Website of the Department of Health

Controlled Drugs (CDs)

Q. Will pharmacist independent prescribers be able to prescribe CDs independently?

A No.  Pharmacists will not be able to prescribe any CDs independently until the Home Office's Misuse of Drugs Regulations has been amended.  The Home Office's Advisory Committee on the Misuse of Drugs is due to consider this matter later this year.

Training

Q What extra training, if any, will existing pharmacist supplementary prescribers need to undertake?

A DH is working with the Royal Pharmaceutical Society of Great Britain, the Pharmaceutical Society of N. Ireland and other stakeholders, to confirm the education and training requirements for pharmacist independent prescribers.

Pharmacists will continue to be able to train and act as supplementary prescribers, and in some settings, supplementary prescribing will continue to be the best option. This will also enable them to prescribe Controlled Drugs and unlicensed medicines provided they are stipulated in the patient's clinical management plan. 

Q Will pharmacist independent prescribers be able to prescribe borderline substances / off-label medicines / unlicensed medicines independently?

A

Funding

Q. What funding will be provided to support prescribing training in the future?

A. Guidance for Strategic Health Authorities will identify funding to support non-medical prescribing training for 2006/07.

Accountability

Q.  Who will bear legal and professional responsibility for the actions of pharmacist prescribers?

A Pharmacist independent prescribers must accept full professional, clinical and medico-legal responsibility for their prescribing decisions. They should therefore only prescribe in situations where they feel fully competent, using those medicines that they feel are effective for the patient and the condition being treated. Where a pharmacist is appropriately trained and qualified as an independent or supplementary prescriber, and prescribes as part of his or her duties with the consent of the employer or local PCT, the employer may also be held vicariously responsible for the pharmacist 's actions. The Department's Guide to Implementation of Nurse and Pharmacist Independent Prescribing, advises all pharmacist independent prescribers to ensure that they have professional indemnity - for example through membership of a professional organisation or trade union.

 The RPSGB Code of Ethics states that all pharmacists who own a pharmacy, superintendent pharmacists and pharmacist managers should ensure that all professional activities undertaken by them or under their control are covered by adequate professional indemnity insurance. The standard on prescribing within the Code also says that pharmacists must only prescribe within the limits of their registration and must comply with statutory requirements applicable to their prescribing.

Training

Q: Who will decide which pharmacists are eligible to be trained as NHS prescribers?

A: This will be a matter for local decision, in the light of local NHS needs and circumstances. No pharmacists will be required to undertake training for prescribing unless they wish to do so.

Q. Will pharmacists employed by prisons or charitable organisations outside the NHS be able to undertake prescribing training?

A:  Yes - pharmacists employed outside the NHS may also apply for a prescribing training course.  Pharmacists employed by prisons or charitable organisations and who provide the majority of their services to NHS patients can also be considered for centrally funded prescribing training.  Other non-NHS pharmacists will need to identify an alternative source of funding.

Independent sector

Q. Will pharmacists employed by private organisations outside the NHS be able to undertake prescribing training?

A. Yes - pharmacists employed outside the NHS may also apply for a prescribing training course.  Non-NHS pharmacists will also need to identify a source of funding for their training and to have identified a medical supervisor who is willing to help with the 'supervision in practice' element of the course, and to have access to a prescribing budget, once qualified. 

Q. Can  independent sector pharmacists prescribe at NHS expense?

A. Community pharmacists (and any other pharmacists employed by the independent sector, but who supply services to NHS organisations) wishing to train to prescribe (at NHS expense) will need to have the backing of their local PCT (or NHS Trust) with whom they are contracted.  In addition, they need to have identified a medical supervisor who is willing to help with the 'supervision in practice' element of the course, and to have access to a prescribing budget, once qualified. 

Q. How should independent sector pharmacists operate prescribing?

A.  They are advised to follow the same guidance as NHS bodies.

Private prescriptions

Q:    Are pharmacists able to issue private prescriptions?

A:     Pharmacists who are trained as supplementary prescribers may issue private prescriptions for any medicines covered by a patient's clinical management plan. 

In the future, pharmacist independent prescribers will be able to prescribe any licensed medicine privately, for any medical condition within their competence, with the exception of Controlled Drugs.

Patient Specific Directions

Q: Are pharmacist prescribers able to give directions to a non-prescriber for the administration of a medicine?

A: Yes. A qualified pharmacist prescriber may give directions for the administration of any product they are legally allowed to prescribe. The prescribing pharmacist will clearly need to be satisfied that the person to whom s/he gives the instructions is competent to administer the medicine concerned.

Patient Group Directions

Q: Are pharmacists able to supply and administer controlled drugs under the terms of a Patient Group Direction?

A: Yes. Pharmacists can use PGDs for the supply and administration of Schedule 4 and Schedule 5 Controlled Drugs - with the exception of anabolic steroids.

British National Formulary (BNF)

Q: How do pharmacist prescribers obtain copies of the BNF?

A: Pharmacist prescribers in hospitals should receive six monthly copies of the British National Formulary through the normal hospital allocation.  Pharmacist prescribers working in primary care or in the local community, should receive their BNF through their local non-medical prescribing lead.

Prescription pad

Q: How do I get a prescription pad?

A: Once qualified and having registered the qualification with the RPSGB, pharmacist prescribers working in primary care should notify their employer, who will need to register the qualification on a separate form and send it to NHS Business Services Authority (formerly the Prescription Pricing Authority, or PPA) (see guidance).  The employer will then be able to order prescription pads from Astron in the usual way.  Pharmacist prescribers working in secondary care will be able to prescribe in the same way as doctors and nurses in that setting.

Q: Are pharmacists able to prescribe or supply blood or blood products on the NHS?

A: Blood, including the cellular elements that are packaged for use as "packed cells" and platelets, is not considered to be a medicinal product and is therefore outside the ambit of the Medicines Act and its subsequent amending Regulations. The "prescribing" of blood for a patient is not therefore appropriate for pharmacist independent prescribing or for supply under the terms of a Patient Group Direction. Pharmacists should discuss the current local policy regarding ordering of these products with their Trust's haematology department. Consideration could be given to developing local guidelines for the ordering and supply of blood, based on the format of a PGD.

However, products derived from the plasma component of blood such as blood clotting factors, antibodies and albumin are considered to be medicinal products and are required to have marketing authorisations. These products may be prescribed by pharmacists under a supplementary prescribing arrangement , provided they are included in the necessary clinical management plan.