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About supplementary prescribing

  • Last modified date:
    9 February 2007
In 1999, the Review of Prescribing, Supply and Administration of Medicines led by Dr  June Crown suggested the introduction of a new form of prescribing, to be undertaken by non-medical health professionals after a diagnosis had been made and a Clinical Management Plan drawn up for the patient by a doctor. The Review's term for this activity, 'dependent' prescribing, has since been superseded by the term 'supplementary' prescribing.

Following publication of the report, health ministers decided to focus initially on extending nurse prescribing and on supplementary prescribing for nurses and pharmacists - the two most numerous non-medical professions, where maximum benefit could be expected for patient care.

The Department of Health and the Medicines Control Agency undertook a public consultation between April and July 2002 on proposals to implement supplementary prescribing for nurses and pharmacists. Lord Philip Hunt announced plans to introduce supplementary prescribing in November 2002. A copy of the press release issued to coincide with this announcement can be found elsewhere in this website. Supplementary prescribing for nurses and pharmacists was made possible through changes to regulations in April 2003.

Ministers have subsequently agreed that supplementary prescribing responsibilities may be extended to physiotherapists, radiographers, podiatrists and chiropodists and optometrists. Work on this will be taking place during 2004.

Supplementary prescribing - definition

Supplementary prescribing is 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.

Legal basis

Section 63 of the Health and Social Care Act 2001 allows Ministers, by Order, to designate new categories of prescriber, and to set conditions for their prescribing.  Amendments to the Prescription Only Medicines Order and changes to NHS regulations to allow the introduction of supplementary prescribing were laid before Parliament on 14 March 2003 and came into force on 4 April 2003.

Key principles

There are a number of key principles that should underpin supplementary prescribing. These principles emphasise the importance of communication between the prescribing partners, and the need for access to shared patient records. It is also essential that the patient is treated as a partner in their care and is involved at all stages in decision making, including whether part of their care is delivered via supplementary prescribing.

The criteria that are currently set in regulations for lawful supplementary prescribing are:-

  • the independent prescriber (IP) must be a doctor (or dentist)
  • the supplementary prescriber (SP) must be a Registered Nurse, Registered Midwife or a registered pharmacist
  • there must be a written Clinical Management Plan relating to a named patient and to that patient's specific conditions. Agreement to the plan must be recorded by both the independent and supplementary prescriber before supplementary prescribing begins
  • the independent and supplementary prescriber must share access to, consult and use the same common patient record.

For supplementary prescribing there will be no legal restrictions on the clinical conditions which supplementary prescribers may treat. As supplementary prescribing requires a prescribing partnership and a Clinical Management Plan for the patient before it can begin, it is likely to be most useful in dealing with long-term medical conditions such as asthma diabetes or coronary heart disease, or with long-term health needs, such as anti-coagulation. However, it will be for the independent prescriber with the supplementary prescriber to decide, in drawing up the Clinical Management Plan, when supplementary prescribing will be appropriate.

Unlike independent nurse prescribing, there is no specific formulary or list of medicines for supplementary prescribing. Provided medicines are prescribable by a doctor or dentist (an independent prescriber) at NHS expense, and that they are referred to in the patient's Clinical Management Plan, supplementary prescribers are able 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 prescription-only medicines with the current exception of controlled drugs [NB subject to Parliamentary approval to changes to the Home Office's Misuse of Drugs Regulations and to related amendments to NHS Regulations, nurses and pharmacists will be able to prescribe controlled drugs under a supplementary prescribing arrangement later in 2004]
  • 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
  • unlicensed drugs that are part of a clinical trial which has a clinical trial certificate or exemption

Note: The supplementary prescriber should not be required to enter into a prescribing partnership that entails them prescribing any medicine that they do not feel competent to prescribe.

Note: Nurses and pharmacists are recommended to prescribe generically, except where this would not be clinically appropriate or where there is no approved generic name - see the Nurse Prescribers' Formulary for District Nurses and Health Visitors, the Nurse Prescribers' Extended Formulary, the BNF and the Drug Tariff.

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