What is it?
Non Medical Prescribing is the prescribing of medicines, dressings and appliances by health professionals who are not doctors. There are 3 models of Non Medical Prescribing:
1. Supplementary Prescribing
This is a voluntary partnership between an independent prescriber who must be a doctor or a dentist and a supplementary prescriber, to implement an agreed patient specific clinical management plan with the patients agreement. Also known as V300
Nurses, Pharmacists, Physiotherapists, Optometrists, Radiographers and Podiatrists can train as Supplementary Prescribers. Free downloads Please use these useful links to download important documents NMC Prescribing Standards DH Guidance 2006 NMC Standards for Medicines Management NMC Circular V150 for Community Nurses NMC Circular Prescribing for children and young people As with the whole website, this section will be updated on a regular basis with links to useful information.
2. Nurse and Pharmacist Independent Prescribing
Nurses and pharmacists who are legally permitted and qualified to prescribe and take the responsibility for the clinical assessment of the patient, establishing a diagnosis and the clinical management required, as well as the responsibility for prescribing, and the appropriateness of any prescribing.
Independent Prescribing Unlicensed Medicines & Mixing Medicines
Medicines legislation has been amended and came into force 21st December 2009 to allow nurse and pharmacist independent prescribers to prescribe unlicensed medication. In addition to this nurse and pharmacist independent prescribers and supplementary prescribers when working within the terms of a clinical management plan are also now allowed to mix medicines for administration and direct others to do so. This does not currently apply to controlled drugs, nurse independent prescribers must continue to adhere to the 13 controlled drugs listed toward the back of the BNF for the conditions and routes indicated.
3. Nurse Prescribers Formulary for Community Practitioners
Formerly known as District Nurse and Health Visitor prescribing, this is a limited formulary for community practitioners to independently prescribe from providing there is a service need and they have completed the Specialist Practitioner Qualification / Specialist Community Public Health Nursing. Also known as V100. The NMC have also outlined guidance for training of Community Nurses without the Specialist Practitioner Qualification called V150
Practice Nurses, District Nurses, Public Health Nurses, Health Visitors, Community Psychiatric Nurses, School Nurses, Community Learning Disability Nurses can train to prescribe from the Nurse Prescribers Formulary for Community Practitioners
What are the benefits?
For the patients
Patients will have a greater opportunity of quickly accessing the right medicines they require at the right time, from the right person. This will result in an avoidance of a delay in receiving medicines, a reduction in the amount of unnecessary appointments with various health professionals, reduced risk of hospitalisation and faster recovery. Patients will also have more choice in who they choose to see regarding their healthcare.
For the organisation
Better use of the workforce, financial savings in terms of less appointments required, less inpatient costs and potentially faster recovery. More efficient delivery of service for both patients and professionals. Profile of organisation elevated.
For the practitioner
Raised professional self esteem in being able to complete a whole package of care for selected patients. Motivated staff who are ideally placed to be innovative in their approach to service delivery.
Who can be a Non Medical Prescriber?
- Nurses (NHS, mental health, community, secondary care, self-employed, military, charity etc)
- Optometrists (NHS, self-employed, private organisation etc)
- Pharmacists (NHS, self-employed, multiple organisation etc)
- Physiotherapists (NHS, self-employed, private organisation, sport etc)
- Podiatrists (NHS, self-employed, private practice etc)
- Radiographers (NHS, private practice etc) role fits well for therapeutic radiography
Nystatin for neonates
The Department of Health (DH) along with recommendation from the Nurse Prescribers' Advisory Group have announced that Community Practitioner Nurse Prescribers should be able to prescribe nystatin off-label for neonates. The Community Practitioner Nurse Prescribers who do prescribe nystatin off-label must be clear that they accept clinical and medico-legal responsibility for prescribing that medicine. They must ensure that they are positive that the diagnosis is one of oral thrush, they should prescribe nystatin at the dose recommended in the BNF for Children. This exception (for nystatin) was made on the basis that there is no systemc absorption of the product and that the use of nystatin in treatment of oral thrush is long established. This decision by the DH is without precedent and there are no other exceptions for off-label prescribing by Community Practitioner Nurse Prescribers. The effective date is 1st August 2007.
Prescribing for children and young people
The NMC have provided more guidance regarding prescribing for children and young people. In a circular they outline that:
The NMC recognise that many registrants will be working in services where treatment would be provided across the age spectrum. As a result they (the NMC) have consulted with a number of bodies representing children and the other regulatory bodies in order to further strengthen the NMC Standards of proficiency for nurse and midwife prescibers (May 2006) in relation to prescribing for children. The Standards state that: "Only nurses with relevant knowledge, competence, skills and experience in nursing children should prescribe for children. This is particularly important in primary care (e.g. out of hours, walk-in clinics and general practice settings). Anyone prescribing for a child in these situations must be able to demonstrate competence to prescribe for children and refer to another prescriber when working outside their area of expertise or level of competence." (NMC Standards, page 7) "It is the responsibility of the employer to ensure that the registrant is able to apply the prescribing principles to their own area of practice" (NMC Standards, page 6).
It has been agreed that all nurse/midwife independent / supplementary prescribing programmes from this point forward, must incorporate an additional learning outcome to ensure that on successful completion of the programme, they can take an appropriate history, undertake a clinical assessment and make an appropriate diagnosis, having considered the legal, cognitive, emotional and physical differences between children and adults.
In addition the assessment must demonstrate the registrant's "recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates, children and young people." (NMC Standards, page 6)
In keeping with the existing standards of proficiency for nurse/midwife prescribers any assessment should take place within the context of their work setting, wherever that might be. If there is any doubt about the ability of the registrant to demonstrate knowledge, skill and competence in the areas described above, further training in relevant aspects of the legal, cognitive, emotional and physical differences between children and adults and in taking an appropriate history, undertaking a clinical assessment and making an appropriate diagnosis for a child, should be undertaken prior to completing a prescribing course.
A medical practitioner who is experienced and competent in prescribing for children should confirm the demonstration of competence. If a registrant who is already a prescriber moves into a new role which requires them to prescribe for children for the first time, or after a break in practice, it would be considered good practice for them to have a period of preceptorship and they may require additional education and supervision in relation to assessment, diagnosis and prescribing for children.
Free ask a question
You are welcome to ask a question in relation to Non Medical Prescribing.