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5. Capacity - developing NMAHP prescribing
Service development and service redesign
NMAHP prescribers have a potentially very significant role to play in service development and service redesign. It is all about looking at services creatively and identifying who is the most effective person(s) to prescribe to secure the greatest patient benefits in terms of safety, timeliness and ease of access. Each service redesign presents an opportunity for services to think creatively about prescribing for patients, with cost/benefits analyses providing a guide to identification of the most appropriate professional prescriber.
Because of their highly specialised skills, proximity to where patients live, long-established relationships with individual patients, unpaid carers and communities, sound communication skills and strong professional relationships with pharmacists and medical practitioners, NMAHP prescribers can be a fulcrum for redesigning services to maximise patient gains.
Senior managers in NHS boards must constantly be aware of the positive impact NMAHP prescribers are having on the way services are evolving. Keeping an eye on the "middle distance", assessing impact and likely demand for the future, will ensure that they do not arrive at a succession planning deficit and find themselves with insufficient numbers of NMAHP prescribers to meet need.
Recommendations
All new service developments and service redesign initiatives should include consideration of the most appropriate professional(s) to prescribe medicines for patients affected by the development/redesign.
Workforce/succession planning for NMAHP prescribing should be an integral part of business plans developed for all new service developments and service redesign initiatives.
Education preparation
Key to meeting these future needs is the availability of sufficient places on NMAHP prescribing education programmes to prepare the right number of practitioners. Part of good strategic husbandry and governance of the NMAHP prescribing service is the development of systems to predict future needs and consequent training places required, a function that should be the responsibility of the Strategic Lead for NMAHP Prescribing (see Chapter 4).
Selection of trainees and the development of the education programme should involve input not just from academic staff, but also from managers, NMAHP prescribers, designated medical practitioners, mentors, patients and the public. The programme must also, of course, take cognisance of new legislative or policy developments and the emergence of guidance and competency frameworks from the NMC, HPC and other organisations.
Innovative and flexible means of delivering the theoretical and practical aspects of the programme, making best use of available information technology, should be considered and developed. This may be particularly beneficial for trainees in remote and rural parts of the country.
Practical elements of the programme are vital to the development of safe and effective NMAHP prescribers. They must not be considered as secondary to the more theoretical aspects, Proper provision has to be made to ensure trainees can gain maximum education and professional benefits from their practical experience.
More generally, the Higher Education Institutions' Prescribing Network in Scotland has been doing sterling work in driving up education standards in the nurse prescribing programme. The network has produced assessment tools and other resources that are proving very beneficial for trainees. It is creating a consistently high standard of education provision across Scotland.
Recommendations
NHS boards should have strategies and service agreements in place to ensure ongoing dialogue and partnerships with HEIs in relation to NMAHP prescribing education.
A system should be in place for predicting future needs for training places.
A robust selection procedure should be in place to ensure the appropriate selection of candidates.
Flexible means of delivering the theoretical and practical aspects of the programme should be considered.
The clinical elements of the programme should be considered to have equal standing to the theoretical components.
NHS boards should support and encourage the Higher Education Institutions' Prescribing Network to continue its excellent work.
Ongoing professional development and support
NMAHP prescribers need to maintain and develop their knowledge and skill over their careers. They find themselves having to maintain their competence in two discrete but linked areas - as professional practitioners, and as NMAHP prescribers. The NMC is preparing a set of standards for ongoing education that nurse prescribers will have to meet to continue practising as registered prescribers.
It is reasonable for an employer to expect NMAHP prescribers to accept responsibility for keeping themselves updated. They are accountable professionals answerable to their regulatory body, which has set standards for ongoing fitness for practice that includes the imperative of updating skills and knowledge.
Employers must, however, accept that they, too, have a responsibility in this area. The professional development planning ( PDP) mechanism within NHS Scotland allows individual NMAHP prescribers to identify their own continuing personal development needs with their line manager, mapping out an agreed course of action that will acquire for them the extra skills and knowledge they need to continue to function effectively.
In addition to the formal PDP process, which may involve only one single meeting each year, NMAHP prescribers have a need for ongoing support, advice and mentorship. They should be encouraged and assisted to identify someone (or a number of people) who can provide this kind of support, which should be considered as an addition to, rather than as a replacement for, traditional managerial supervision and/or clinical supervision.
A range of ways of engaging with supervision has been developed in NMAHP circles over the last decade or so. These offer a variety of solitary activities (critical reflection, journal-keeping), one-to-one processes (mentoring, clinical supervision) and group activities (networks, special interest groups) to help NMAHPs identify and pursue continuing personal development needs.
Recommendation
NHS boards should be prepared to ensure a range of appropriate sources of support are in place for NMAHP prescribers to enable them to identify and meet ongoing development needs. Central to this is the PDP process, through which NMAHP prescribers can be supported to meet mandatory ongoing professional standards and other development needs.
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