Prescribing Rights

Pharmacists and nurses allowed Supplementary Prescriber status

The UK Department of Health (DoH) has announced that pharmacists and nurses will be able to prescribe medicines as supplementary prescribers (SP) beginning in early 2003¹. This follows a positive response to the joint consultation letter MLX 284 issued in April 2002². Supplementary prescribing is defined as `a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber, to implement an agreed patient-specific clinical management plan with the patient's agreement'³. The criteria that will be set in regulations for lawful supplementary prescribing are:

• the independent prescriber (IP) must be a doctor or dentist;
• the SP must be a registered nurse, registered midwife or a registered pharmacist;
• there must be a written clinical management plan (CMP) relating to a named patient and to that patient's specific conditions; agreement to the CMP must be recorded by both the IP and SP before supplementary prescribing begins; and
• the IP and SP must share access to, consult and use the same common patient record.

The proposals in MLX 284 were intended to be complementary to other proposals (since adopted) to extend the range of prescription only medicines available to independent nurse prescribers⁴. Unlike independent nurse prescribing however, there is no specific formulary or list of medicines. Also, there will be no legal restrictions on the clinical conditions which SPs may treat. Although an SP should not be required to enter into a prescribing partnership, nor to prescribe any medicine that he/she does not feel competent to prescribe, the SP will be permitted to prescribe:

• all general sales list (GSL) medicines, pharmacy (P) medicines, appliances and devices, foods and other borderline substances approved by the Advisory Committee on Borderline Substances;
• all POMs with the current exception of controlled drugs; and
• medicines for use outside of their licensed indications (i.e. off label prescribing), black triangle drugs and drugs marked `less suitable for prescribing' in the BNF.

According to the DoH, because supplementary prescribing requires a partnership and a clinical management plan, it is likely to be most useful in dealing with chronic medical conditions such as asthma, diabetes or coronary heart disease, or with long term health needs such as anti-coagulation. Nurse prescribing courses will start in early 2003 and comprehensive training for pharmacists will begin in spring 2003, with the aim of having up to 10 000 nurses and up to 1 000 pharmacists trained by the end of 2004. In addition, DoH supplementary prescribing guidance is expected in early 2003.

References

1. Department of Health, press release No 2002/0488, 21 November 2002

2. Medicines Control Agency consultation on proposals for supplementary prescribing by nurses and pharmacists and proposed amendments to the prescription only medicines (human use) order 1997, MLX 284, 16 April 2002, http://www.mca.gov.uk

3. Department of Health, supplementary prescribing web page, http://www.doh.gov.uk

4. The Regulatory Affairs Journal , 2002, 13 (7), 624