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Extended prescribing powers -Three views

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VOL: 98, ISSUE: 44, PAGE NO: 37

DIANNE BURNS, BSc (Hons), RGN, is a nurse practitioner, Pennine Medical Centre, Mossley, Greater Manchester

Sponsored by PFIZER



New relationships will be created with the extension of nurse prescribing, particularly if the proposals for supplementary prescribing for nurses and pharmacists (DoH, 2002), come into force. In this final Part of the series on nurse prescribing we have sought the views of a nurse, a GP and a pharmacist on the issue of extended prescribing.



A nurse’s view
The extension of the Nurse Prescribers’ Formulary by the Department of Health has been long awaited. However, many nurses working in general practice will be bitterly disappointed by the limitations of the new formulary, particularly the omission of certain drug groups, for example, some asthma therapies, which will leave them with no alternative but to continue to provide prescription-only products to their patients via patient group directions until such time as ‘supplementary prescribing’ arrangements are in place.



Until recently, practice nurses were unable to attend a prescribing course unless they possessed a health visitor or district nurse qualification. This has now changed, and the opportunity to participate in such training should be welcomed. No one can argue against all nurses being involved in the provision of medication, and that, by whatever means, they need a well developed understanding of pharmacology and of the processes involved in prescribing, even if they do not sign the prescription themselves. Access to such training programmes allows practice nurses to increase their knowledge and awareness of important prescribing issues, debate prescribing dilemmas and increase their awareness of the legal and ethical issues related to prescribing, particularly if they have not yet been able to do so.



However, the training involves time away from surgeries in addition to many hours of supervision by the nurse’s GP colleagues. Many nurses feel it will be a waste of time and effort on their part, with little benefit to their patients, to undertake this further training, as access to such a limited formulary will not really make a significant difference to the quality and effectiveness of the care they provide.



In its current form, the Nurse Prescribers’ Formulary is of very limited use, particularly to those working in primary care who deal with minor illness and manage chronic disease. Even though a small number of antibiotics have been included in the formulary, the list is limited, and the nurse will be allowed to prescribe them only for certain clinical conditions.



Furthermore, the inclusion of travel and childhood vaccines demonstrates a lack of understanding of the way that such products are routinely provided to patients. In many surgeries, vaccines are kept in stock and are supplied and administered under patient group directions. If this were to change and the nurse had to write a prescription for every patient, this would treble the ever-increasing workload.



Although the government is now considering proposals to extend prescribing rights further to include ‘supplementary prescribers’ and additional drug groups, for example, for asthma and diabetes therapies, it remains unclear how effective and useful this will be given the extra documentation and time involved in setting up written individual arrangements for patients. I suspect that the right to prescribe in such a manner will make very little difference to the way practice nurses provide care for their patients.



It has already been demonstrated that nurses working in areas such as asthma, diabetes and women’s health, influence GPs’ prescribing habits to a large degree (Jones, 1994). However, the government appears not to have recognised this. I hold the view that there is no reason why an appropriately trained and competent nurse should not be able to access a wider formulary. However, for the foreseeable future, it appears that unless there are radical changes, some nurses working in general practice will continue to provide medications to their patients via current existing mechanisms.



It seems a shame that a golden opportunity to provide nurses with the tools they need to improve access to healthcare for patients appears to have been missed. If the government really wants nurses to play a part and be able to deliver their plans for the NHS they must give them the tools to be able to do ‘so.

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