An Evaluation of the Expansion of Nurse Prescribing in Scotland

Nurse prescribers in Scotland can now prescribe a range of controlled drugs for specific medical conditions. This research project which is summarised below provides an evaluation of the extension of nurse prescribing following the introduction of new legislation in 2001.


Adverse Drug Reactions ( ADRs): An ADR is an undesirable response associated with use of a drug that either compromises therapeutic efficacy, enhances toxicity, or both. An ADR incident is an ADR event which results in unintended harm or a 'near miss'. ADRs in Scotland are monitored and reported through the Yellow Card Centre Scotland ( YCC Scotland). YCC Scotland is a joint venture with the Medicines and Healthcare products Regulatory Agency ( MHRA) and the Scottish Government aimed at improving drug safety in Scotland. It is sited within the Centre for Adverse Drugs Reactions Scotland ( CARDS), in Edinburgh. (For more information about the Yellow Card System, see below).

British National Formulary ( BNF): The BNF is published twice a year by the British Medical Association and the Royal Pharmaceutical Society of Great Britain, the BNF provides practical information on the selection and clinical use of medicines and guidance on prescribing, dispensing and administering medicines.

Clinical Management Plans ( CMPs):CMPs are the foundation stone of supplementary prescribing. Before supplementary prescribing can take place, it is obligatory for an agreed CMP to be in place (written or electronic) relating to a named patient and to that patient's specific condition(s) which will be managed by the supplementary prescriber.

Cognitive Behavioural Therapy ( CBT): CBT aims to help patients begin to identify and change extreme thinking and unhelpful behaviour. It is thought to be particularly effective for stress related ailments, phobias, obsessions, eating disorders and (at the same time as drug treatment) severe depression.

Committee on Safety of Medicines ( CSM): The CSM is an advisory committee of the Medicines and Healthcare products Regulatory Agency ( MHRA) it advises the UK on the quality, efficacy and safety of medicines. The Committee on Safety of Medicines is an advisory committee established, by Ministers, under Section 4 of the Medicines Act 1968. The Licensing Authority in the UK may not refuse to grant a medicines product licence or marketing authorisation, nor revoke, vary or suspend it (except, in the latter case, in an emergency) on grounds relating to safety, quality or efficacy, without first consulting this advisory body.

Community Psychiatric Nurse ( CPN): A CPN is a qualified mental health nurse who works as part of a team of professionals to provide mental health services in the community. CPNs have a broad knowledge of mental health problems and a wide range of skills that they can use to enable clients to work through any programmes agreed. As well as working directly with people experiencing mental health problems the CPN will try to ensure that the needs of carers are considered. This may mean working directly with a carer or may be related to making sure that the carer is able to access the support needed from other sources.

Community Mental Health Nurse ( CMHN) is another term for a qualified mental health nurse working in the community (see CPN above).

Continuing Professional Development ( CPD):CPD is the concept of life long learning, whereby skills, knowledge and competence are maintained through a process of study, reflection as well as personal and professional development, and is a recognisable part of the nurse's professional pathway. Once trained and qualified a nurse independent prescriber and supplementary prescriber the nurse has a commitment to maintain his/her prescribing competence.

Controlled drugs: Controlled drugs include opiates, secobarbital, amphetamine and cocaine. Activities that control the manufacture, supply and possession of Controlled drugs are governed by the Misuse of Drugs Act 1971. Penalties applied to offences involving different drugs are graded according to the harmfulness attributable to a drug when it is misused. For this purpose the drugs are defined into 3 classes; Class A, Class B and Class C. Drugs included in these Classes are listed in the BNF.

Central Office for Research Ethics Committees ( COREC):COREC, which is now known as the National Research Ethics Service ( NRES), is a UK-wide system of ethical review that aims to protect the safety, dignity and well being of research participants, whilst facilitating and promoting ethical research within the NHS.

Cumulative Index to Nursing and Allied Health ( CINAHL):CINAHL was originally a print index to the literature of nursing and allied health information. CINAHL® is now a searchable database which covers the nursing and allied health literature from 1982 to the present.

District Nurse and Health Visitor Prescribers: Following training, which is incorporated into the initial preparation of district nurses and health visitors, these groups of nurses can prescribe from the Nurse Prescribers' Formulary for District Nurses and Health Visitors (now known as the Nurse Prescribers Formulary for Community Practitioners).

Drug Tariff: The Scottish Drug Tariff is published for and on behalf of the Health Directorates of the Scottish Government. The Tariff contains information regarding the prescribing, dispensing and reimbursement of medicines and appliances on primary care NHS prescriptions.

Extended Formulary Nurse Prescribers: Nurse Prescribers who had completed the necessary training from 2002 to prescribe from the Nurse Prescribers' Extended Formulary list. They could legally prescribe all General Sale List ( GSL) and pharmacy medicines prescribable by general practitioners ( GPs), together with a list of almost 180 specified Prescription Only Medicines ( POMs) plus all items from the nurse prescribers' formulary. This type of prescriber as the Extended Formulary List no longer exists in the BNF.

