Extending Prescribing Responsibilities from Policy to Implementation

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Extending Prescribing Responsibilities from Policy to Implementation

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Registered Health Professionals: Nurses. Midwives. Health Visitors ... Over 1,800 Extended Formulary Nurse Prescribers - qualified and registered with NMC ... – PowerPoint PPT presentation

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Title: Extending Prescribing Responsibilities from Policy to Implementation


1
Extending Prescribing Responsibilities- from
Policy to Implementation
  • Paul Robinson
  • Policy Lead, Extending Prescribing
    Responsibilities
  • Department of Health

2
Aim
  • To maximise benefit to patients and the NHS,
    through increased flexible use of workforce skills

3
Mechanisms
  • Patient Specific Directions
  • Patient Group Directions August 2000
  • Exemptions under Medicines legislation
  • Extended Formulary Nurse Prescribing April 2002
  • Supplementary Prescribing (nurses and
    pharmacists) April 2003

4
Extending Prescribing - DH Core Delivery Team
  • Administrators - Paul Robinson
  • Doctor - Peter Clappison
  • Nurse - Maureen Morgan
  • Pharmacist - Gul Root
  • AHP - Kay East
  • Modernisation Agency - Jackie Younger

5
Review of Prescribing, Supply and Administration
of Medicines
  • Dr June Crown CBE - March 1999
  • made recommendations and helped inform DH policy

6
Patient Group Directions (PGD)
  • Definition
  • A written instruction for the supply or
    administration of medicines to groups of patients
    who may not be individually identified before
    presentation for treatment

7
Patient Group Directions (PGD)
Who can currently use a PGD?
  • Registered Health Professionals Nurses
  • Midwives
  • Health Visitors
  • Ambulance Paramedics
  • Optometrists
  • Chiropodists
  • Radiographers
  • Orthoptists
  • Physiotherapists
  • Pharmacists
  • NB As named individuals

8
Patient Group Directions (PGD)
  • Intention to expand this list by April 2004
  • MHRA proposes to add four more AHPs -
  • Dietitians
  • Occupational therapists
  • Prosthetists and orthotists
  • Speech and language therapists

9
Patient Group Directions (PGD)
  • The majority of clinical care should be on an
    individual, patient-specific basis
  • Signed by a senior doctor (or dentist) and a
    senior pharmacist
  • NB - No discretion.
  • plus Exemptions under Medicines legislation -
    e.g. for Paramedics, Midwives, Optometrists

10
Independent Prescribing by Nurses
  • District Nurses and Health Visitors - limited
    formulary, over 25,500 nurses
  • Nurse Prescribers Formulary for District
    Nurses and Health Visitors
  • - mainly appliances, dressings and a few
    medicines (13 POMs)
  • Extended Formulary Nurse Prescribers

11
Nurse Prescribers Extended Formulary
  • Range of medical conditions
  • broadly covering minor ailments, minor injury,
    health promotion and palliative care
  • Potential for emergency care

12
Nurse Prescribers Extended Formulary
  • all Pharmacy (P) and GSL medicines for these
    conditions
  • 140 POMs
  • 170 POMs from Feb 2004

13
Numbers
  • Over 1,800 Extended Formulary Nurse Prescribers
  • - qualified and registered with NMC
  • several hundred more in training - examples
  • Nurse Practitioners in primary care
  • Practice Nurses
  • AE / Minor Injuries Unit nurses
  • Walk-In-Centre nurses

14
Training
  • Outline Curriculum agreed in 2001
  • Prescribing Training course 26 days, plus 12 days
    with supervising medical practitioner
  • Face-to-face contact, but provision now also for
    some open and distance learning

15
Funding for Training
  • DH funds direct training costs, via SHA Workforce
    Directorates
  • More flexible use of funding, from April 2003

16
Expanding the Nurse Prescribers Extended
Formulary
  • Consultation by MHRA and DH April 2003
  • Announcement by SofS - November 2003
  • 10 new medical conditions
  • 30 additional medicines added to Extended
    Formulary - from 1st February 04

17
Next Steps
  • CSM considering proposals to fill other gaps in
    Extended Formulary - particularly for Emergency
    care
  • Further consultation early in 2004
  • Website www.doh.gov.uk/nurseprescribing

18
Supplementary Prescribing
  • introduced through POM Order amendment and NHS
    regs in April 2003
  • nurses and pharmacists
  • will assist continuing care, rather than one-off
    episode of care e.g. asthma, diabetes, other
    chronic disease, mental health

19
Definition
  • Supplementary Prescribing
  • A voluntary prescribing partnership between
    the independent prescriber and a supplementary
    prescriber, to implement an agreed
    patient-specific Clinical Management Plan with
    the patients agreement.

