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'Multidisciplinary prescribing standards should improve transfers and team working’

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The Nursing and Midwifery Council decided last month to formally adopt the Royal Pharmaceutical Society’s multidisciplinary prescribing competency framework as its standards of proficiency.

catherine picton picture

catherine picton picture

Catherine Picton

In future, all NMC-approved prescribing programmes will need to deliver outcomes which meet the RPS’s Competency Framework for all Prescribers. This decision is to be welcomed.

The use of multidisciplinary set of standards has the potential to help improve the quality of prescribing for patients - and provide consistency - as the number of professionals, and professions, able to prescribe increases.

The NMC consulted extensively on whether to adopt the RPS framework, and views expressed via the consultation were strongly in favour of the proposal.

According to the NMC, 82% of those responding to the consultation were in support and 95% of that group felt it would lead to shared approaches to competency across health and social care professions.

This is perhaps a reflection of the desire to ensure that all members of the multidisciplinary prescribing team are working together in the best interests of patients.

“It is well recognised that prescribing errors often occur at the interfaces where care is transferred”

The need for shared approaches to prescribing is crucial for many reasons – the foremost one being that the NHS is actively exploring new models for delivering care.

We are seeing that, as new models develop, the lines between settings are blurring, with patients previously managed in a hospital either transferred for ongoing care to community or primary settings, or treated in them in the first instance.

What this means for any prescriber is that the patient’s care and, with it, the prescribing of medicines, will move through a range of different, and in some cases new, environments.

At the same time, the evolving needs of the service and the expectations of the public mean that a range of different prescribers are taking on more responsibilities, and this is likely to continue.

Paramedics have become the most recent professional group able to undertake prescribing training. We can expect that prescribing practice is likely to become a key requirement of future care delivery across other professions too.

All of these changes are already having an impact on the governance of prescribing. Not least because it is well recognised that prescribing errors often occur at the interfaces where care is transferred.

Meanwhile, the increasing complexity of prescribing is a major challenge for all – both in terms of the number and range of complicated drugs in use.

“Medicines are used more than any other intervention to manage medical conditions”

Medicines are used more than any other intervention to manage medical conditions. As the population ages and more patients have multiple long-term conditions, polypharmacy is becoming the norm.

There is also an ongoing debate about consultation times and the effective use of skill mix in multidisciplinary teams, driven by the need to ensure patients’ medicines are regularly reviewed.

In light of all this, it is encouraging to see the NMC become the first professional regulator to have adopted the RPS’s framework. (Though it is perhaps not surprising the nursing regulator has taken the lead, as the first prescribing competency framework used in Britain, developed in 2001, was created specifically to support the roll-out of nurse prescribing.)

The NMC’s decision last month gives it and other nursing organisations the opportunity to be at the forefront of promoting cross regulatory working and supporting cross-professional collaborations to improve prescribing practice.

Encouraging our colleagues, our professions, other regulators and professional bodies to use the same framework to promote multidisciplinary learning and embed generic professional skills for all can only be a good thing for the delivery of high quality and safe care to patients.


Catherine Picton is a policy and healthcare consultant and the lead author of the RPS’s Competency Framework for all Prescribers


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