NON-MEDICAL PRESCRIBING POLICY MARCH 2019 Prescribing... · 4.3 Chief Pharmacist / Deputy Director of Nursing 4.3.1 The Chief Pharmacist and Deputy Director of Nursing will be responsible

NON-MEDICAL PRESCRIBING POLICY MARCH 2019

This policy supersedes all previous policies for Non-Medical Prescribing

I NON-MEDICAL PRESCRIBING POLICY: PHA07: MARCH 2018

Policy title Non-Medical Prescribing Policy

Policy reference

PHA07

Policy category Clinical

Relevant to Clinical staff & service managers

Date published March 2019

Implementation date

March 2019

Date last reviewed

February 2019

Next review date

March 2022

Policy lead Lucy Reeves, Chief Pharmacist

Contact details Email: [email protected]

Accountable director

Dr Vincent Kirchner, Medical Director

Approved by (Committee):

Drugs and Therapeutic Committee

Approved by (Committee):

Quality Committee

Document history

Date Version Summary of amendments

2006 1 New Policy

2010 2 Review

2015 3 Clarification of each stage of the process, pathways and governance structures.

2018 4 Review/Removal of supplementary prescribing stage

2019 5

Addition of criteria for Independent NMPs able to diagnose and prescribe for previously undiagnosed conditions

Membership of the policy development/ review team

Lucy Reeves/Simon Peel/NMP Staff

Consultation

Divisional Clinical Directors, Consultant DMPs, Nursing Executive, Non Medical Prescribers (Nursing and Pharmacy)

DO NOT AMEND THIS DOCUMENT

Further copies of this document can be found on the Foundation Trust intranet.

mailto:[email protected]

II NON-MEDICAL PRESCRIBING POLICY: PHA07: MARCH 2018

Contents Page

1 Introduction 4

2 Aims and objectives 4

3 Scope of the policy 5

4 Duties and responsibilities 5

5 Implementing non-medical prescribing within services 7

6 Eligibility criteria for non-medical prescribers 7

7 Qualification and preparing to prescribe 8

8 Independent NMP 10

9 Record Keeping 11

10 Continuing professional development (CPD) 11

11 Supervision 13

12 Return to practice as NMP following a break 13

13 Changing prescribing speciality 13

14 Maintaining the NMP register 14

15 Liability and professional indemnity 15

16 Dissemination and implementation arrangements 15

17 Training requirements 16

18 Monitoring and audit arrangements 16

19 Review of the policy 16

20 References 16

21 Associated documents 17

22 Glossary 17

23 Appendix 1: Responsibilities & Duties

24 Appendix 2: Proposal for implementing non-medical prescribing into

service

25 Appendix 3: Designated Medical Practitioner (DMP)

Appendix 4: A competency framework for all prescribers

Appendix 5: Checklist for newly qualified non-medical prescribers

III NON-MEDICAL PRESCRIBING POLICY: PHA07: MARCH 2018

Appendix 6: Assessment record for non-medical prescribers (new to the

trust, returning to practice, changing speciality)

Appendix 7: Approval to practice form: Newly qualified NMP

Appendix 8: Template for Inclusion to Individual Job Description.

Appendix 9: Restrictions applied in relation to non-medical prescribing

Appendix 10: Approval to practice form: Independent NMP

Appendix 11: Sample letter NMP notifying GP of change in medication

Appendix 12: Equality Impact Assessment Tool

4 Non-Medical Prescribing Policy: PHA07: March 2019

1 Introduction

1.1.1 This policy sets out a framework for the management of non-medical prescribing by nurses and pharmacists throughout Camden and Islington NHS Foundation Trust (C&I) The policy has been produced to support the on going strategic development for Non-Medical Prescribing within (C&I) and ensure robust governance systems are in place to enable high standards of practice and manage associated risks.

1.1.2 Non-medical prescribers (NMPs) need to be experienced practitioners before they can undertake the education programme necessary to become prescribers. After successful completion of an approved education programme, nurses, pharmacists and optometrists can become independent prescribers. All non-medical prescribing is underpinned by legislation and regulatory standards. Accordingly, all non-medical prescribers must record their qualification with their professional regulator and have a responsibility to remain up to date with the knowledge and skills that enable them to prescribe competently and safely.

1.1.3 This policy is in accordance with current legislation and is based on the following documents:

NMC Standards for Nurses and Midwives.

Home Office Circular 009/2012

Competency Framework for Pharmacists.

Independent Nurse Prescribing within the NHS in England (DH 2006).

Improving Patients‟ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England (DH April 2006). Physiotherapists and Radiographers within the NHS in England (DH May 2005).

1.1.4 This policy should be read in conjunction with guidance documents from the DH the prescriber‟s professional or regulatory body standards (NMC, GPhC, RPharmS), and C&I medicines management policies ( see section 24), in particular:

C&I Medicines Management Policy

Controlled Drug Policy and SOP

FP10 (HNC) prescription policy

FP10 (MDA) procedure (SMS services only)

Trust formulary

1.1.5 Definitions of non-medical prescribing are listed in section 22: Glossary.

2 Aims and objectives

To govern the practice of non-medical prescribing within C&I

To provide a guide to services that wish to consider non-medical prescribing as an

option for their service users

To ensure changes make tangible improvements to patient care


To ensure prescribing practice is compatible with the service development plans of

the trust and is an appropriate extension of the practitioner‟s role

To ensure that new prescribers are appropriately qualified for the role, work within

agreed national and local policies and are identified within the trust so that

prescribers can be kept up to date on prescribing matters

To ensure that new prescribers are supported in their role and continued professional

development

3 Scope of the policy

3.1.1 This policy applies to:

Service managers considering implementation of non-medical prescribing

within their service.

Nurses and pharmacists employed or contracted by the C&I who are formally

registered with C&I as non-medical prescribers. Job descriptions must specify

the independent non-medical prescribing role accordingly.

Bank/agency/temporary staff are not permitted to practice as non-medical

prescribers in C&I.

This policy does not include Patient Group Directions (PGDs). A PGD is a

written instruction for the supply and administration of a named medicine to a

group of patients in a specific, identified clinical situation. There is a separate

policy for PGDs.

4 Duties and responsibilities

4.1.1 Refer to appendix 1 for more detailed information on the responsibilities of the non-medical prescribing lead, line manager and non-medical prescriber.

4.2 Drug & Therapeutics Committee (DTC)

4.2.1 The DTC is responsible for approving the policy, ensuring governance systems are in place including systems for monitoring compliance with the policy and that appropriate actions are taken where there are deviations. Approval of non-medical prescribers to practice in C&I (i.e. inclusion of their name on the trust NMP register) will be noted at the DTC and recorded in the minutes of the meeting.


4.3 Chief Pharmacist / Deputy Director of Nursing

4.3.1 The Chief Pharmacist and Deputy Director of Nursing will be responsible for the final approval of non-medical prescribers. This will involve ensuring all necessary requirements set out in this policy have been satisfactorily completed for each individual. The names of individuals who have been approved as non-medical prescribers and their area of practice will be reported to the DTC.

4.3.2 The Medical Director / Deputy Medical Director / Director of Nursing may be required to perform this duty in the absence of the either the Chief Pharmacist or Deputy Director of Nursing.

4.4 Non-medical Prescribing Lead/Co-ordinator

4.4.1 The NMP lead will be responsible for ensuring that all necessary requirements set out in this policy have been satisfactorily completed for each individual prior to final approval by the Chief Pharmacist / Deputy Director of Nursing.

