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Nurse prescribers in England saving NHS millions, says report

  • 8 Comments

Non-medical prescribers are saving the NHS in England an estimated annual £777m, which could be increased further by at least £270m a year if more GP practices were to employ them, according to a new report.

Commissioned by NHS Health Education North West, the report investigated the economic benefits of non-medical prescribers (NMPs) in both primary and secondary care.

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The report – by data analysis firm i5 Health – noted that, despite “considerable evidence” that already exists showing non-medical prescribing is safe and advantageous to patients, the “adoption of NMP within the NHS is still at a relatively slow pace”.

It looked at money saved as a result of reduced GP appointments, hospital attendances, admissions and other patient contacts. National estimates were based on an annual clinicians’ audit in the North West of England.

The audit found almost 1,500 nurse prescribers in that region prevented around 20,000 further contacts in just one month.

This was equivalent to a £2.53m saving, with the majority of this coming from reduced admissions and follow up hospital appointments, as a result of nurse prescribers in secondary care, community settings and GP practices.

The report – called Non-Medical Prescribing (NMP): An Economic Evaluation – also looked at the potential impact on secondary care from having NMPs in primary care, in relation to 16 long term conditions.

It found accident and emergency and non-elective hospital admissions, and 30 day re-admissions were significantly reduced for patients registered with a GP practice with at least one NMP compared to practices with no NMPs.

“It has long been advocated that the non-medical prescribing model in England enhances patient experience [but] the discipline has not been widely adopted”

NHENW report

The study investigated potential benefits for a quarter of GP practices in England that do not have NMPs and are considered to be “most challenged” – those with the highest levels of attendances and admissions from long term conditions.

If these practices were to introduce at least one NMP, it was estimated resulting secondary care savings could be more than £270m every year.

“The introduction of just one NMP practitioner into the primary care setting can have effects well beyond the saving of doctors’ time,” said the report. “Those effects reach across the long term condition spectrum and right into the secondary care sector.”

Meanwhile, introducing NMPs into settings such as care homes, out of hours practices and palliative care, could result in annual savings for a clinical commissioning group of up to £1m.

“[This analysis] underlines the importance of commissioners in particular introducing, as a matter of course, the consideration of the NMP initiative into their planning and decision making processes. In many parts of the country…. it is [currently] given relatively little consideration,” said the report.

“It has long been advocated that the non-medical prescribing model in England enhances patient experience without endangering patients, improves overall performance and brings about significant economies. However, the discipline has not been widely adopted in either the primary or secondary care environments,” it added.

“This report seeks to demonstrate that not only the data can be collated, connected and analysed but that the results of such exercises can provide strong support for the wider adoption of NMP,” it concluded.

  • 8 Comments

Readers' comments (8)

  • as per usual nurses are seen as cheap

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  • dtbarron

    What a shame 'anonymous' on 10th December fails to grasp the opportunity outlines in the article. Instead of seizing this to demonstrate the added value that nurses bring to the team 'anonymous' reduces it to a comment about money. Did they actually read the article? The article clearly laid out numerous health and wellbeing benefits for patients - just because an article looks for an attention grabbing headline doesn't mean we have jump on the bandwagon - look beyond the headline, this article is about so much more than money - this is a clear demonstration of the added value to the whole system that well trained and highly skilled nurses bring: NMP being one more example of that.

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  • Derek, you are absolutely right in your observations. Name a field of healthcare and there is evidence of the unique impact that nursing brings to the table, in this case with prescribing.

    Whatever opportunities present themselves in the future we will be there, beating a path to make things better for patients.

    I do, however, have sympathy with Anons comment. Those running healthcare will always provide the service at the cheapest cost. Sadly, however, nurses have a track record for failing to protect the profession financially. The recent farce over the pension was a good example of that. The erosion of unsocial extra duty payments will be next. The fact that these payments make approx 20% of a band 5 take home salary, for someone on regular night duty that is 37%. Compare us to ANY other graduate public service and we are not paid with parity. We are conditioned to accept it.

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  • dtbarron

    Thanks Andrew
    Yes, we have to protect nurses, sometimes from other nurses when it comes to Ts&Cs I agree with you.

    What prompted me to respond to Anon was the lack of ambition in their comment, the reductionist moan in the few words they penned.

    Will we and should we always consider value for money in what we do? - yes, it's a limited lot of public money; might that mean on occasions that nurses are a less expensive option than other professions? Again the answer is yes. Does that mean we shouldn't sieze the opportunity? - no it doesn't.

    We need to balance value for money with the scope of nursing practice and having a watchful eye to being done 'on the cheap' rather than being done with value for money in mind.

    Thanks for your comment, important points you noted.

    DTB

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  • Thanks Derek - I take on board your points. Value for money is always something we bring to the table. Usually whilst improving quality - but I have to take issue with the nursing profession that it has never had the courage to value itself financially. Yes, there is a limited pot of money - but there are choices. For example, the gvt choose to give those at the top of the tree a tax cut whilst pegging our salary. For 4 years. And intends to do so again. Whilst the gvt savaged our pension we did nothing.
    I developed a service that utterly transformed cancer diagnosis in our Trust for my specialty - shortening diagnosis from 10days to same day by radically developing the role of nurses. Better for patients and much cheaper - delivered by nurses rather than docs. And I now teach on the SpR training programme to share the transformation in care. Major developments like this are littered throughout the nursing profession, and I am as guilty as anyone about failing to celebrate it publicly - I just get on with the job, looking for the next thing to improve at cheaper cost.
    I do believe we are undervalued and that in recent times the austerity mantra is just an excuse to drive down our salary whilst the gvt continues to break up the NHS to the highest bidder.
    Have you looked into TTIP? Will tell you everything you need to know about the political direction of travel.
    Best
    Andrew
    PS apologies for the long winded nature - am v tired t the end of a very challenging day!

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  • dtbarron

    It's useful and interesting to hear your perspective, much of which I concur with.

    I'm in the fortunate position of living and working in Scotland with a government that doesn't believe in selling the NHS to the highest bidder - that doesn't mean they've got everything right though; it is however a comfort to be somewhere where the NHS is valued.

    Thanks for sharing your thoughts.

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  • David Solomon

    Very promising article on the benefits of NMP on healthcare. NMPs are a valuable contributer towards positive health outcomes throughout the field of nursing. The NMP courses seem to be overflowing in universities with physio's, chiropodists and pharmacists adding varied expertise and quality within the NHS and other health providers slowly growing. Lets appreciate the growing opportunities for nurses and other health professionals. Very positive!

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  • michael stone

    Slightly off [immediate] topic, but I think 'on theme', a few minutes before I read this, I read a comment on BMJ by Sarah C Evans, GP at:

    http://www.bmj.com/content/353/bmj.i2751/rr-3

    She ends her piece with 'We need to change. But we personally have large amounts of money invested in an out-moded, no longer wanted, model of care. The pathway of change for us skilled, valued, old dinosaurs is not at all certain.' having previously made comments such as:

    'Chronic disease, disability, self management? Patients want an expert that knows them. Their consultant supported by their specialist nurse. Our diabetic nurse is so good, backed up by us for a once or twice a day two minute discussion.'

    The 'model' of healthcare, is changing - it is changing for both doctors and nurses.

    PS For my follower: Yes, I've extracted from a BMJ piece, without asking for permission from the copyright holder (but I've no doubt that neither Dr Evans nor the BMJ is going to complain).

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