Published: 01/03/2005

DH consultation: how to expand independent nurse prescribing?

A consultation suggesting options for expanding independent nurse prescribing, including opening up the BNF to all independent nurse prescribers, has been published by the Department of Health (DH) and the Medicines and Healthcare products Regulatory Agency (MHRA; download consultation document here).

The recent evaluation of nurse prescribing at the University of Southampton (see here for details) has concluded that nurses and some doctors believe that the format of the Nurse Prescribers’ Extended Formulary (NPEF) is sometimes restricting efficient NHS practice and benefits to patients, according to the consultation. With three years’ experience of the NPEF, and recent changes in nursing practice, the government says that the time is now right to look again at the basis of the NPEF and the options for the future of nurse prescribing from it. The document provides a framework for considering five options for expansion.
 
Option A: Current arrangements to be continued
The DH and MHRA will continue to consider changes to the list of conditions and medicines in the NPEF, possibly annually or biennially. The consultation points out that this method has proven to be resource-intensive and slow: it is therefore difficult to keep the formulary up-to-date.

Option B: Prescribing for any medical condition from a specific formulary
Using the NPEF (with any future additions), independent nurse prescribers would be able to prescribe for any medical condition for which the medicine was appropriate (according to the BNF) and which they are competent to treat. Certain conditions could be excluded and the consultation particularly requests views on whether there are any and, if so, which. The need to update the NPEF would remain but there would be more flexibility in service provision that with Option A.

Option C: Prescribing for specific conditions from a full formulary
Independent nurse prescribers would be able to prescribe any medicine from the BNF for a specific range of medical conditions. The issue of how to update the NPEF would therefore not arise. It would, however, be possible to restrict prescribing of particular medicines and this could be done locally. Views on which specific medical conditions should be added to the current list are particularly requested.

Option D: Prescribing for any condition from a full formulary
Independent nurse prescribers would be able to prescribe any medicine from the BNF for any condition. This option could probably be modified to restrict the prescribing of particular drugs and this could also be done locally. Any views on classes of medicines that it would be inappropriate are particularly sought.

Option E: Advanced practice nurses prescribe for any condition from full formulary
Under this option, nurses fulfilling particular criteria and attaining ‘specialist nurse status’ would, after training, be able to prescribe for any condition using the whole BNF, provided they have the appropriate competence and expertise. Extended Formulary Nurse Prescribers without these higher level competencies would be limited, as at present, to specific conditions and medicines. These lists would therefore still need updating.

Controlled drugs
Following the Shipman Inquiry, the government has agreed that more controlled drugs will be added to the NPEF (supplementary prescribers will soon be able to prescribe them; see here), although such expansion will be subject to amendment of the Misuse of Drugs regulations. This would apply to any of the options and the consultation requests views on whether independent prescribing of controlled drugs by nurses should be subject to restrictions, and if so what they should be.

Risks and benefits
The consultation says that the risks of not making changes are that: the NPEF may become more difficult for nurses to follow, that patients may not easily access the medicines they need, and that nurses’ professional skills will not be made full use of.

It points out that independent nurse prescribers need training and accreditation, and that evidence of updating skills and knowledge is required to maintain the latter. They should only work within their areas of competence.
If one of options B to E is adopted, then the governments says that patients and staff will all benefit. Patients will have a faster and more accessible service, doctors will be able to focus their energies on patients and areas where their specific skills are needed, and nurse prescribers will have the opportunity to use their skills more widely and develop them further. Although the government does not recommend one option, it does point out that options B to E meet its objectives of improving patients’ access to medicines and maximizing use of nurses’ professional skills.

The process
Responses are requested by 23 May 2005 and the Committee on Safety of Medicines will then consider the proposals and the comments received before giving advice to Ministers. Subject to ministerial agreement, and changes will then be made by Statutory Instrument by early 2006.


 

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