Independent pharmacist prescribing now legal but training still
to be finalised
Legislation to allow qualified independent pharmacist prescribers to prescribe any licensed medicine (except for Controlled Drugs) has been in force since 1 May. Prescribing for unlicensed uses (ie, “off-label” prescribing)
is also allowed, where it is in accordance with accepted clinical practice
and where a pharmacist is willing to accept professional, legal and clinical
responsibility for that prescribing. Work to bring about legislative
changes in Scotland and Wales is currently under way.
In practice, final decisions about the training requirements for independent
prescribers have yet to be made, and so pharmacists are currently unable
to adopt this role. The Royal Pharmaceutical Society has confirmed that
work on a curriculum, allowing pharmacists to qualify both as supplementary
and independent prescribers has begun, and is expected to be completed
later this year.
The independent prescribing legislation for pharmacists and nurses comes
shortly after the publication
of Department of Health guidance about
how the new prescribing role should be implemented.
According to the guidance, the use of off-label medicines should be approved
through mechanisms such as drugs and therapeutics committees. Pharmacists
must prescribe within their own level of experience and competence and
in accordance with the Royal Pharmaceutical Society’s “Medicines,
Ethics and Practice” guide. They must not prescribe medicines for
themselves, their friends or members of their family.
Pharmacists to be trained as independent prescribers must have at least
two years post-registration experience and will need to prescribe within
a robust clinical governance framework, the Society’s clinical
governance framework being advocated as helpful. Employers will also
need to confirm that prescribers will have the need and the opportunity
to do so immediately after they become qualified and will have access
to continuing professional development opportunities. When deciding which
pharmacists (and/or nurses) to train, local health economies are advised
to use the three key principles of: patient safety; maximum benefit to
patients in terms of quicker and more efficient access to medicines;
and better use of professional skills.
Best practice regarding patient records is that details of any prescription
and consultation are entered onto the shared patient record immediately,
or as soon as possible after the consultation. Prescribing and dispensing
can be carried out by the same individual pharmacist only in exceptional
circumstances and where another suitably qualified person is available
to carry out a final accuracy check.
Central funding to meet the direct costs of training for non-medical
prescribers working for the NHS is being made available through strategic
health authorities. Independent prescribers will have an annotation against
their names in the Society’s register signifying that they have
successfully completed an accredited training programme. An up-to-date
list of all nurse and pharmacist prescribers employed by an institution
should be kept in each hospital pharmacy, together with specimen signatures.
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Hospital Pharmacist