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Background to non-medical prescribing

  • Last modified date:
    12 March 2007

There are currently three types of non-medical prescribing:

  • The Nurse Prescribers' Extended Formulary gives those trained as independent prescribers access to 240 prescription-only medicines, including some controlled drugs, to treat around 110 medical conditions.  Currently over 6,100 nurses are qualified as extended formulary nurse prescribers.
  • Nurse Prescribers' Formulary for District Nurses/Health Visitors (Community Practitioners)
     Over 29,000 district nurses and health visitors are able to prescribe from a more limited formulary comprising a limited range of medicines, dressings and appliances suitable for use in community settings.
  • Supplementary prescribing enables qualified nurses and pharmacists to prescribe any medicine (including controlled drugs), within the framework of a patient- specific clinical management plan, agreed with a doctor.   Over 5,700 nurses and 450 pharmacists in England are presently qualified to do this.

Since April 2005 physiotherapists, chiropodists/podiatrists and radiographers, have also been able to qualify as supplementary prescribers.

Changes to regulations to enable optometrists to train and register as supplementary prescribers came into force in July 2005.

Consultation

A joint MHRA/DH consultation was undertaken earlier in 2005 to examine options for the future of independent nurse prescribing. This was in response to claims that the Nurse Prescribers' Extended Formulary was too complex and that supplementary prescribing could not be used in all settings where patients would benefit, such as emergency care, as the clinical management plan must be prepared in advance. Experience had also shown that updating the Formulary is difficult and resource intensive, with changes taking 12 to 17 months to finalise.

At the same time, a similar consultation examined options for the introduction of independent prescribing by pharmacists. These proposals aimed to benefit patients by providing greater access to pharmacists' knowledge and expertise, as well as a faster and more accessible service.

Options

Five options were put forward in the consultation for nurses and seven for pharmacists. The options were however broadly similar and were essentially:

  • no change, i.e. prescribing for specific conditions from a specific formulary by nurses and no independent prescribing by pharmacists;
  • allow prescribing for any medical condition from a specified formulary;
  • allow prescribing for specific medical conditions from a full formulary;
  • allow prescribing for any medical condition from a full formulary;
  • allow different approaches in different clinical settings or linked to specialist competencies.

CSM

A Working Group of the Committee on Safety of Medicines (CSM) first considered the responses to both consultations in September 2005. The full CSM on 27 October decided to recommend that suitably trained and qualified nurses and pharmacists should be able to prescribe any licensed medicine for any medical condition, within their own competence.

Regulation

Changes to medicines and NHS regulations are planned by April/May 2006.

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