Dr Andrea Hilton and Kirsty Fishburn, Faculty of Health Sciences, University of Hull.
Over the past two decades, there has been continued growth in the number of nurses and midwives who can act as independent and supplementary prescribers. Nursing and Midwifery Council (NMC) ‘extended’ and ‘supplementary’ nurse prescribing qualifications were launched in 2002 and 2003 respectively, allowing nurses and midwives to prescribe from a limited formulary. In 2006, legislation allowed for independent nurse prescribers to be able to prescribe licensed medication from the whole of the British National Formulary (BNF) (National Institute for Health and Care Excellence (NICE), 2019). Further legal changes over the next 6 years allowed the prescribing of unlicensed drugs and controlled drugs (with some exceptions) within the nurse/midwife sphere of competence (Pharmaceutical Serviced Negotiating Committee (PSNC), 2013).
The growth of non-medical prescribing has gone far beyond nurses and midwives. With additional training and education, independent prescribing can also be undertaken by pharmacists and a range of Health and Care Professions Council (HCPC) registrants such as therapeutic radiographers, podiatrists, physiotherapists and – from 2018 – advanced paramedics.
Central to the development of this role is the provision of a medical practitioner as the assessor of practice-based competencies, known as a “designated medical practitioner” (DMP). The National Prescribing Centre (which became part of NICE in 2011) stated in 2005 that the requirements needed to act as DMP were;
“The DMP must be a registered medical practitioner who:
- Has normally had at least three years recent clinical experience for a group of patients / clients in the relevant field of practice
- Is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post-graduate Training in General Practice Certificate or is a specialist registrar, clinical assistant or a consultant within a NHS Trust or other NHS employer
- Has the support of the employing organisation or GP practice to act as the DMP who will provide supervision, support and opportunities to develop competence in prescribing practice
- Has some experience or training in teaching and / or supervising in practice”
This effectively has not changed until 2018, with the introduction of the new practice standards from the NMC, new standards for prescribing from the General Pharmaceutical Council (GPhC) in 2019, and new standards for prescribing from the HCPC in 2019. All now refer to the role of the DMP as someone who may be other than a medical practitioner. The HCPC state the practice educator is “…a qualified prescriber, on the register of their statutory regulator with annotation(s) for prescribing where applicable and with the relevant skills, knowledge and experience to support safe and effective learning and ……must undertake regular training which is appropriate to their role, learners’ needs and the delivery of the learning outcomes of the programme” (HCPC, 2019).
The GPhC align this role to the Designated Prescribing Practitioner (DPP) with the following requirements:
“Prospective designated prescribing practitioners must have:
- active prescribing competence applicable to the areas in which they will be supervising
- appropriate patient-facing clinical and diagnostic skills
- supported or supervised other healthcare professionals, and
- the ability to assess patient-facing clinical and diagnostic skill” (GPhC, 2019)
The NMC use the term practice assessor and practice supervisor and, for the prescribing course, the practice assessor “is a registered healthcare professional and an experienced prescriber with suitable equivalent qualifications for the programme the student is undertaking” (NMC, 2018).
All three regulators have slightly different requirements which need to be recognised and addressed by Universities, practice partners and practitioners. These changes to ‘practice assessors’ are going to be supported with guidance and practical help from the Royal Pharmaceutical Society, who should publish in December 2019 a Competency Framework for Designated Prescribing Practitioners (RPS, 2019).
With changes to who will assess non-medical prescribers in the future – not to mention the new professional groups potentially to add to the non-medical prescribing list – it could be argued that for nurses, this has been largest change to prescribing since 2012. However, are there still questions to answer about whether nurses and midwives want – or feel ready – to take on the role being proposed as practice assessor. New standards highlight the training and support which Universities should provide, but what additional skills and support do non-medical prescribers themselves think they need in order to undertake this role? Let’s open this discussion.
General Pharmaceutical Council (2019) Standards for the education and training of pharmacist independent prescribers. Available online: https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-education-and-training-of-pharmacist-independent-prescribers-january-19.pdf [Accessed September 2019 ]
Health & Care Professions Council (2019) Standards for prescribing. Available online: https://www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing/ [Accessed September 2019]
National Institute for Health and Care Excellence (2019) BNF. Available online: https://bnf.nice.org.uk/ [Accessed September 2019]
National Prescribing Centre (2005) Training non-medical prescribers in practice. Available online: https://www.webarchive.org.uk/wayback/archive/20140627112130mp_/http:/www.npc.nhs.uk/non_medical/resources/designated_medical_practitioners_guide.pdf[Accessed September 2019]
Nursing & Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers. London: NMC. Available online: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-proficiency-nurse-and-midwife-prescribers.pdf[Accessed September 2019
Nursing & Midwifery Council (2018) Part 3: Standards for prescribing programmes. Available online: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/programme-standards-prescribing.pdf [Accessed September 2019
Pharmaceutical Serviced Negotiating Committee (2013) Prescribing rights. Available online: http://archive.psnc.org.uk/pages/prescribing_rights.html [September 2019]
Royal Pharmaceutical Society (2019) Competency framework for Designated Prescribing Practitioners. Available online: https://www.rpharms.com/recognition/all-our-campaigns/competency-framework-for-designated-prescribing-practitioners[Accessed September 2019]