The Pharmaceutical Journal
Vol 276 No 7387 p166-167
11 February 2006

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· Skin conditions (2)
· Statins
· Independent prescribing
· Compliance aids (2)
· Universal health care
· Assisted dying
· CPD
· The Society

Letters to the Editor

Independent prescribing

Not just an extension of our present duties

From Mr G. M. S. Hill, MRPharmS

I would like to respond to the Broad spectrum article by Roger Cotton (PJ, 14 January, p38). I would like to think that I have some expertise in the field of prescribing, since I qualified as a supplementary prescriber last year.

The arguments used to urge caution against independent prescribing are disingenuous and reflect unfairly upon a group of practitioners who are pioneering in their training and consequently their approach to the consultation process. It is regrettable that the term “independent pharmacy prescriber” should be prevalent, rather than a more relevant description such as, specialist prescriber in “specialty” or prescriber (competent in “specialty”). This distinction is important for two reasons:

· It dissociates the health care professional from his or her original chosen field (after all, the legislative changes affect nurses and other sub-groups of the health care field).

· The intention is surely not to compete with GPs but rather to pursue the Government’s agenda of greater access to medicines and an improvement in clinical governance.

Mr Cotton has made the mistake of assuming our powers will be the same as that of the local doctor. This is simply not the case because:

· The new generation of prescribers are bound by national or local guidelines and will be obliged to adhere to best practice. Protocols will have to be in place from everything from taking blood to ensuring notes are entered on patient records in the appropriate format.

· Accountability is a cornerstone of the contractual obligations of workers in these fields. Being signed off as an independent prescriber will not be a satisfactory conclusion to the audit process of a pharmacist or nurse practitioner. Rather, the highest standards will have to be maintained to justify our existence to our paymasters, the primary care organisations.

We are not accountable for the culture of prescription “expectation” and have been trained how to deal with such situations in our supplementary guise. Furthermore, the explicit detail of guidance for each particular area of competence will ensure no over-prescribing can nor will take place. Any individual found wanting should not be allowed to practise as a prescriber (not every pharmacist is going to be an independent prescriber, the same as not every pharmacist is a supplementary prescriber). The principal reason for the existence of such prescribers is to oversee chronic conditions already diagnosed. If any diagnosis takes place it will only be when the prescriber has had the necessary training or demonstrated they have had the necessary experience.

The professional that Mr Cotton describes is a new one and should be valued as such. It is wrong to assume the matter of prescribing is simply an extension of our present duties.

Graeme Hill
Halsall, Lancashire

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