The Pharmaceutical Journal
Vol 270 No 7238 p291
1 March 2003

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DoH: Supplementary prescribing (more)

DoH issues guide to implementation of supplementary prescribing online

The Department of Health has issued a guide for implementation of supplementary prescribing in England. The guide, which applies to pharmacists and nurses, explains how such prescribing will work and who can undertake it and covers legal, training and evaluation issues.

Gul Root, principal pharmaceutical officer at the DoH, reminded The Journal that it plans to introduce supplementary prescribing from April 2003. Nurses have already begun training, while pharmacists will begin to train from spring 2003.

The relationship between independent and supplementary prescribers is the key to safe and effective prescribing, says the guide. The two professionals must be willing and able to work together and communicate easily, share access to and keep a common patient record up to date. Both may work in more than one prescribing partnership.

Supplementary prescribers must prescribe in accordance with the clinical management plan (CMP). They must monitor and assess the patient's progress and work within their clinical competence. They have clinical responsibility for and must be professionally accountable for their practice but must pass responsibility back to the independent prescriber if adequate reviews are not undertaken. The supplementary prescribing must be supported by regular clinical review of the patient by the independent prescriber at intervals no longer than one year, and much less if antibiotics are included.

The guide says that individual CMPs should be drawn up and agreed before supplementary prescribing begins. The DoH has drafted two sample templates. The independent prescriber is responsible for setting the parameters of the CMP although they do not need to draw it up personally.

Pharmacists are encouraged to record all details of monitoring and supplementary prescribing. Information should ideally be entered immediately on the common patient record. Pharmacists should not have a system of separate records. If not possible, separate records should be transferred to the common patient record within 48 hours.

For pharmacists prescribing with the consent of their employer, the employer is held vicariously liable for their actions. The guide says that all supplementary prescribers should ensure they have professional indemnity insurance. Pharmacists are reminded that they should not prescribe any medicine outside their area of competence.

Pharmacists undertaking supplementary prescribing must have at least two years post registration experience and have completed an approved training programme (PJ 4 January p21).

The DoH says that dispensing and prescribing need not necessarily be separated provided clear accountability arrangements are in place to assure patient safety and probity. Rules for dispensing and reimbursement of supplementary prescribers' scripts will be the same as for GPs'.

Dispensing pharmacists will have to check the status of prescriptions received from supplementary prescribers. The guide advises them to have a local list of bona fide prescribers with a copy of their signatures. An individual's prescribing status will also be held by the Nursing and Midwifery Council and the Royal Pharmaceutical Society.

The guide can be downloaded as a PDF file from the Department of Health website.