliver, monitor and review services, pharmacists have had no opportunity to input to its activities.

The most recent full review of mental health legislation was the Percy Commission's report, produced in the 1950s, explained Dr Branford. In June 2002, the draft Mental Health Bill was issued. This followed an Expert Committee's report on which the UK Psychiatric Pharmacists' Group had commented at every stage. Dr Branford said that because medicines are central to making and keeping patients well, there are concerns over the way they are used in psychiatric illnesses and, as patients currently feel uninformed with little or no ability to influence their treatment, this Bill has important implications for pharmacy.

To safeguard patients, the Department of Health will draft a new Code of Practice. Patients must be fully involved in decisions, have access to specialist advocacy services and provide consent to treatment. There will be greater involvement of carers and the sharing of information will be improved. The redefinition of treatment in the draft Bill is so broad that it is unhelpful, limits the freedom to prescribe and proposed timelines may well bog down the treatment process in bureaucracy. The proposals have serious implications for medical manpower (600 additional psychiatrists are required) and the opportunity to develop existing checks and balances, such as specialist psychiatric pharmacists, has been ignored. There is overwhelming opposition to the draft Bill, which is expected to be taken away for rewriting.

Dr Branford went on to discuss nurse prescribing, saying that last year supplementary prescribing proposals allowed nurses and others to treat mental illness after an initial assessment by a doctor. Since nurses have hardly any training in therapeutics, pharmacists are better placed to take on the prescribing role, he said. The process of mental health prescribing could be assisted by a wider range of patient group directions, the development of agreed protocols implemented by nurses and pharmacists, supervised nurse/pharmacist-led clinics and the development of prescribing care plans, suggested Dr Branford. He added that in the future there may be specialist-advanced nurse practitioners.

However, as was pointed out during the discussion period, pharmacists are already training nurses, but once nurses realise how much they do not know, they do not wish to take on the responsibility of prescribing. Pharmacists working in mental health need to provide a monitoring and training role for nurses and it was suggested that the pharmaceutical industry could help enormously by assisting the development of training packages for nurses.