Extended and Supplementary Prescribing
Mar 27, 2015
Extended and Supplementary Prescribing
Supports modernisation in the
NHS “Vision for Pharmacy” “More staff, working differently” NICE/CHAI Improving working lives Junior Hospital Doctors hours Working Time Directive Skill-mix
Benefits of Supplementary Prescribing
Improved access Improved patient choice Greater flexibility for management of
patients Re-distribution of prescribing workload Improved job satisfaction for
supplementary prescriber Formalises some vicarious prescribing
that currently goes on
Latest DoH position "We need to fundamentally transform the NHS by giving and
extending choice. Nursing and midwifery has a central part to play in this transformation because you are close to people - you listen to them and they listen to you. Patients must play a bigger role in their health care and your help is vital in helping them to learn how to manage their condition."
Mr Reid also announced that independent nurse prescribing would be expanded with the addition of a further 10 new medical conditions and more than 30 additional medicines to the list, which Extended Formulary nurse prescribers can prescribe. These conditions include acute attacks of asthma and animal and human bites. He also made clear that nurse prescribing would be further extended next year to include emergency care.
John Reid CNOs Conference 14/11/03
Role of Extended and Supplementary
Prescribing Mode 1 and 2 prescribing
– Original legislation to allow health visitors and district nurses to prescribe from limited list
Extended prescribing for nurses– Allows independent prescribing from wider range
of products, but still doesn’t include all products Supplementary prescribing
– Very few limits to drugs that can be prescribed, but must be done in conjunction with independent prescriber and clinical management plan
What is Supplementary
prescribing? “A voluntary prescribing partnership
between the independent prescriber and a supplementary prescriber, to implement an agreed patient-specific Clinical Management Plan with the patient’s agreement”.
The Supplementary Prescriber must be a Registered Nurse, Registered Midwife or Registered Pharmacist.
Coming soon – optometrists, physiotherapists, other AHPs
Supplementary Prescribing
is not restricted SRx to specific clinical conditions
decision to introduce SRx arrangements for a specific patient will depend on agreement between the independent and the supplementary prescriber, and the patient
Prescribing Partnerships
Voluntary Share responsibility Professionally accountable for own
decisions If responsibility moves from one
medical practitioner to another, the supplementary needs to forge new partnership
Independent prescriber responsible for:
the initial clinical assessment of the patient and the formulation of a diagnosis,
the development of a written clinical management plan, in conjunction with the supplementary prescriber, following diagnosis
ensuring the clinical management plan is kept up-to-date
informing the supplementary prescriber of the limits of responsibility delegated to that supplementary prescriber
providing access to the patient’s record for the supplementary prescriber.
Independent prescriber responsible for:
providing advice and support to the supplementary prescriber as required
carrying out a review of patient’s progress at appropriate intervals, depending on the nature and stability of a patient’s condition, or at the request of the supplementary prescriber, and normally not longer than 1 year from the initial assessment
resuming full responsibility for the patient’s care at the request of the supplementary prescriber
Supplementary prescriber responsible for:
monitoring and assessing the patient’s progress as set out in the clinical management plan, and as appropriate to the medicines prescribed, including the reporting of any adverse reactions
contributing to the clinical management plan prescribing for the patient in accordance with
the agreed clinical management plan changing the medicine prescribed, within the
limits set out in the clinical management plan, if monitoring of the patient’s progress indicates that this is clinically appropriate
Supplementary prescriber responsible for:
accepting clinical responsibility and professional accountability for their prescribing decisions and practice
working at all times within their clinical competence and their professional Code of Conduct, consulting the independent prescriber as necessary and particularly if a matter falls outside their own clinical competence.
Supplementary prescriberresponsible for:
as soon as possible, and preferably contemporaneously, recording clinically relevant facts, including prescribing and monitoring activity, in the patient’s medical records.
referring prescribing responsibility back to the independent prescriber if the agreed clinical reviews are not carried out within the intervals specified in the clinical management plan or if monitoring of the patient’s progress indicates that this is appropriate
Principles of SRx
there should be benefit to patients and the NHS
supplementary prescribing should support but not replace multi-disciplinary care
patient safety should be paramount prescribing and dispensing responsibilities
should, where possible, be separate in keeping with the principles of patient safety and governance.
How can SRx be used in Practice?
Ongoing management of long-term conditions– Asthma, diabetes , hypertension, mental
health– Heart Failure, COPD
Management of out-patients– HRT clinic, renal patients, HIV/AIDs, anti-coag.
In-patient settings with predictable pathways– Nausea in oncology, post-operative pain
The clinical management plan MUST
– specify the range of medicines that may be prescribed
– specify the range and circumstances within which the supplementary prescriber can vary the dosage, frequency and formulation of the specified range of medicines as appropriate.
– when to refer back to the independent prescriber– contain relevant warnings about any known
sensitivities of the patient to particular medicines – Include arrangements for the notification of any
adverse drug reactions.– Start date and review date (max 12 months)
Before starting
The nurse or pharmacist must– successfully complete the specified training
and preparation for SRx – record their SRx competency on the relevant
professional register– agree with their employer that SRx should be
included in their job description.– make arrangements for Rx pads, prescribing
budget or other arrangements (e.g. patients’ prescription charts in hospitals)
Training and preparation - nurses
consultation, decision-making, therapy and referral
influences on and psychology of prescribing
prescribing in a team context clinical pharmacology including the
effects of co-morbidity and recognition of potential adverse drug reactions
Training and preparation - nurses
evidence-based practice and clinical governance in relation to nurse prescribing
legal, policy and ethical aspects professional accountability and
responsibility prescribing in the public health context.
Managed Entry System
Single system for SW WDCs for application for training
All applications go to one place Ensures appropriate practitioners
are applying and training will be used in suitable situation
Can help to form networks of supplementary prescribers
Process for ApplicationDecision that supplementary prescribing is necessary and appropriate
Fill in Application form and send to Project Team
Project Team consider applications and approve / advise where necessary
Approved applicants apply to university
Applicant undertakes supplementary prescribing training
Supplementary prescriber uses training. Project team provide support and links to prescriber networks
www.prescribing.swest.nhs.uk
Points to Consider
Availability of mentors Backfill Candidate ability to undertake
distance learning study Whether qualification will be used
after training Whether there are other ways to
fulfil the role e.g. PGDs
Course providersCourse providers
PharmacistsPharmacists– BathBath
NursesNurses– GloucestershireGloucestershire– BournemouthBournemouth– PlymouthPlymouth– Oxford BrookesOxford Brookes– PlymouthPlymouth
Further Information
All information can be found on the website
» www.prescribing.swest.nhs.uk» National information at
www.doh.gov.uk/supplementaryprescribing
Contacts– Kim Hogan – Avon, Gloucestershire, Wiltshire
– Alaster Rutherford – Devon and Cornwall» [email protected]
– Danielle Gorman – Dorset and Somerset» [email protected]