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News Round-Up 2005 Updated: 04/07/2005
More responses to the consultations on extending prescribing for nurses and
pharmacists have now been published (see here for previous responses
1,
2,
3).
They believe that this will allow advanced nurse practitioners to prescribe
within the full range of their competencies. Although they assume that this
would usually be within specialist disease areas in which the practitioners
have had additional training and experience, further training beyond what is
provided in the current courses would also be needed. It should focus on
understanding the limits of competence and on issues such as adverse drug
reactions, drug interactions and patient factors that might alter drug
metabolism and distribution.
In the consultation on independent prescribing for pharmacists, they favour
Option 5 (any condition, full BNF;
see here for details and
here
for response). They believe that the initiative will support the provision
of holistic pharmaceutical care. Given pharmacists’ extensive training in
pharmacology, they are well placed to act only within the limits of their
professional diagnostic competencies. This option provides a flexible
framework for the future. The need for pharmacists to have access to patient
records is stressed. The Dispensing Doctors’ Association (DDA) believes that there should be no extension of independent prescribing to pharmacists at present, and is concerned that the tone of the consultation document shows a preference for some form of independent pharmacist prescribing without any discussion of the possible problems (see here for response).
It also believes that any change should take account of the different working
practices of a pharmacist working in a multidisciplinary team in secondary
care and an independent community pharmacist in a high street. It has concerns
in three areas: diagnosis, legal liability and access to patient records. In its response to the consultation on independent prescribing for pharmacists, the London Specialist Pharmacy Services and the London Pharmacist Supplementary Prescribing Support Team says that it supports Option 5 (any condition, full formulary). It suggests locally agreed scope of practice statements (either for individuals or groups), which would be agreed between practitioners and employers, and would define the clinical areas and circumstances in which the practitioner can prescribe. It also supports a similar model for nurses, and suggests that there are advantages in adopting a model that could be applicable to all professionals who become prescribers in the future.
It describes a prescribing model, in which independent prescribing by doctors
tackles the most complex drug therapy, with supplementary prescribing
partnerships catering for less complex situations, and independent prescribing
by other healthcare professionals dealing with the most straightforward
situations.
More Quick Reference Guides on a range of conditions have been published on the Prodigy website (see here). They indicate which medication is prescribable under the Nurse Prescribers’ Extended Formulary.
Health professionals and the public need education programmes about over-the-counter (OTC) medicines, according to the conclusions of a report by the BMA’s Board of Science (see here for report). It is likely that self-management of medical conditions and long-term treatment to prevent ill-health will become more extensive, and the public and health professionals need to understand the risks as well as the benefits of OTC medication. Research is also needed on the effects on public health as more potent medicines are reclassified as OTC.
The report also raises the question of whether OTC medicines should be
formally included in patient records, commenting that patient safety could be
improved by including it in the NHS core electronic patient record.
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