4.4.2 For further detailed information on the responsibilities of the NMP lead/co-ordinator see appendix 1

4.5 Divisional Directors and Clinical Directors

4.5.1 The divisional directors and clinical directors are responsible for:

Reviewing and approving proposals for the implementation of non-medical prescribing to a service within their division.

Ensuring the policy is followed and that appropriate actions are taken where there are deviations.

4.6 Consultant for service

4.6.1 The consultant for the service will be responsible for:

Assessing the suitability for non-medical prescribing within their service and completing the proposal plan with the service manager


4.7 Service / line manager

4.7.1 The service/line will be responsible for:

Assessing the suitability for non-medical prescribing within their service and completing the proposal plan with the consultant.


4.7.2 For further detailed information on the responsibilities of the line manager see appendix 1


4.8 Non-medical prescriber

4.8.1 The non-medical prescriber is responsible for ensuring they adhere to the policy and provide all necessary evidence to support their applications and on-going continual professional development (CPD)

4.8.2 For further detailed information on the responsibilities of the line manager see appendix 1

5 Implementing non-medical prescribing within services

5.1.1 Local teams must first establish the need for non-medical prescribing services and demonstrate clear patient or service user benefit with minimum risk. See appendix 2 for guidance on assessing the suitability for non-medical prescribing.

5.1.2 Services wishing to develop non-medical prescribers must discuss this with the NMP lead, Divisional Director and Clinical Director and complete the proposal plan in appendix 2.

5.1.3 A copy of the completed service NMP proposal should be agreed and signed by the Divisional Director / Clinical Director and Chief Pharmacist / Deputy Director of Nursing. A copy of the final signed version should be kept with central records.

6 Eligibility criteria for non-medical prescribing

6.1.1 Nurses or pharmacists wishing to undertake the non-medical prescribing course must meet the following criteria

Minimum of 3 years for nurses and 2 years for pharmacists, post registration

experience, of which at least one year immediately preceding the application has been in the clinical area in which the applicant intends to prescribe on successful completion of the course

Minimum of Band 6 in clinical practice (and hold relevant position)

Have worked for C&I for 12 months

Evidence of successful study at degree level

Successful completion of a physical assessment course

Have support of a consultant from their area of practice who is eligible and willing to act as Designated Medical Practitioner (DMP) and Supervisor (see appendix 3)

Have sufficient opportunity to prescribe and maintain competence and confidence after the training is complete

Have support from their manager, Clinical Director and Divisional Director

Must be willing and able to prescribe in practice and participate with the trust NMP forum once qualified.

6.1.2 All NMP students require the support of designated medical practitioner (DMP) from his or her own field of practice who will act as a medical supervisor and assessor.The DMP will provide supervision, support and will assist with


shadowing opportunities, for the equivalent time of 12 days during the course, ensuring that the student is exposed to a broad range of learning opportunities.

6.1.3 Appendix 3 outlines the criteria and role of the DMP. The DMP should include the role of NMP supervisor in their Job Plan.

Information on job plans can be found here: https://www.bma.org.uk/advice/employment/job-planning/job-plan-overview

6.1.4 Full guidance on the role of the DMP can be obtained from: www.npc.co.uk/pdf/designated_medical_practitioners_guide.pdf

6.1.5 Each member of staff who meets the criteria and is interested in being considered for training should convene a meeting with the NMP lead, service manager and expected DMP to discuss how the role will be incorporated into the team and the supervision arrangements for the trainee. The DMP and trainee NMP should use „A Single competency framework for all prescribers‟ published by NICE/NPC 2012 (appendix 4) as an aid during supervision and guide for CPD.

6.2 Application process

6.2.1 Applications to undertake the non-medical prescribing course should be made in accordance with the trust Study Leave and Funding Policy.

7 Qualification and preparing to prescribe

7.1 Newly Qualified staff

7.1.1 On successful completion of the non-medical prescribing course the member of staff should inform the NMP lead and arrange a meeting to go through the checklist for newly qualified NMPs in appendix 5.

7.1.2 The member of staff should bring:

Copy of notification of registration for NMP from their professional body

https://www.bma.org.uk/advice/employment/job-planning/job-plan-overview

http://www.npc.co.uk/pdf/designated_medical_practitioners_guide.pdf


Completed copy of the competency framework for prescribers (appendix 4) signed by their DMP.

7.1.3 Following qualification, to ensure high standards of practice, there will be a period of preceptorship by the DMP, requiring supervision of 10 assessments / prescriptions and completion of the Assessment form (appendix 6). The assessments/prescriptions supervised should be a representative sample of the range of medicines that would typically be prescribed by the NMP in practice. If necessary an extended period of preceptorship will be agreed between the DMP, the NMP lead and the NMP‟s team manager.

7.1.4 An Approval to Practice – Newly Qualified NMP form (appendix 7) must be completed and sent to the Chief Pharmacist / Deputy Director of Nursing for final approval. A copy will be retained centrally. A register is maintained by the NMP lead of all NMPs approved to practice in the trust.

7.1.5 Once completed the NMPs name will be recorded in the minutes of the Drug and Therapeutics Committee, confirming the trust will accept vicarious liability for the NMP.

7.1.6 A copy should be sent to HR and the NMP‟s job description amended to include the parameters of their non-medical prescribing practice. The appropriate wording for inclusion in the JD and person specification is listed in Appendix 8


7.2 New staff with NMP qualification

7.2.1 Staff new to the trust that hold an NMP qualification must meet with the NMP lead, service manager and lead consultant to discuss their scope of practice, previous prescribing activity, their intended activity, provide evidence of their qualification, professional registration number and CPD. The intended activity must be appropriate to the service area.

7.2.2 A period of preceptorship should be agreed, giving consideration to the requirements set out in this policy in relation to:

Area of competence (in previous post)

Level of experience within the clinical practice area of the service (new post)

Previous type of non-medical prescribing.

Recent / current breaks in practice (duration and reason)

At minimum the NMP will be subject to 10 supervised assessments/prescriptions and the assessment form (appendix 6) completed and submitted to the NMP lead for formal record. The assessments/prescriptions supervised should be a representative sample of the range of medicines that would typically be prescribed by the NMP in practice. The supervisor must be a DMP in the field of expertise who is willing to offer the supervision and make written declaration at the end of the preceptorship period that the NMP is competent.

7.2.3 On successful completion of the preceptorship the same authorisation to practice process, as set out in this policy, should be followed.

7.2.4 If non-medical prescribing is not currently implemented operationally within the service then a proposal plan must first be completed, as described above in section 6.

8 Independent NMP

8.1.1 Once authorised to prescribe, nurse and pharmacist Independent NMPs may prescribe medicines (see 11.2.1) for any clinical condition within their level of competence to service users with an existing diagnosis, who have been seen by mental health /substance misuse services within the last year. Independent NMPs are able to diagnose and prescribe for previously undiagnosed conditions within their area of competence if the following criteria are fulfilled:

There is a comprehensive framework around diagnosis (For example the diagnostic assessment tools used in the Adult ADHD Service)

Multi-disciplinary team working

Stated in the approved proposal for implementing non-medical prescribing in service (Appendix 2) and Approval to practice form: Independent NMP (appendix 10)

8.1.2 Independent NMPs are expected to prescribe in accordance with the trust/local formulary and adhere to trust policies on prescribing and medicines management. Appendix 9 provides further information on legislative restrictions that apply in relation to non-medical prescribing of off-label medicines, unlicensed medicines and controlled drugs.


