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Extending Independent Nurse Prescribing within NHSScotland
INTRODUCTION
This guidance sets out the administrative or procedural steps that are needed to enable nurses and midwives to prescribe from the extended formulary, and provides information and advice on good practice.
[NB where the term 'nurse' is used in this document it includes Registered Midwives.]
Brief history of nurse prescribing in Scotland
The nurse prescribing scheme for district nurses and health visitors was based on the recommendations contained in the Report of the Advisory Group on Nurse Prescribing 1989, which advised Ministers how patient care in the community might be improved by introducing nurse prescribing. The report identified a number of clear benefits that could arise from nurse prescribing:
an improvement in patient care;
better use of the patients', nurses' and GPs' time;
clarification of professional responsibilities leading to improved communications between team members.
Implementation of nurse prescribing was piloted in England in 1994 and followed by its introduction in the other UK countries. The necessary legislation to enable community nurses in Scotland with either a district nursing or health visiting qualification to prescribe independently from a limited formulary was passed in 1996.
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The scheme was introduced in Scotland by a phased implementation, which commenced in 1996 and is now complete. It enabled all practising district nurses, health visitors, and practice nurses with either qualification to undertake a course of preparation approved by the former National Board for Nursing, Midwifery and Health Visiting for Scotland (NBS) (Now NHS Education for Scotland (NES)) for independent prescribing from the Nurse Prescriber's Formulary. This comprised a stand-alone course of 2 days attendance preceded by a period of open learning.
Since 1999, preparation for prescribing from this formulary has been included in the district nursing and health visiting pathways of specialist practitioner programmes. Prescribing is now integral to the role of all district nurses, health visitors and the small number of practice nurses who have successfully completed the assessment requirements of either the stand alone or integrated course and whose prescribing status is noted on the Professional Register held by the Nursing and Midwifery Council (NMC). There are approximately 3000 nurse prescribers in Scotland today.
Extending nurse prescribing
Following a 3-month consultation with nursing, medical and pharmacy professional organisations from October 2000, Ministers announced in May 2001 that nurse prescribing would be extended to more nurses and to a wider range of medicines, to cover four broad areas of practice:
Minor ailments
Minor injuries
Health promotion
Palliative care.
The extension is intended to provide patients with quicker and more efficient access to medicines, and to make the best use of nurses' skills. The key principle underlying the extension is that patient safety is paramount.
Following training, nurses prescribing under this extended scheme will be able to prescribe all General Sales List and Pharmacy medicines currently prescribable by GPs under the NHS (General Medical Services) (Scotland) Regulations, with the exception of those products which contain controlled drugs, together with a list of Prescription Only Medicines (POMs). 2 million of central funding is allocated over the period 2001-2004 to train an additional 1500 nurse prescribers.
Ministers also announced in May 2001 that steps would be taken to allow 'supplementary prescribing' by nurses and other health professionals, allowing them, after initial assessment of a patient by a doctor, to prescribe for that patient in accordance with a clinical management plan. This form of prescribing is thought to be particularly suitable for nurses working with patients with enduring conditions such as asthma, diabetes, heart disease or mental illness. A consultation document issued in April 2002 states nurses and pharmacists will be the first professionals involved in supplementary prescribing.
Current nurse prescribers
District Nurses and Health Visitor prescribers will continue to be able to prescribe from the current Nurse Prescribers' Formulary, which will be regularly reviewed to keep it up to date and in line with the practice requirements of this professional group. DNs and HVs will also be eligible for consideration for training to qualify as prescribers from the Extended Formulary, where there is a service need for them to do so. Higher Education Institutions offering the specific programme of preparation for the Extended Formulary may accredit the nurse prescriber's prior learning.
Scope of this guidance and effect of devolution
This guidance sets out the steps to implement extended nurse prescribing in Scotland. The legislation that permits the extension of prescribing applies across the UK, and Ministers in Scotland have decided that extended nurse prescribing will be implemented.
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