Newsletter_January05

Newsletter

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March 2005

Should qualified nurse prescribers be able to prescribe from the whole of the BNF for any condition? That is one of the options put forward in the new consultation on how to extend independent nurse prescribing from the Department of Health (DH; see here for news item). The five options proposed are:

Option A: Current arrangements continue

Option B: Prescribing for any medical condition from a specific formulary (perhaps with certain conditions excluded)

Option C: Prescribing for specific conditions from a full formulary (possibly with central or local restrictions on certain medicines)

Option D: Prescribing for any condition from a full formulary (possibly with central or local restrictions on certain medicines)

Option E: Advanced practice nurses prescribe for any condition from full formulary; extended formulary nurse prescribers (EFNPs) without additional competencies and training would continue with current arrangements

It has long been clear that the current arrangement for adding conditions and medicines to the Nurse Prescribers’ Extended Formulary (NPEF) is cumbersome and slow (see here). The Chief Nursing Officer was quoted at the end of last year as saying that the system of incremental additions to the formulary must stop (see news item).

In addition, EFNPs have been frustrated at the anomalies in the system and at the number of conditions that they are competent to treat for which they still need to obtain a doctor’s prescription. Options D or E would provide a massive opportunity for nurse prescribing enthusiasts. The Royal College of Nursing has long argued for the whole formulary to be opened up and has welcomed the consultation.

The debate generated by the publication of this consultation, and a similar one for independent prescribing for pharmacists (see here for news item) is likely to include discussion of aspects of the two professions’ training. Since nurses started prescribing, their training has been criticized for failing to provide adequate pharmacological knowledge and specialist clinical knowledge (see here), and this discussion will probably continue in the light of the options proposed. The issue of continuing support and development for non-medical prescribers will also be central.

Essentially, if the whole formulary is opened up for all conditions, it will be up to nurses to determine their competence to prescribe and treat a particular condition with a particular medicine, as is the case with doctors at present. Is there any reason why nurses should not be able to do this? Join the debate in the forum and let us know your views on the different options and how they would work, and do respond to the consultation. The government says that legal changes could be made early next year, so this document could herald a radical and rapid development of nurses’ responsibilities and culture. Make sure your views are heard.

The long-awaited consultation on how to introduce independent prescribing for pharmacists (see here for news item) suggests seven options, some of which correspond to those proposed for nurses. It also raises the possibility that the arrangements could be different for pharmacists working in different clinical settings: community pharmacists might use a formulary similar to the NPEF for example, with hospital pharmacists prescribing from the whole BNF within their specialised areas. Do let us know what you think of these proposals too (the forum).