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4. Capability - delivering NMAHP prescribing
Leadership
Leadership is a vital element in the effective implementation, monitoring and evaluation of NMAHP prescribing.
For transformational change to happen in NHS Scotland, the culture and climate of change in the NHS needs to be further developed. Clinical leadership will be vital to achieving this aim.
Much has been achieved in promoting clinical leadership in NHS Scotland in recent years. Delivery through Leadership (Scottish Executive, 2005) , the NHS Scotland leadership development framework, aims to build leadership capacity and capability in NHS Scotland and grow new leaders to meet the service change agenda. It represents a single, national approach to leadership development in NHS Scotland focused on the needs of the service, teams and individuals.
Good examples of strong leadership that has helped to promote NMAHP prescribing can be found in Scotland, but overall, the approach to leadership in NMAHP prescribing has lacked consistency. The audit of nurse prescribing in Scotland (Pollock and Dudgeon, 2006) reported little direction being given to guide service development at strategic level within NHS boards.
The following is presented as a model of leadership for NMAHP prescribing that NHS boards can use to identify their own requirements.
At strategic level, a Strategic Lead for NMAHP Prescribing is given overall strategic responsibility for ensuring policies, auditing and quality mechanisms and support structures are in place within the NHS board to underpin a safe and effective NMAHP prescribing service. This person will also lead on the development of a local strategy and action plan for the contribution NMAHP prescribing can make to service development and redesign. He or she should ensure synergy with other service delivery plans in the area and develop mechanisms to support communication and information sharing with patients, the public, service professionals and other key stakeholders such as higher education institutions, the NMC and HPC, and the media.
At operational level, a Local NMAHP Prescribing Lead is in place to provide local leadership and direction. He or she will also be involved in selection of new trainees, delivery of support to trainees and existing NMAHP prescribers, co-ordination with designated medical practitioners, mentors, other professionals and local services, patients and the public, and development of an NMAHP prescriber database.
This position could be full or part-time, depending on the demands of the post, but is embedded at a sufficiently high position within the organisation to give the post-holder authority. The post-holder has clear reporting lines to the Strategic Lead for NMAHP Prescribing and other senior managers in the NHS board and is a member of the Local Drug and Therapeutics Team. Workforce planning and succession planning âˆ' ensuring operational issues around backfill, sickness and absence cover and study leave do not impact negatively on continuity of patient services âˆ' is a significant factor in this person's job description.
Recommendations
NHS boards should appoint a Strategic Lead for NMAHP Prescribing with clearly defined roles and responsibilities. The Strategic Lead should report to the board at regular intervals.
NHS boards should appoint Local NMAHP Prescribing Leads with clearly identified roles, responsibilities and reporting lines.
Information technology
The national eHealth Programme aims to change the way NHS Scotland uses information and related technology ( IT) to improve patient services. The key deliverables from the programme that will impact on NMAHP prescribing are the electronic patient record ( EPR) and electronic prescribing. Many of the clinical governance concerns around NMAHP prescribing will be resolved when these systems are put in place.
Great strides have already been made towards delivering on this agenda. The Emergency Care Summary 7 ( ECS) has been implemented, allowing practitioners (in NHS 24, out-of-hours services and accident and emergency departments) to access (with patient consent) information on patients' current medication regimen and allergy status. This information allows prescribers to make informed decisions on the appropriateness of medicines they might wish to prescribe "out of hours". An outline business case that proposes the broadening of access (with appropriate controls) to the ECS summary to other staff groups in both primary and secondary care settings, including palliative care nurses and acute receiving units, is being prepared.
The benefits of electronic prescribing are well documented (Bates, 2000), and the implementation of these systems will make a substantial contribution to patient safety. Electronic prescribing is already in place in GP surgeries and an outline business case has been prepared to ensure an integrated primary and community care system. A pilot of the hospital electronic prescribing and medicines administration ( HEPMA) system has been undertaken in secondary care, and an outline business case for the inclusion of HEPMA within the Patient Management System has been prepared.
It is crucial that steps are taken to ensure all NMAHP prescribers using systems such as these remain compliant with national legislative and policy initiatives relating to protection of patient information and data confidentiality.
Recommendation
NHS boards should ensure that NMAHP prescribers using IT systems in relation to their NMAHP prescribing work comply with legislation on data protection and information governance and with NHS Quality Improvement Scotland standards on handling patient information ( NHSQIS, 2005).
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