9 Record Keeping

9.1 Patient records

9.1.1 All health care professionals are required to keep accurate, legible, unambiguous and contemporaneous records of a patient‟s care. NMPs should adhere to their own professional / regulatory bodies on standards for record keeping along with the trust policy for record management. All NMPs are required to document details of the prescription and the consultation into the shared patient record as soon as possible.

9.1.2 The record should indicate the following:

The date and time of the prescription.

The name of the NMP (and that they are acting as a Nurse or Pharmacist independent prescriber).

The name, strength and form of the item prescribed, quantity supplied, the dosing frequency, the route of administration, and duration of treatment.

In the case of dressings, details of how the wound should be treated and cleaned and what dressings should be used and how they should be applied as well as the frequency of change.

Advice given regarding General Sales List and Pharmacy medicines should also be recorded.

Circumstances, such as an acute exacerbation of the patient‟s condition may necessitate that the NMP notifies/liaises with the medical prescriber (i.e. GP or Consultant) before issuing a prescription. This notification/liaison should be clearly documented in the common patient record

The record should indicate details from the patient consultation, including history, the assessment and diagnosis.

Advice given related to the patient‟s treatment and / or health promotion should also be recorded.

9.1.3 The GP should be informed of any changes made to the patient‟s medication. A sample template is provided in Appendix 11.

9.2 Prescribing Log

9.2.1 Non-medical prescribers should also keep a log of their prescribing activity for the first 3 months of prescribing in the trust, for review at supervision. The log should include the date, patient identifier (EPR), medication and dose.

10 Continuing Professional Development (CPD)

10.1.1 NMPs are responsible for maintaining standards by taking professional responsibility for updating their practice by:


Reflecting on own/others prescribing practice. A CPD Needs Assessment provides a framework for NMPs which can be used as evidence of reflective practice and for agreeing Personal Development Plans with their service line manager

10.1.2 All nurses and pharmacists have a professional responsibility to keep themselves abreast of clinical and professional developments. Nurse and pharmacist prescribers will be expected to keep up-to-date with best practice in the management of conditions for which they may prescribe, and in the use of relevant drugs, dressings and appliances.

Nurses may use the learning from this activity as part of their Post Registration Education and Practice (PREP).

Pharmacists may use this as part of their mandatory CPD record.

Nurse and pharmacist prescribing should be discussed at appraisal and personal development planning and any training needs identified through CPD

10.1.3 NMPs are expected to keep a CPD learning portfolio, including a review of prescribing-related critical incidents and learning from them

10.1.4 The NPC/NICE Single competency framework for all prescribers, 2012 (appendix 4) is a tool to be used to reflect on prescribing practice, to identify gaps and learning needs and should be used to form the basis of personal development plans and provide evidence for approval to practice within the trust.

10.1.5 An NMP CPD forum will be run by the trust NMP lead. The aim will be to update all NMPs and share good practice on the principles of prescribing and medicines management.

10.1.6 The NMP will access ongoing education offered and be self-directed in meeting learning and development needs, including:

Attend non-medical prescribing CPD forum.

Attend CPD sessions provided by Middlesex University, accessed via the training dept.

Attend medicines management training where offered

Attend practice nursing prescribing updates

Ensure that prescribing is in line with up-to-date best practice in the management of conditions that are being treated

Use the NPC/NICE Competency Framework as a working tool to reflect on prescribing practice (appendix 4)

Non-medical prescribing will be discussed at appraisal and any training needs identified through PDP

Access regular Clinical Supervision

The NMP will have an annual review with their service manager, Consultant and NMP Lead.


11 Supervision

11.1.1 Agreement on supervision arrangements should be reached with the NMP‟s line manager and the consultant lead for the service as per trust supervision policy.

11.1.2 Prescribing supervision may be seen as additional to routine clinical supervision (NPC/NIMHE/DH 2005). This supervision will highlight any further training requirements and direct CPD. The NPC/NICE Single competency framework for all prescribers should be used to support supervision and CPD.NMPs should make diary notes of discussions at prescribing supervision meetings of what was discussed and who attended.

11.1.3 Supervision for independent NMPs should be provided by a registered medical practitioner monthly for at least the first year of practice as independent NMP. Supervision may then be reduced to quarterly during the second year and 6 monthly thereafter depending on agreement with NMP and designated medical practitioner.

11.1.4 A degree of flexibility may be applied to the frequency of supervision; however an appropriate registered medical practitioner should be accessible for advice between supervision (this may not necessarily be the person providing regular supervision). Responsibility will also be with the NMP to seek advice. Where flexibility to supervision frequency is applied this should be agreed between the NMP, medical supervisor and lead consultant / service manager.

12 Return to practice as NMP following a break

12.1.1 On returning to practice following a break support will be facilitated by the NMP lead, service manager and Consultant.

12.1.2 Depending on the reason and duration of the break, there may be a period of preceptorship by the medical mentor. The length of time of the preceptorship will be agreed between the medical prescriber/mentor, Consultant, service manager and Chief Pharmacist/Deputy Director of Nursing.

NMPs who have not prescribed for 6 months or more will be subject to a minimum of 10 supervised prescriptions and the Assessment form (appendix 6) completed and submitted to the NMP lead for formal record. The supervisor will be a designated medical practitioner (DMP) experienced in the field of expertise who is willing to offer the supervision and make written declaration at the end of the preceptorship period that the NMP is competent. The relevant Approval to Practice form should be completed and sent to Chief Pharmacist / Deputy Director of Nursing for final authorisation and updating of the register – as outlined in sections 7 and 10.

13 Changing Prescribing Speciality

13.1.1 A NMP intending to change their prescribing specialty must meet with the Deputy Director of Nursing/Chief Pharmacist before doing so in order to discuss their suitability to do so. The NMP must provide evidence of a minimum of one year‟s (or part time equivalent) experience in the new field and written support from their Line Manager and Consultant about their suitability and need to act as a NMP in the new role/area.


13.1.2 At minimum the NMP will be subject to 10 supervised prescriptions and the Assessment form (appendix 6) completed and submitted to the NMP lead for formal record. The supervisor must be an appropriate registered medical practitioner in the field of expertise who is willing to offer the supervision and make written declaration at the end of the preceptorship period that the NMP is competent. The relevant Approval to Practice form should be completed and sent to Chief Pharmacist / Deputy Director of Nursing for final authorisation and updating of the register – as outlined in sections 7 and 10.

14 Maintaining the NMP register

14.1.1 An up-to-date register of NMPs will be maintained within the trust by the NMP lead. A copy of this will be kept centrally.

The NMP Register must contain:-

Name

NMC pin number or RPSGB number

Qualification: e.g. RMN

Date of qualification if newly qualified

Contact details

Eligibility to prescribe – Independently, Area of competency / practice - new

Controlled drugs eligible to prescribe.

14.1.2 The non-medical prescriber must notify the NMP lead of a change of details for any of the following:-

Change of name

Change of contact number

Change of NMC pin number or GPhC number

14.1.3 The service line manager must inform the non-medical prescribing lead of any of the following:-

Termination of employment

Suspension from practising

Appointment of qualified NMPs not currently on the trust register


14.1.4 Managers must be aware that NMPs who are already qualified when starting employment in the trust must undergo the same authorisation process as newly qualified NMPs, see section 7.

