Non medical prescribing in Scotland: implementation guide

Nurse Independent Prescribers

Which nurses can act as 'nurse independent prescribers'?

32. A nurse independent prescriber must be a registered first level nurse, midwife and/or specialist community public health nurse whose name is held on the NMC professional register, with an annotation signifying that the nurse has successfully completed an approved programme of preparation and training for nurse independent prescribing.

Selection of nurses for an approved programme of preparation

33. The selection of nurses (see paragraph 73) to receive training in prescribing is a matter for employing organisations who are best placed to assess local service and patient needs, and ensure fit with NHS Board strategic plans (see paragraph 27).

All individuals selected for prescribing training must have the opportunity to prescribe in the post that they will occupy on completion of training. The therapeutic area in which they will prescribe should also have been identified before they begin training to prescribe. Almost certainly this will be in the field in which they already hold considerable expertise.

The NMC (2006) ¹¹ have published Standards of Proficiency for nurse and midwifery prescribers which contain the requirements for admission to programmes leading to the nurse independent/supplementary prescribing qualification.

34. Applicants must provide evidence of meeting NMC criteria for eligibility to undertake educational preparation for nurse independent/supplementary prescribing as summarised below:

• Nurses should be able to study at degree level (Scottish Credit and Qualifications Framework, level 9) evidenced through the Accreditation of Prior Experiential Learning APEL), or the Accreditation of Prior Learning ( APL) process.
• At least three years' post-registration clinical nursing experience, of which at least one year immediately preceding their application to the training programme should be in the clinical area in which they intend to prescribe. Part-time workers must have practised for a sufficient period to be deemed competent by their employer. ¹²
• Nurses must be assessed by their employer as clinically competent in the area in which they wish to prescribe. For example, they must be able to carry out a comprehensive assessment of the patient's physiological and/or psychological condition and understand the underlying pathology and the appropriate medicines regime. It is:
  • the combination of expertise in the condition being treated
  • appreciation of the patient's particular manifestation of it
  • the medicines which will be effective that make a proficient and competent prescriber.
• Have written confirmation from a designated medical practitioner who meets the eligibility criteria described by the National Prescribing Centre ¹³ that s/he has agreed to facilitate learning and assess competence during the learning in practice element of the education programme.
• Applicants will also need written confirmation from their employer that:
  • their post is one in which they will have the need and the opportunity to act as a nurse independent prescriber immediately upon qualifying
  • they will have access to a budget to meet the costs of their prescribing on completion of the course. This applies to nurses in all settings (community, primary care, acute, out-of-hours, unscheduled care, etc.)
  • they will have access to continuing professional development ( CPD) opportunities on completion of the course
  • there has been prior agreement about the therapeutic area in which they
    will prescribe
  • the nurse independent prescribers will work within a robust clinical governance framework (see para 73).

35. There are likely to be many nurses in any local health economy who meet these criteria. The three key principles that should be used to prioritise potential applicants are:

• patient safety;
• maximum benefit to patients and the NHS in terms of quicker and more efficient access to medicines for patients;
• best use of the nurses' skills.

No nurse shall be required to undertake training unless s/he wishes to do so, and individual practitioners must also understand and accept the higher level of clinical responsibility associated with prescribing.

36. The Scottish Executive considers nurse prescribing to be a significant driver of change, ¹⁴ (also see paragraphs 25-26), and it is anticipated that the benefits of nurse prescribing go well beyond community and primary care. It is expected that nurses from all settings will become nurse independent prescribers and thus deliver improved services and better outcomes for patients. NHS Board strategic plans must embrace this whole systems approach (see also paragraph 27).

Central funding for approved education programmes for nurse independent/ supplementary prescribing

37. Central funding will continue to be made available to prepare nurses for prescribing. This funding will be allocated on the basis of named lists of nurses which have been nominated by NHSScotland NHS Boards who have prioritised nurses for training. The Scottish Executive will also take account of remote rural issues when allocating funding. Central funding currently includes a contribution to other costs incurred by employers in addition to the course fees. However, this funding is not guaranteed, and depends upon the fees set by Higher Education Institutions.

38. The central funding allocated for the above is intended to benefit patients and their access to medicines in the NHS. Training for nurses employed by NHS bodies (e.g. NHS Board employees, GP practices) can therefore be funded from this resource.

Non- NHS staff

39. Nurses employed by non- NHS organisations, and who provide the majority of their clinical services to NHS patients (e.g. nurses working in hospices and prisons) may have their training funded from the above.

40. In nominating for training any nurses whose posts are directly or indirectly funded by pharmaceutical and other companies, employers should be aware of, and take necessary steps to remove, any conflicts of interests that may subsequently arise in the nurse's practice.

41. Nurses are reminded of the Code of Professional Conduct ( NMC 2002), ¹⁵ Clause 7.2, which states that, in the exercise of her/his professional accountability, a registered nurse must 'ensure that your registration status is not used in the promotion of commercial products or services, declare any financial or other interests in relevant organisations providing such goods or services, and ensure that your professional judgement is not influenced by any commercial considerations'.

Funding from other sources

42. There is no reason why an NHS organisation or a private organisation should not pay for the preparation of more nurses and midwives by identifying other sources of funding.