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Mr Jones is editor of Hospital Pharmacist |
Supplementary prescribing training is not being tailored to meet the needs of pharmacists, and the requirements of the clinical management plans, the bedrock of supplementary prescribing, are grey. These were some of the views expressed at the Hospital Pharmacist conference by pharmacists on the supplementary prescribing courses, which demonstrated that many issues are still unresolved in this latest advancement in pharmacy practice. Other opinions expressed suggested that the new legislation
and training attached to pharmacist prescribing is required just to legitimise
what is already widespread practice in hospitals, and its purpose is
simply to plug the current
significant gaps in the medical workforce. On a more positive note, much
was said about how pharmacist supplementary
prescribing can contribute to patient care.
This year’s conference brought together pharmacists from around
the country with people who shaped the concept of
pharmacist prescribing, such as Dr June Crown, representatives of government
and the Royal Pharmaceutical Society and one pharmacist representing
those who are currently training and will be prescribing for their patients
within the next few months. The intention was to answer questions such
as “why should pharmacists prescribe?”, “how will patients
and hospitals
benefit from having pharmacist prescribers?” and “where is
supplementary prescribing
taking the profession?”
The driving force behind pharmacist supplementary
prescribing is a desire for patients to have an improved access to health
care staff, a
better quality of care, greater convenience and increased choice. From
the point of view of the National Health Service, extending prescribing
rights to pharmacists helps meet the goal of making better use of the
skills of the workforce.
At the British Pharmaceutical Conference in September 2003, Health Minister
Rosie
Winterton said that
supplementary prescribing for pharmacists was a watershed.
“Supplementary prescribing by pharmacists offers huge
potential to improve patient care, particularly for people with long-term
conditions, by making much better use of pharmacists’ skills,” she
said.
Further support for
pharmacist prescribing is given in “A vision for pharmacy in the
new NHS” and “Pharmacy in a new age”.
Clinical management plans set out the treatment plan, and are agreed
by the patient, the supplementary prescriber and the independent prescriber
(usually the diagnosing
clinician). They will set out how the patient will be managed, list the
circumstances under which patients should be referred back to the independent
prescriber and describe the responsibilities of the supplementary
prescriber. Concern has been expressed that the first
supplementary prescribers are leaving themselves open to legal action
if courts do not recognise the legality of the clinical
management plan under which they prescribe. However, clear advice and
examples are
available from the Department of Health website with
further examples being provided by the London
supplementary prescribing
for pharmacists project team (available here).
Over 150 pharmacists in Great Britain are enrolled on current courses,
the majority working in hospitals. The end point of accreditation as
a
supplementary prescriber should be the same for both nurses and pharmacists.
But is it realistic to accredit courses to take both nurse and pharmacist
trainees? The skills of the two professions are quite different, as demonstrated
by the entry level training. Nurse training of
pharmacology varies at
different institutions from a few hours up to 100 hours.1 Compare this
to pharmacists who have a much deeper and broader understanding of
pharmacology, which is a core element of the four-year
undergraduate degree. There are, of course, skills required to prescribe
in which initial
nursing training equips nurses better than pharmacists. How,
therefore, can the training be focused and relevant when it is being
delivered at the same time to two disparate
professions?
Looking further forward,
pharmacists may be in the
position to prescribe
independently. Hospital
pharmacists are accustomed to altering and stopping
prescriptions and writing
discharge prescriptions, but will they have the opportunity to do much
more? It must therefore be asked whether the new
prescribing role, while it may bring training, recognition and legitimacy
to practice, is anything new.
Will pharmacists prescribe any better than doctors? There is
currently little published
evidence that pharmacists can prescribe even as well as doctors. It will
therefore be important for further developments in the field of pharmacist
prescribing that clear evidence is generated to demonstrate its safety
and
efficacy. Unless pharmacists can show that they are better than other
health professionals at
prescribing, then, in taking on prescribing roles, the profession may
be moving in a direction where pharmacists no longer have a unique feature
to
differentiate themselves from others.
The outstanding question, however, remains. Is pharmacist supplementary
prescribing just about covering workforce gaps in the health care system,
or does it offer tangible benefits to patients? Only when the
pharmacists currently training start to undertake their roles in the
new year will the answer become clearer.
References
1. Leathard HL. Understanding medicines: conceptual analysis
of nurses’ needs
for knowledge and understanding of pharmacology. Nurse Education Today
2001;21:266-71. |