15 Liability and Professional Indemnity

15.1.1 NMPs are accountable for all aspects of their prescribing decisions. The NMP is individually and professionally accountable for his/her prescribing decision, action and omission and cannot delegate this accountability to another person. This accountability extends to decisions taken to recommend „over the counter‟ items.

15.1.2 The NMP must ensure that their prescribing activity is within their sphere of competence and nature of work, is safe, cost effective, consistent with the clinical need of the patient and in line with National and local guidance.

15.1.3 The role of other people in the delivery of health care to service users must be recognised and respected.

15.1.4 The NMP must recognise and deal with pressures (e.g. from the pharmaceutical industry, patients, relatives or colleagues) that might inappropriately affect their prescribing decision and refuse to be influenced by such pressures. Any prescription must be in the best interests of the patient only. The NMP must report such pressure to the Chief Pharmacist and Non-medical Prescribing Lead.

15.1.5 All NMPs must ensure they have sufficient professional indemnity insurance. Comprehensive Professional Indemnity Insurance may be obtained from their professional organisation, trade union or insurance provider. NMPs risk invalidation of their indemnity cover if they fail to disclose membership of a provider to other professional / union or insurance bodies that they are insured with. The Indemnity Insurance must provide adequate cover for their prescribing practice (DH 2005, 2006).

15.1.6 Both the employer and employee should ensure that the employee‟s job description includes a clear statement that prescribing is required as part of the duties of that post or service.

15.1.7 Where a NMP is appropriately trained and qualified and provided he/she prescribes with the consent of the employer as part of their professional duties and in accordance with the employer‟s policies and the Law, the employer is held vicariously liable for their actions. In addition NMPs are accountable to their Professional Regulatory Body.

16 Dissemination and implementation arrangements

16.1.1 This document will be circulated to all managers who will be required to cascade the information to members of their team. It will be available to all staff via the trust intranet. The pharmacy department / NMP lead will inform consultants, non-medical prescribers and managers via newsletter and meetings of any updates. Clarification on any aspect of the policy should be obtained from the Chief Pharmacist or Deputy Director of Nursing.


17 Training requirements

17.1.1 Staff should attend the relevant training and CPD as outlined in this policy

17.1.2 The manager will have responsibility for ensuring all staff attend the relevant training and maintain all records relating to the staff competency assessments.

18 Monitoring and audit arrangement

Elements to

be monitored

Lead How trust will

monitor compliance

Frequency Reporting arrangements Which committee or group will the monitoring report go to?

Acting on recommendations and Lead(s) Which committee or group will act on recommendations?

Change in practice and lessons to be shared How will changes be implemented and lessons learnt/ shared?

Prescribing

Deputy Director of Nursing / Chief Pharmacist

Audit patient records

Annually DTC

Required actions will be identified and completed in a specified timeframe

Required changes to practice will be identified and actioned within a specific time frame. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders

Clinical Supervision

Deputy Director of Nursing / Chief Pharmacist

Audit Annually DTC

19 Review of the policy

This policy shall be reviewed in March 2022

20 References

Home Office circular 009/2012 https://www.gov.uk/government/publications/nurse-and-pharmacist-independent-prescribing-mixing-of-medicines-possession-authorities-under-patient-group-directions-and-personal-exemption-provisions-for-schedule-4-part-ii-drugs

NICE /National Prescribing Centre (NPC) A single competency framework for all Prescribers (2012) www.nice.org.uk

Independent Nurse Prescribing within the NHS in England (DH 2006) www.gov.uk

https://www.gov.uk/government/publications/nurse-and-pharmacist-independent-prescribing-mixing-of-medicines-possession-authorities-under-patient-group-directions-and-personal-exemption-provisions-for-schedule-4-part-ii-drugs




http://www.nice.org.uk/

http://www.gov.uk/


Improving Patients‟ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England (DH April 2006). www.gov.uk

DH (2007) Improving Patients‟ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England www.gov.uk

Nursing and Midwifery Council :Standards of Proficiency for Nurse and Midwife

Prescribers www.nmc-uk.org

General Pharmaceutical Council (GPhC):

http://www.pharmacyregulation.org/education/pharmacist-independent-

prescriber/entry-requirements

Independent prescribing of controlled drugs; A quick reference guide, 2012. Royal

Pharmaceutical Society of Great Britain www.rpsgb.org.uk

21 Associated documents

Medicines Management policy

Controlled Drug policy

Controlled Drug procedure

FP10 HNC policy

FP10 MDA procedure

Medicines Formulary policy

Medicines Formulary

Unlicensed medicines policy

Pharmaceutical Representatives policy

Study leave and funding policy

Mandatory training policy

Supervision policy

Consent to treatment policy

Clinical prescribing guidelines - trustnet

22 Glossary

22.1 Non-medical prescribing

Non-medical prescribing is prescribing by specially trained nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers, working within their clinical competence. (Only nurses, optometrists, pharmacists may practice as independent prescribers).

22.2 Independent prescribing

Independent prescribing is prescribing by a practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing. In practice, there are TWO distinct forms of non-medical independent prescriber.

http://www.gov.uk/

http://www.nmc-uk.org/

http://www.pharmacyregulation.org/education/pharmacist-independent-prescriber/entry-requirements

http://www.pharmacyregulation.org/education/pharmacist-independent-prescriber/entry-requirements

http://www.rpsgb.org.uk/


An independent prescriber may currently be a specially trained nurse, pharmacist or optometrist who can prescribe any licensed medicine within their clinical competence. Nurse and pharmacist independent prescribers can also prescribe unlicensed medicines and controlled drugs.

A community practitioner nurse prescriber (CPNP), for example district nurse, health visitor or school nurse, can independently prescribe from a limited formulary called the Nurse Prescribers‟ Formulary for Community Practitioners, which can be found in the British National Formulary (BNF).

22.3 The regulators of non-medical prescribers

Professional regulators are required to set standards of education, training, conduct and performance and approve education programmes that prepare healthcare professionals to prescribe. They record the qualification of prescriber on their register. The regulators are:

Nursing and Midwifery Council (for nurses and midwives)

General Pharmaceutical Council (for pharmacists)

General Optical Council (for optometrists) Health Professions Council (for physiotherapists, podiatrists and radiographers


Appendix 1

Responsibilities and Duties

Non-Medical Prescribing Lead / Co-ordinator has responsibility to:

Promote non-medical prescribing

Cascade information received from the Department of Health (DH) about changes in non-medical prescribing

Work in partnership with universities to assist in the development of NMP programmes, assess the quality of training provided and ensure an appropriate number of courses are available for all disciplines and for associated continuing professional development

Liaise with L&D department to ensure appropriate training is accessible and secure funding where appropriate.

Ensure managers and prescribers are aware of this policy and their duty to adhere to the policy and medicines legislation

Ensure arrangement and delivery of NMP forum and provide advice and support in regard to Non-medical prescribing

Ensure that arrangements are in place for assessment of practice, clinical supervision, audit, monitoring and continuing professional development for all NMPs.

Screen applications for NMP, acting as the central point for the co-ordination of applications.