Nurse Independent Prescribers ( NIPs):NIPs are fully responsible for their own prescribing decisions and are able to prescribe any licensed medicine from the BNF, for any medical condition, within their competence, including some Controlled Drugs as listed in Part 8C of the Scottish Drug tariff.

Independent prescribing: This term is generally applied to any prescriber who is legally permitted and qualified to prescribe and is responsibility and accountable for the clinical assessment of the patient, establishing a diagnosis and the clinical management required. Within the supplementary prescribing rules, the 'independent prescriber' must be a medical practitioner or a dentist.

Information Statistics Division ( ISD): Information Services Division ( ISD) is Scotland's national organisation for health information, statistics and IT services.

Local Research Ethics Committee ( LREC): An LREC is a local research ethics committee which receives applications from researchers to undertake research on NHS participants. Multi Site Research Ethics Committees ( MRECs) are similar to LRECs, but review applications from researchers applying to undertake research across three or more NHS sites. Applications are made to LRECs and MRECs via COREC (see COREC above). LRECs and MRECs ethically reviews research applications regarding NHS participants to determine whether they are granted ethical approval, and therefore whether the research can take place.

MEDLINE:MEDLINE is an International Journal data-base of published medical and health science research.

MHRA: The Medicines and Healthcare products Regulatory Agency ( MHRA) is an Executive Agency of the Department of Health (DoH). It was established on 1 April 2003 and created from a merger of the Medicines Control Agency and the Medical Devices Agency. Department of Health Ministers in England account to Parliament on all matters concerning regulation of human medicines in England, Scotland and Wales. Although responsibility for securing enforcement of the Medicines Act 1968 and related legislation in Scotland and Wales is the responsibility of the Scottish Government and the National Assembly for Wales respectively, the MHRA acts on behalf of those administrations under agency arrangements to ensure that medicines for human use, sold or supplied in the United Kingdom, are of an acceptable standard of safety, quality and efficacy and promotes the safe use of medicines and devices.

NHS (Education) Scotland NES):NHS Education for Scotland ( NES) contributes to provide better patient care by providing educational solutions for workforce development. It does this by designing, commissioning, quality assuring and where appropriate providing education for NHS staff in Scotland.

National Prescribing Centre ( NPC): The National Prescribing Centre is an English Health Service organisation, formed in April 1996 by the Department of Health. Its aim is to 'promote and support high quality, cost-effective prescribing and medicines management across the NHS, to help improve patient care and service delivery' The NPC delivers a wide range of activities focused on the English NHS including:

  • Information on medicines and their use
  • Education and development
  • Dissemination of good practice
  • Information technology
  • Informing research and development

Nurse Prescribers Formulary ( NPF) / Nurse Prescribers Extended Formulary ( NPEF): Appropriately trained nurses and midwives prescribed from the Nurse Prescribers' Formulary. This formulary no longer exists.

Over the Counter medicine ( OTC): Medicines which can be bought over the counter ( OCM) by members of the pubic in a pharmacy and do not require a prescription.

Patient Group Direction ( PGD): A Patient Group Direction ( PGD) is a written instruction for the sale, supply and/or administration of a named medicine in an identified clinical situation. It applies to a group of patients who may not be individually identified before presenting for treatment. 1

Prescription only Medicines ( POM): POMs are medicines which can only be given to a patient via a prescription.

Senior House Officer ( SHO): A senior house officer ( SHO) is a doctor undergoing specialist training anywhere in the United Kingdom National Health Services. A doctor typically works as an SHO for 2-3 years, or occasionally longer, before becoming a registrar.

Supplementary prescribing: The concept of supplementary prescribing, formerly referred to as 'dependent prescribing', was first identified within the 'Review of Prescribing, supply and administration of medicines 1999'. Supplementary prescribing is defined as a voluntary partnership between an independent prescriber (doctor or dentist) and a supplementary prescriber to implement an agreed patient-specific CMP (see CMP above), with the patient's agreement. The key principles of supplementary prescribing emphasise the importance of communication between the prescribing partners, the need for access to shared patient records and that the patient is treated as a partner in their care. Currently nurses, pharmacists and some allied health professionals are eligible to train as supplementary prescribers.

Yellow Card Adverse Drug Reactions Reporting Scheme (see adverse drug reactions above): The Yellow Card Adverse Drug Reactions Reporting Scheme is the method by which adverse reactions to medicines are monitored and collected across the UK. It is vital as an early warning system, by enabling the identification of previously unrecognised adverse reactions, as well as a way of increasing knowledge about known adverse reactions. An electronic version of the schemes was launched in October 2002. At the same time the scheme was extended to include nurses, midwives and health visitors as recognised reporters.

The electronic Yellow Card currently provides a simple and fast way to report suspected adverse reactions. The electronic Yellow Card, together with instructions on how to use it, is available at: Health professionals are encouraged to report all suspected adverse drug reactions using this method, although hard copy Yellow Cards are also acceptable (and can be found bound to the back of the BNF) 2.

Back to top