Independent prescribing could be beneficial for patients, says BMJ
With appropriate training, support and governance in place, extended
prescribing rights could combine the benefits of high quality pharmaceutical
care with greater convenience and improved access to treatment for
patients, an editorial in last week’s BMJ concludes (2005;331:1154).
The editorial, by Anthony Avery, professor of primary health care, and
Mike Pringle, professor of general practice, at the University of Nottingham
Medical School, acknowledges the British Medical Association’s
concerns that it is not safe to prescribe without training in diagnosis,
but points out that as a result of training available for pharmacists
and nurses in the UK, both professions are able to diagnose and manage
acute illness in primary care, and some are already prescribing independently
from a limited formulary.
However, they argue that extending prescribing rights is an important
departure from current practice and deserves scrutiny. A key question,
they say, is whether non-medical prescribers are likely to prescribe
beyond their competence. They highlight some evidence that suggests that
pharmacists and nurses tend to stick within their area of competence
but argue that it is impossible to draw clear conclusions on the safety
and appropriateness of extended prescribing. They question the Department
of Health’s decision to launch the policy without waiting for further
evidence to accumulate.
To limit the potential risks of extended prescribing, they recommend
that prescribers should be appropriately trained and that additional
training, support and mentoring is available following training. In addition,
independent prescribers should have access to the tools needed to prescribe
safely, including computer systems that generate prescriptions, they
say. Finally, they emphasise the need for strong clinical governance
to ensure that any prescriber exceeding his or her competence is identified. |
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