Maintain the Non Medical Prescriber database and register. The register will include the name of the prescriber, type of prescriber/qualification and when obtained, work base and contact number, Professional Registration number, specimen signature

Ensure validation of the register annually

Facilitate DH monitoring requirements. Line Manager

Ensure that non-medical prescribing is necessary and beneficial to patient care and does not pose unnecessary risk

Ensure that only staff who meet the eligibility criteria are supported to undertake training for NMP

Ensure that the staff member has completed the necessary training/courses in order prescribe and provide evidence

Ensure that the NMP is supervised and assessed in prescribing activities following completion of the qualification and deemed competent before being permitted to act independently

Ensure that the NMP engages in CPD relevant to their prescribing practice and maintains evidence of such in their portfolio

Ensure that the NMP has read and adheres to this policy and related national guidance and legislation

Ensure the NMP‟s job description includes their role and responsibilities in relation to Non-medical Prescribing

Undertake regular appraisal of prescribing activity to ensure adherence to local and National guidance

Support CPD and clinical supervision, ensuring that this forms part of the NMP‟s personal development plan


Non-Medical Prescriber

Adhere to policy, national/local guidance, legislation and their professional code of conduct

Independent non-medical prescribers prescribe for clients with an existing diagnosis taking full responsibility and accountability for clinical assessment and management of patients and their prescribing decisions. They may prescribe medications as considered safe and appropriate under national and local guidance and within their competency. Independent NMPs are able to diagnose and prescribe for previously undiagnosed conditions within their area of competence if the following criteria are fulfilled:

o There is a comprehensive framework around diagnosis (For example the diagnostic assessment tools used in the Adult ADHD Service)

o Multi-disciplinary team working o Stated in the approved proposal for implementing non-medical prescribing in

service (Appendix 2) and Approval to practice form: Independent NMP (appendix 10)

Ensure that their professional registration is current and active, with their NMP role registered with their professional body and that all required information is provided for trust NMP register

Ensure that their role as an independent NMP is clearly described in their job description

Ensure that they provide evidence-based, safe, cost effective prescribing in accordance with trust policy, guidance and formulary, to their patients/clients at all times which is patient centred and responds to their needs

Keep accurate, legible, unambiguous and contemporaneous records of a patient‟s care which identifies them as the non-medical prescriber including details of all prescriptions issued in accordance with trust policies/procedures

Ensure that patients are aware of the scope and limits of non-medical prescribing and ensure patients understand their rights in relation to non-medical prescribing. Patients have the right to refuse treatment/prescribing from a NMP

Liaise with other healthcare providers as appropriate in accordance with service policies, ensuring patients are referred to other healthcare professionals as necessary to access other aspects of their healthcare

Ensure that prescriptions are written legibly and legally and in accordance with the trust Medicines Management Policy.

Ensure that they comply with prescription security and maintain a personal record of prescription numbers

Take part in peer review, co-operate with investigations and undertake audit and monitoring of prescribing and patient satisfaction surveys as requested

Hold appropriate indemnity insurance

Ensure that their practice is up-to-date and they engage in appropriate CPD, supervision and submit evidence on request.

Provide guidance, supervision and training to other staff in relation to non-medical prescribing issues as appropriate.

Report all incidents including adverse drug reactions in accordance with trust policy.

Lead on/assist with development of trust policies and procedures relating to non-medical prescribing


Appendix 2

Proposal for implementing non-medical prescribing in service

Guidance for assessing suitability for non-medical prescribing

What is the current system for issuing prescriptions for patients?

Why does this system need to change?

What are the intended benefits for patients/clients?

What are the risks of introducing non-medical prescribing and how will these be minimised?

Could the medicines be offered by Patient Group Direction?

What type of non-medical prescriber are you hoping to develop in your service? Why this type of prescriber?

What are the names of the Service Manager, Clinical Director and Service Director who support the development of non-medical prescribing in your area?

What medicines and for what condition(s) are you proposing the prescriber should prescribe?

Is non-medical prescribing requisite for the prospective candidate’s role?


Does the prospective candidate meet the eligibility criteria for the prescribing course?

Can you release the prospective candidate for the required study time?

What is the name of the GP/Consultant from your service area who supports this initiative and is willing for you to prescribe for their patients?

What is the name of the GP/Consultant in your service area who is eligible and willing to act as the Designated Medical Practitioner and supervisor for the course?

Can your service provide supervised practice for the post-qualifying minimum of 3 months? How will this be achieved and who will provide supervision?

What support will be available to the non-medical prescriber in the event of doubt/query of diagnosis or drug?

How will you monitor and audit the effectiveness, quality and safety of the nonmedical prescriber?

Does the candidate’s job description state the type of non-medical prescribing as requisite?

Service Manager …………………………………………………………………Date…………….. (Sign & print name)

Lead Consultant …………………………………………………………………Date…………….. (Sign & print name)

Designated Medical Practitioner…………………………………………….Date……………… (Sign & print name)

Agreed by: Divisional Director / Clinical Lead (Sign & print name)

…………………………………….…………………………………………………Date…………….. Chief Pharmacist / Deputy Director of Nursing (Sign & print name)

………………………………….……………………………………………………Date……………..


Appendix 3 Designated Medical Practitioner (DMP)

The National Prescribing Centre has developed guidance entitled „Training non-medical prescribers in practice – A guide to help doctors prepare for and carry out the role of designated medical practitioner‟ to help inform the selection of DMPs. It is available from the NPC website. The curricula for preparing nurse and pharmacist prescribers to become non-medical Independent prescriber includes no less than 12 days of learning in practice. This period of learning in practice is to be directed by a DMP who will also be responsible for assessing whether the learning outcomes have been met and whether the trainee has acquired certain competencies. Normally these outcomes and competencies will be identified by the University running the individual courses. Before taking on the role of DMP, the Doctor and the Trust should consider the competencies needed to effectively undertake the role The DMP must be a registered medical practitioner who:

Has had at least three years recent clinical experience for a group of patients/clients in the relevant field of practice

Is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post Graduate Training in General Practice Certificate or is a specialist registrar, clinical assistant or a consultant within a NHS Trust or other NHS employer

Has the support of the employing organisation or GP practice to act as the DMP who will provide supervision, support and opportunities to develop competence in prescribing practice

Has experience or training in teaching and/or supervising practice

Normally works with the trainee prescriber. If this is not possible (such as in nurse led services or community pharmacy) arrangements can be agreed for another doctor to take on the role of DMP provided the above criteria are met and the learning in practice relates to the clinical area in which the trainee prescriber will ultimately be carrying out their prescribing role

The DMP has a crucial role in educating and assessing non-medical prescribers. This involves:

Establishing a learning contract with the trainee

Planning a learning programme which will provide the opportunity for the trained to meet their learning objectives and gain competency in prescribing

Facilitating learning by encouraging critical thinking and reflection

Providing dedicated time and opportunities for the trainee to observe how the DMP conducts a consultation/interview with patients and/or carers and the development of a management plan

Allowing opportunities for the trainee to carry out consultations and suggest clinical management and prescribing options, which are then discussed with the DMP

Helping ensure that the trainee integrates theory with practice

Taking opportunities to allow in-depth discussion and analysis of clinical management using a random case analysis approach, when patient care and prescribing behaviour can be examined further

Assessing and verifying that, by the end of the course, the trainee is competent to assume the prescribing role


Appendix 4

A Competency Framework for all Prescribers

This word version can be used as a template to record notes and actions. Please refer to the full

PDF version for further information.

Publication date: July 2016

Review date: July 2020

This prescribing competency framework replaces all previous

profession specific competency frameworks published by the

National Prescribing Centre

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-02-13-163215-030


Framework design The competency framework (illustrated below) sets out what good prescribing looks like.

There are ten competencies split into two domains. Within each of the ten competency

dimensions there are statements which describe the activity or outcomes prescribers should

be able to demonstrate.


Tips on using the competency framework to identify strengths and development

areas

1. Before reviewing the competency framework take some time to think about the

following questions. This can be done alone or with relevant colleagues.

