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Funding and lack of access to records could slow progress of independent pharmacist prescribing

Concerns that a lack of funding could hinder the progress of independent prescribing were raised at a meeting in London last week, organised by the Social Market Foundation. Continuing professional development for pharmacist and nurse prescribers is one of the first things being pushed to one side as primary care trusts struggle to balance their books, said David Green, specialist pharmacist at Essex Rivers Healthcare NHS Trust. PCTs are still putting people through supplementary prescribing courses but if qualified prescribers want to refresh and improve their knowledge through further training they are finding it difficult to obtain funding and time for study, he explained.

David Pruce, director of practice and quality improvement at the Royal Pharmaceutical Society, added that he has concerns over whether the NHS’s financial problems would affect PCTs’ ability to commission enhanced services. “Prescribing is a tool and clinical services need to be developed alongside it. A critical factor is whether PCTs will have enough money to commission enhanced services where it would be useful to have pharmacists prescribing,” he said.

Lack of access to patients’ medical notes was also raised as a possible stumbling block. “This is a big debate, a lot of which is driven by patient confidentiality,” said Mr Green. “We have to keep pushing for electronic access to records, and equality of access to records for all prescribers,” he said.

Potential conflict between community pharmacists’ commercial interests and the interests of their patients was also raised. Mr Pruce explained that supplementary prescribing courses for pharmacists and nurses include a section about external influences on prescribing. The Society is still in discussions with the Department of Health about courses for independent prescribers but Mr Pruce suspects that they will be similar to those for supplementary prescribers. The course also deals with the influence of pharmaceutical industry representatives. Mr Green said that he believes pharmacists are more aware of the need for critical appraisal of marketing material from the pharmaceutical industry than those working in other sectors.

Teamwork will be essential if independent prescribing by pharmacists and nurses is to be a success. “The word ‘independent’ conjures up people working in isolation — that would be a disaster. We must work as part of a team so that everyone is aware of what each other is doing,” said Mr Pruce. He predicted that the first independent pharmacist prescribers are not likely to qualify before the end of the year.