20
Quote
  • I am enthusiastically in favour of this
    development. With the right safeguards in place,
    this will be of benefit to nurses, doctors, and
    particularly patients - saving everyone time, and
    increasing teamwork, skillmix, and efficiency
  • Prof David Haslam, Chairman of Royal College of
    General Practitioners

21
Principles
  • Patient safety paramount
  • Benefit to patients and the NHS
  • Patient agreement
  • Communication between all prescribers and Access
    to the Patient Record

22
Principles (Continued)
  • Voluntary Partnership
  • Separation of Prescribing and Dispensing
    responsibilities where possible

23
Criteria
  • Independent Prescriber must be a doctor (or
    dentist) - who makes Diagnosis
  • Supplementary Prescriber must be a Registered
    Nurse, Registered Midwife or registered
    Pharmacist
  • Written Clinical Management Plan specific to a
    named patient and the patients condition

24
Medical conditions
  • Clinical Management Plan agreed with the doctor -
    sets out how much (or how little) responsibility
    is delegated

25
Medicines
  • No legal restriction, except
  • Controlled Drugs (for the present) - Home Office
    consultation ended in September
  • Unlicensed medicines MHRA/DH consultation began
    late December 2003
  • BUT off- label prescribing is permissible

26
Clinical Management Plan - Templates
  • Two blank draft Templates on the DH website
    www.doh.gov.uk/supplementaryprescribing
  • Clinical Management Plan needs to be simple -
    otherwise, it wont happen!

27
Training
  • Outline Curriculum agreed in 2001 by former ENB.
    NMC endorsed in 2002 and 2003
  • Prescribing Training course 26 days, plus 12 days
    with supervising medical practitioner
  • Face-to-face contact, but provision now also for
    some open and distance learning

28
Supplementary Prescribing
  • work has started on extending Supplementary
    Prescribing to some AHPs
  • physiotherapists
  • podiatrists
  • radiographers
  • and Optometrists

29
Current Position
  • Nurses in training since January 2003
  • Nearly 1,100 nurse supplementary prescribers
    qualified already
  • Pharmacists in training, qualifying from February
    2004

30
Quote
  • Before Kathy qualified, she like the other
    nurses, would see patients but have to get doctor
    approval for prescriptions. Now she can deal
    with that herself, saving GP time to concentrate
    on complex cases. Supplementary prescribing has
    valuable long term benefits, but this is a fairly
    major change to the way practice works and so we
    have to take it slowly to get it right.
  • - Dr Vish Kini, GP in Chester

31
Conclusions
  • Mechanisms that will assist emergency care and
    one-off episodes of care
  • PGDs for supply and administration of medicines
  • Exemptions for sale and supply, under the
    Medicines Act
  • Nurse Prescribers Extended Formulary
  • Continuing care and chronic disease -
    Supplementary Prescribing (and PGD)

32
Nurse Prescribers Extended Formulary
  • More medical conditions and medicines from
    February 2004
  • Further discussions with CSM about needs of
    emergency care nurses
  • Consultation on more medical conditions and
    medicines from Spring 04

33
Supplementary Prescribing
  • Controlled Drugs likely to be made available
  • Consultation on three AHPs and optometrists
    Spring 2004

34
The Future
  • Non-Medical Prescribing Programme -
  • taking work on nurses, pharmacists, optometrists
    and AHPs under one umbrella Programme
  • Commitment to work on a Framework for Pharmacist
    Independent Prescribing - from early 2004

35
The future - continued
  • Is it making a difference to patients?
  • Its beginning to!
  • Have we reached critical mass yet?
  • Perhaps not quite, but were well on the way

36
Extending Prescribing Responsibilities- from
Policy to Implementation
  • Paul Robinson
  • Policy Lead, Extending Prescribing
    Responsibilities
  • Department of Health
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