In your view, what are the most important behaviours and skills that prescribers

use, and need to maintain, to be good prescribers? Why?

Reflect on a recent 'prescribing' encounter that you had with a patient that you

felt did not go well, or resulted in an error - what happened? How might it have

been prevented?

Reflect on a recent 'prescribing' encounter that you had with a patient that you

felt went well - what happened?

2. Approach the framework one competency at a time to keep it manageable. There

may be overlap between the different sections.

3. All competencies will be relevant to all prescribers however some of the supporting

statements may be more relevant to some prescribers than others. Spend some time

thinking about how the statements apply to your individual prescribing context.

PRESCRIBING COMPETENCY FRAMEWORK

THE CONSULTATION (COMPETENCIES 1-6) Competency 1: ASSESS THE PATIENT

Indicator Notes 1.1 Takes an appropriate medical, social and medication history, including allergies

and intolerances.

1.2 Undertakes an appropriate clinical assessment. 1.3 Accesses and interprets all available and relevant patient records to ensure

knowledge of the patient’s management to date.

1.4 Requests and interprets relevant investigations necessary to inform treatment

options.

1.5 Makes, confirms or understands, the working or final diagnosis by systematically

considering the various possibilities

1.6 Understands the condition(s) being treated, their natural progression and how

to assess their severity, deterioration and anticipated response to treatment.

1.7 Reviews adherence to and effectiveness of current medicines. 1.8 Refers to or seeks guidance from another member of the team, a specialist or a

prescribing information source when necessary.

Competency 2: CONSIDER THE OPTIONS

Indicator Notes 2.1 Considers both non-pharmacological (including no treatment) and

pharmacological approaches to modifying disease and promoting health.

2.2 Considers all pharmacological treatment options including optimising doses as

well as stopping treatment (appropriate polypharmacy, de-prescribing).

2.3 Assesses the risks and benefits to the patient of taking or not taking a medicine

or treatment.

2.4 Applies understanding of the mode of action and pharmacokinetics of medicines

and how these may be altered (e.g. by genetics, age, renal impairment, pregnancy).

2.5 Assesses how co-morbidities, existing medication, allergies, contraindications

and quality of life impact on management options.

2.6 Takes into account any relevant patient factors (e.g. ability to swallow, religion)

and the potential impact on route of administration and formulation of medicines.

2.7 Identifies, accesses, and uses reliable and validated sources of information and

critically evaluates other information. 2.8 Stays up-to-date in own area of practice and applies the principles of evidence-

based practice, including clinical and cost-effectiveness.

2.9 Takes into account the wider perspective including the public health issues

related to medicines and their use and promoting health.

2.10 Understands antimicrobial resistance and the roles of infection prevention,

control and antimicrobial stewardship measures.

Competency 3: REACH A SHARED DECISION

Indicator Notes 3.1 Works with the patient/carer in partnership to make informed choices, agreeing

a plan that respects patient preferences including their right to refuse or limit

treatment.

3.2 Identifies and respects the patient in relation to diversity, values, beliefs and

expectations about their health and treatment with medicines.

3.3 Explains the rationale behind and the potential risks and benefits of management

options in a way the patient/carer understands.

3.4 Routinely assesses adherence in a non-judgemental way and understands the

different reasons non-adherence can occur (intentional or non-intentional) and how

best to support patients/carers.

3.5 Builds a relationship which encourages appropriate prescribing and not the

expectation that a prescription will be supplied.

3.6 Explores the patient/carers understanding of a consultation and aims for a

satisfactory outcome for the patient/carer and prescriber.

Competency 4: PRESCRIBE

Indicator Notes 4.1 Prescribes a medicine only with adequate, up-to-date awareness of its actions,

indications, dose, contraindications, interactions, cautions, and side effects.

4.2 Understands the potential for adverse effects and takes steps to avoid/minimise,

recognise and manage them.

4.3 Prescribes within relevant frameworks for medicines use as appropriate (e.g.

local formularies, care pathways, protocols and guidelines).

4.4 Prescribes generic medicines where practical and safe for the patient and knows

when medicines should be prescribed by branded product.

4.5 Understands and applies relevant national frameworks for medicines use (e.g.

NICE, SMC, AWMSG and medicines management/optimisation) to own prescribing

practice.

4.6 Accurately completes and routinely checks calculations relevant to prescribing

and practical dosing.

4.7 Considers the potential for misuse of medicines. 4.8 Uses up-to-date information about prescribed medicines (e.g. availability, pack

sizes, storage conditions, excipients, costs).

4.9 Electronically generates or writes legible unambiguous and complete

prescriptions which meet legal requirements.

4.10 Effectively uses the systems necessary to prescribe medicines (e.g. medicine

charts, electronic prescribing, decision support).

4.11 Only prescribes medicines that are unlicensed, ‘off-label’, or outside standard

practice if satisfied that an alternative licensed medicine would not meet the

patient’s clinical needs.

4.12 Makes accurate legible and contemporaneous records and clinical notes of

prescribing decisions.

4.13 Communicates information about medicines and what they are being used for

when sharing or transferring prescribing responsibilities/ information.

Competency 5: PROVIDE INFORMATION

Indicator Notes 5.1 Checks the patient/carer’s understanding of and commitment to the patient’s

management, monitoring and follow-up.

5.2 Gives the patient/carer clear, understandable and accessible information about

their medicines (e.g. what it is for, how to use it, possible unwanted effects and how

to report them, expected duration of treatment).

5.3 Guides patients/carers on how to identify reliable sources of information about

their medicines and treatments.

5.4 Ensures that the patient/carer knows what to do if there are any concerns about

the management of their condition, if the condition deteriorates or if there is no

improvement in a specific time frame.

5.5 When possible, encourages and supports patients/carers to take responsibility

for their medicines and self-manage their conditions.

Competency 6: MONITOR AND REVIEW

Indicator Notes 6.1 Establishes and maintains a plan for reviewing the patient’s treatment.

6.2 Ensures that the effectiveness of treatment and potential unwanted effects are

monitored.

6.3 Detects and reports suspected adverse drug reactions using appropriate

reporting systems.

6.4 Adapts the management plan in response to on-going monitoring and review of

the patient’s condition and preferences.

PRESCRIBING GOVERNANCE Competency 7: PRESCRIBE SAFELY

Indicator Notes 7.1 Prescribes within own scope of practice and recognises the limits of own

knowledge and skill.

7.2 Knows about common types and causes of medication errors and how to

prevent, avoid and detect them.

7.3 Identifies the potential risks associated with prescribing via remote media

(telephone, email or through a third party) and takes steps to minimise them.

7.4 Minimises risks to patients by using or developing processes that support safe

prescribing particularly in areas of high risk (e.g. transfer of information about

medicines, prescribing of repeat medicines).

7.5 Keeps up to date with emerging safety concerns related to prescribing.

7.6 Reports prescribing errors, near misses and critical incidents, and reviews

practice to prevent recurrence.

Competency 8: PRESCRIBE PROFESSIONALLY

Indicator Notes 8.1 Ensures confidence and competence to prescribe are maintained.

8.2 Accepts personal responsibility for prescribing and understands the legal and

ethical implications.

8.3 Knows and works within legal and regulatory frameworks affecting prescribing

practice (e.g. controlled drugs, prescribing of unlicensed/off label medicines,

regulators guidance, supplementary prescribing).

8.4 Makes prescribing decisions based on the needs of patients and not the

prescriber’s personal considerations.

