4e Non-medical prescribing

Non-medical prescribing was first suggested in 1986 in the Cumberledge Report. It took 13 years for the vision to be realized and for nurse prescribing to be piloted in the community setting using a very limited formulary. Following a successful pilot, non-medical prescribing became a national initiative in 1998. Initially, it was aimed at health visitors and district nurses. Then in 2002 this was extended to enable nurses in other clinical areas, including palliative care, to train as non-medical prescribers using a limited formulary. In 2006 the decision was made to allow nurses, who had completed relevant training, to prescribe independently within their professional scope of practice, from the whole British National Formulary (with the exception of certain controlled drugs).

Evaluations of non-medical prescribing have been favourable, with patients and doctors being generally positive about the concept.¹ The majority of nurse prescribers feel strongly that prescribing has had a positive impact on quality of patient care and improved access to medicines. Nurses have also reported that the training to be a non-medical prescriber has enhanced their knowledge about medication and increased their confidence to engage in prescribing decisions.²

With end of life care and choice of place of care being key principles of palliative care, nurse prescribing could play an important role in developing and meeting these challenges in the future. We repeatedly hear how there have been delays in gaining a prescription for a patient in the community, causing them to have to wait to commence new medication, or in the extreme case needing to be admitted to hospital. Non-medical prescribing is an option to be considered to assist in meeting these issues as community palliative care nurses will often advise GPs on medication options. Community palliative care nurses who have become non-medical prescribers suggest that patients receive medicines more quickly which they have interpreted as improving patient care.³

It is not only community palliative care nurses who should consider non-medical prescribing as part of their role. Hospital palliative care nurses and hospice nurses need to consider whether there is a place for non-medical prescribing within their role, asking the question would it improve the care I provide for patients?