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1. Introduction
Legislation to introduce Nurse 1 Independent Prescribing in Scotland came into effect on 31 May 2006.
It marked the culmination of a long and at times arduous process that stretched as far back as 1989, when the Report of the Advisory Group on Nurse Prescribing (The Crown Report) (DoH, 1989) claimed that nurse prescribing would lead to better patient care, better use of patients', nurses' and GPs' time, and better communications between team members.
The initiative took off properly in Scotland in 1996 with a phased introduction that is now complete. A review carried out by the University of Stirling (Watterson et al, in press) has found that many of the claims made for nurse prescribing in the Crown Report have been borne out. It found that:
- the public had considerable confidence in nurse prescribing;
- nurse prescribers believed their prescribing roles made them more effective nurses;
- GPs' workloads had been reduced as a result of nurse prescribing;
- nurses were regarded as "safe prescribers" by patients and professionals.
Legislation is now in place to allow some allied health professionals ( AHPs), such as radiographers, podiatrists and physiotherapists, to train as supplementary prescribers. 2 Joint postgraduate education courses for nurses, midwives and allied health professionals ( AHPs) from a variety of professions commenced in Scotland in autumn 2007.
The introduction of prescribing into AHP practice provides a unique opportunity to jointly consider the education, strategic and operational needs of prescribers who are nurses, midwives and AHPs ( NMAHPs).
NMAHP prescribing is now at an important point in its history. Delivering Care, Enabling Health (Scottish Executive, 2006) stated that NMAHPs should make the best use of their skills, knowledge and expertise to provide patients with quicker and more efficient access to medicines, and NMAHP prescribing clearly has a big role in enabling this aspiration to happen in practice.
At around the same time as Delivering Care, Enabling Health was published (December 2006), the Guidance for Nurse Independent Prescribers document was produced (Scottish Executive, 2006a). It sets out the parameters and standards for prescribing practice - the "nuts and bolts", day-by-day operational issues that will ensure safe and effective practice.
What is needed now is a strategic vision to drive NMAHP prescribing over the next decade, a vision that will enable NMAHP prescribing to support and complement national policy imperatives and help NHS boards to meet their responsibilities to patients and the public across a wide range of clinical and health areas.
This document provides that strategic vision. It sets out the infrastructure that will be needed to drive NMAHP prescribing forward in relation to three key areas:
- culture
- capability
- capacity.
The main driver for the strategy is a recognition that while nurse prescribing is bedding down well in certain parts of Scotland, 3 with safe, effective nurse prescribers providing valuable services to patients and the NHS, the overall picture in Scotland is patchy.
There are significant differences between regions and boards on how many nurse prescribers are in place, how they operate, how they are managed and how they are resourced. The University of Stirling research referred to above found "a lack of coherent, integrated and stable board-level infrastructure for prescribers and, in some instances, there have been slow responses of boards to the prescribing agenda."
Models of excellence in developing nurse prescribing services are emerging, and some of these are referenced in the document. But the main aim of the strategy is to provide NHS boards with a framework from which they can develop NMAHP prescribing services that are right for patients and the public, right for NMAHPs, and right for fellow health professionals.
While local differences in emphasis will always exist, the strategy also puts in place a set of recommendations on developing and managing an NMAHP prescribing service that will help to create consistency in quality throughout Scotland. In addition, a self-assessment tool designed to facilitate implementation of the strategy recommendations at local level is presented at the end of the document.
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