8.5 Recognises and deals with factors that might unduly influence prescribing (e.g.

pharmaceutical industry, media, patient, colleagues).

8.6 Works within the NHS/organisational/regulatory and other codes of conduct

when interacting with the pharmaceutical industry.

Competency 9: IMPROVE PRESCRIBING PRACTICE

Indicator Notes 9.1 Reflects on own and others prescribing practice, and acts upon feedback and

discussion.

9.2 Acts upon colleagues’ inappropriate or unsafe prescribing practice using

appropriate mechanisms.

9.3 Understands and uses available tools to improve prescribing (e.g. patient and

peer review feedback, prescribing data analysis and audit).

Competency 10: PRESCRIBE AS PART OF A TEAM

Indicator Notes 10.1 Acts as part of a multidisciplinary team to ensure that continuity of care across

care settings is developed and not compromised.

10.2 Establishes relationships with other professionals based on understanding, trust

and respect for each other’s roles in relation to prescribing.

10.3 Negotiates the appropriate level of support and supervision for role as a

prescriber.

10.4 Provides support and advice to other prescribers or those involved in

administration of medicines where appropriate.

Appendix 5

Check List for Newly Qualified Non-medical Prescribers

1. Have you read the relevant Trust Medicines Management Policies and prescribing guideines? Specify.

2. Have you received notification of registration for Non-Medical Prescribing from your

professional body? (Please bring this notification with you for your meeting with the NMP lead)

3. Has your job description been amended to incorporate Non-Medical Prescribing?

4. Have you attended Human Resources and provided a sample signature?

5. Have you agreed with your manager, the budget holder, the lead consultant for your team

and pharmacy which prescription forms you will be using?

6. Have you agreed with your line/service manager how your prescribing clinics will be organised; how patients will be referred to you; how your annual leave / sickness will be covered; whether any additional administrative support will be needed and how you will access additional admin support?

7. How and when will you inform community pharmacies and GP practices of your intention to

prescribe including the scope of medications you will be prescribing?

8. Are your team members and colleagues aware of your intention to prescribe?

9. Have you agreed with your manager and consultant a period of preceptorship prior to starting prescribing? If so how long?

10. Are governance arrangements in place to ensure monitoring of your prescribing? E.g.

Prescribing log, audit

11. Have you agreed monthly supervision with medical supervisor?

12. Do you have access to an experienced prescribing colleague (medical or NMP) for support and guidance in NMP decision making?

13. Have you identified how you will meet your ongoing Non-medical Prescribing Continuing

Professional Development Needs?

14. Have you worked through and completed the „Single competency framework for all prescribers‟ (NICE/NPC 2012) with your DMP. (This should be brought with you to the meeting with the NMP lead)

Appendix 6: Assessment record for Non-Medical Prescribers (new to the trust, returning to practice, changing prescribing specialty) The Supervisor must be an experienced, Designated Medical Practitioner in the field of expertise in which the Supervisee intends to practice

Name of Prescriber (Supervisee)……………………….. Place of work........................................... Name of Manager .......................................... Name of Supervisor ......................................... Supervised Practice (1) Date……………

Example of practice assessed: patient case number: Clinical presentation, medicine, route & dose prescribed: I certify that the above named competently assessed patients/clients and prescribed safely and appropriately in accordance with Trust Policy and National Guidance Signed…………………………..… Name & Title (Block Letters)…………………………..

Supervised Practice (2) Date……………


















Declaration of Supervisor I confirm that ....................................................................... (name of supervisee) has demonstrated competence in non-medical independent prescribing in the field of ............................................................ (state specialty/area of work) Signed………………………………………. Name & designation (Print)………………………………………………………….Date…………………… Declaration of Supervisee I confirm that I have achieved competence in non-medical independent prescribing in the field of.............................................. and am willing to undertake this as part of my role. I will act at all times in accordance with Trust Policy and National Guidance. I am aware of my professional and legal responsibilities. Should my level of proficiency or competency fall, I shall cease practice in this domain, inform my manager and the Non-Medical Prescribing Lead and seek retraining and re-evaluation. Signed....................................................... Name and Designation (block caps).............................................. A copy of this document must be given to your Manager and the Non-Medical Prescribing Lead

Appendix 7

Approval to practice form: Newly Qualified

Full name:

Name (print)

Signature

Date……………………..

Email

Profession:

Prescribing qualifications:

RPSGB / NMC number:

Area of practice:

Approved to prescribe for:

Service:

Approved by Supervising Consultant:

Name (print)

Signature

Date……………………..

Approved By Service Line Manager

Name (print)

Signature

Date……………………..

Checklist completed (usually Non medical prescribing lead):

Name (print)

Signature

Date……………………..

Approved by Deputy Director Of Nursing:

Name (print)

Signature

Date……………………..

OR

Approved by Chief Pharmacist:

Name (Print)

Signature

Date……………………..

Original to: Personal file

Copies to: Trust lead for NMP Pharmacy (Chief Pharmacist) Deputy Director Nursing

Human Resources (Associate Director)

Trust NMP register updated: (date)………………………… Drug & Therapeutics Committee notified: (date of meeting)……………………...

Appendix 8

Template for Inclusion in the Individual Job Description

Updating Job Description

Prior to the selection and appointment process, the relevant manager will ensure that the job description and personal specification is updated as follows:

The following should form part of the main body of the job description under clinical duties:

To work as an independent non-medical prescriber, within the designated areas of practice.

As an Independent non-medical prescriber, prescribe for clients with an existing diagnosis taking full responsibility and accountability for clinical assessment and management of patients and their prescribing decisions. They may prescribe medications as considered safe and appropriate under national and local guidance and within their competency. Independent NMPs are able to diagnose and prescribe for previously undiagnosed conditions within their area of competence if the following criteria are fulfilled:

o There is a comprehensive framework around diagnosis (For example the diagnostic assessment tools used in the Adult ADHD Service)

o Multi-disciplinary team working o Stated in the approved proposal for implementing non-medical prescribing in service

and Approval to practice form: Independent NMP

Adhere to policy, national/local guidance, legislation and their professional code of conduct

Ensure that their professional registration is current and active, with their NMP role registered with their professional body and that all required information is provided for trust NMP register

Ensure that their role as an NMP/IP is clearly described in their job description

Ensure that they provide evidence-based, safe, cost effective prescribing in accordance with trust policy, guidance and formulary, to their patients/clients at all times which is patient centred and responds to their needs

Keep accurate, legible, unambiguous and contemporaneous records of a patient‟s care which identifies them as the non-medical prescriber including details of all prescriptions issued in accordance with trust policies/procedures

Ensure that patients are aware of the scope and limits of non-medical prescribing and ensure patients understand their rights in relation to non-medical prescribing. Patients have the right to refuse treatment/prescribing from a NMP

Liaise with other healthcare providers as appropriate in accordance with service policies, ensuring patients are referred to other healthcare professionals as necessary to access other aspects of their healthcare

Ensure that prescriptions are written legibly and legally and in accordance with the trust Medicines Management Policy.

Ensure that they comply with prescription security and maintain a personal record of prescription numbers

Take part in peer review, co-operate with investigations and undertake audit and monitoring of prescribing and patient satisfaction surveys as requested

Hold appropriate indemnity insurance

Ensure that their practice is up-to-date and they engage in appropriate CPD, supervision and submit evidence on request.

Provide guidance, supervision and training to other staff in relation to non-medical prescribing issues as appropriate including the mentoring and supervision of NMP SPs by NMP IPs

Report all incidents including adverse drug reactions in accordance with trust policy.

Lead on/assist with development of trust policies and procedures relating to non-medical prescribing

Updating Person Specification

The person specification for the post of NMP should include the following:-

• Have a certificate to demonstrate he/she has successfully completed a non-medical prescribing course at post graduate level. The course must be at least 6 months duration and have been validated by the RPSGB (Pharmacists) or/and the NMC (Nurses).

• Hold current registration as an Independent and Supplementary non-medical prescriber with the RPSGB or the NMC.

• Have a certificate to demonstrate he/she has successfully completed the physical health course for mental health staff

• Demonstrable track record of prescribing practice • Detailed working knowledge of medication management and compliance issues • In-depth understanding of the risks associated with NMP and the management of side

effects and medication errors. • Well-developed analytical and judgement skills

Appendix 9

The following restrictions apply in relation to non-medical prescribing: The non-medical prescriber may only prescribe within their sphere of expertise and competence. Off-label / off-licence medicines – Nurse and Pharmacist independent prescribers may prescribe medicines independently for uses outside their licensed indications/UK marketing authorisation (so called „off-licence‟ or „off-label‟). They must, however, accept professional, clinical and legal responsibility for that prescribing, and should only prescribe „off-label‟ where it is accepted clinical practice. The prescriber should explain the situation to the patient/guardian or carer, where possible, but where a patient is unable to agree to such treatment, the prescriber should act in accordance with best practice in the given situation. The prescriber must comprehensively document their reasons for prescribing such a medicine and their discussion with the patient. Unlicensed medicines – Nurse and pharmacist independent prescribers are allowed to prescribe unlicensed medicines within their competence and field of expertise, where it is accepted clinical practice and has been agreed by the Medicines Management Committee (see Unlicensed Medicines Policy). Supplementary prescribers may prescribe unlicensed medicines if they form part of a Clinical Management Plan. Again, the prescriber remains accountable and liable for off-label prescribing and should comprehensively document their reasons for prescribing. The patient or patient‟s guardian should be informed and consent obtained for the treatment. Controlled Drugs (CDs) – Pharmacist and Nurse Independent Prescribers may prescribe, administer and give directions for the administration of Schedule 2, 3, 4 and 5 Controlled Drugs. They are not permitted to prescribe diamorphine, dipipanone or cocaine for treating addiction but may prescribe these items for treating organic disease or injury. Prescribers must ensure that they are familiar with the various drug schedules, details of which can be found in the British National Formulary.

All the legal requirements for a CD prescription must be met. Computer generated prescriptions may be used for CDs, providing the software is in place and an audit trail of prescribing practice is evident.

The quantity of any CD prescribed must not exceed 28 days supply per prescription (excluding schedule 5 drugs).

All NMPs are required to familiarise themselves with, and adhere to, the Trust‟s Controlled Drug Policy and Controlled Drug procedure.

Mixing of Medicines - “Mixing” has been defined by the Department of Health as “the combination of two or more medicinal products together for the purposes of administering them to meet the needs of a particular patient”.

Due to the risks of drug incompatibility and chemical reaction which may have serious adverse effects, the mixing of drugs should be avoided where possible. There may be instances where mixing of drugs is safe and acceptable practice e.g. in palliative care where a narcotic and anti-emetic may be mixed and delivered in a low volume, continuous sub-cutaneous infusion.

Under no circumstances may medicines used for mental health care be mixed in the same syringe

Guidance from the Royal Pharmaceutical Society states: „The mixing of drugs should be avoided unless essential to meet the needs of the patient, and that those involved in both the prescribing and actual mixing should be competent to do so and take full professional and clinical responsibility for their actions. In addition such actions must be within the governance structures and guidance of the employing authority and of the relevant statutory bodies.‟

Nurse and pharmacist independent prescribers are allowed to mix medicines prior to administration and provide written directions for others to do so. They must ensure that the medicines are compatible for mixing before doing prescribing, mixing, administering or providing directions for others.

Appendix 10

Approval to practice form: Independent NMP

Full name:

Name (print)

Signature

Date……………………..

Email

Profession:

Prescribing qualifications:

RPSGB / NMC number:

Area of practice:

Approved to prescribe for:

Service:

How long has the NMP been actively prescribing and in what capacity? – please give dates and duration of any gaps in prescribing.

Independent NMP:

Evidence to support practice as Independent NMP

Consistent level of competency against the single competency assessment framework for all prescribers (NICE/NPC)

Supervised assessment of prescribing practice (attach form if applicable)

Ongoing CPD

Prescribing log

In what way(s) will the NMP enhance patient care?

Improve access to services / treatment for service users

Improve the quality of services to patients without compromising safety

Make it easier for service users to get the medicines they need

Increase service user choice in accessing medicines

Make better use of the skills of healthcare professionals

Contribute to the introduction of more flexible team working

Approved by Supervising Consultant:

Name (print)

Signature

Date……………………..

Approved By Service Line Manager

Name (print)

Signature

Date……………………..

Checklist completed (usually Non medical prescribing lead):

Name (print)

Signature

Date……………………..

Approved by Deputy Director Of Nursing:

Name (print)

Signature

Date……………………..

OR

Approved by Chief Pharmacist:

Name (Print)

Signature

Date……………………..

Original to: Personal file

Copies to: Trust lead for NMP Pharmacy (Chief Pharmacist) Deputy Director Nursing

Human Resources (Associate Director)

Trust NMP register updated: (date)………………………… Drug & Therapeutics Committee notified: (date of meeting)……………………...

Appendix 11

Sample letter NMP notifying GP of change in medication NMP‟s name & address

………………… Date: Dear Dr …………………………….. Re: …………………………………………. ……………………..

Patient‟s name Patient‟s DOB …………………………………………………………………………….. Patient‟s address

I am writing to inform you that I have seen the above patient today. I have made the following amendments to their prescription, in relation to this patient (delete if not applicable).

Medication discontinued: …………………………………………………………………………. …………………………………………………………………………………………………………

Medication initiated:

……………………………………………………………………………………………… …………………………………………………………………………………………………………

Any dosage changes:

…………………………………………………………………………………………….. (delete as appropriate)

I have issued a prescription for …….. days supply on (date)……………………and would appreciate it if you could amend your records and then issue subsequent prescriptions (delete if not applicable e.g.

clozapine, depot).

If you have any problems with this arrangement, please contact me on …………………………… Yours sincerely NMP

Appendix 12

Equality Impact Assessment Tool

Yes/No Comments

1. Does the policy/guidance affect one group less or more favourably than another on the basis of:

Race NO

Ethnic origins (including gypsies and travellers) NO

Nationality NO

Gender NO

Culture NO

Religion or belief NO

Sexual orientation including lesbian, gay and bisexual people

NO

Age NO

Disability - learning disabilities, physical disability, sensory impairment and mental health problems

NO

2. Is there any evidence that some groups are affected differently?

NO

3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

N/A

4. Is the impact of the policy/guidance likely to be negative?

NO

5. If so can the impact be avoided? N/A

6. What alternatives are there to achieving the policy/guidance without the impact?

N/A

7. Can we reduce the impact by taking different action?

N/A

Documents

NON-MEDICAL PRESCRIBING POLICY MARCH 2019 Prescribing... · 4.3 Chief Pharmacist / Deputy Director of Nursing 4.3.1 The Chief Pharmacist and Deputy Director of Nursing will be responsible