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We must tackle the barriers to prescribing

Soon after I qualified as a prescriber in 2008, I attended a meeting of hospital pharmacist prescribers. Many there were being prevented from using their qualifications, mostly due to unresolved issues around trust medicines management policies. The following year, a survey of pharmacist prescribers showed that only half of the respondents were prescribing in practice.

Until 2008, the only non-medical prescribers (NMPs) practising in my trust were nurses. At the time, the medicines management policy said: “NMPs may only cross off or rewrite items that they originally prescribed. If other changes are required the NMP must contact the team looking after that patient.”

In a previous column, Emma Graham-Clarke extolled the virtues of cancelling prescribed medicines (Clinical Pharmacist 2010;2:110). How can anyone be an effective prescriber if they cannot cancel any medicines that need to be stopped? Two of our nurse prescribers run an eye clinic. What would be the point of them doing so if they would have to repeatedly contact a doctor in order to change therapy? Where was the “independent” part of their prescribing?

The trust, like many others, is selective when choosing people for the prescribing course, and all who are chosen are experienced practitioners in their field. It was therefore disappointing to be given fewer prescribing rights than newly qualified doctors who, at times, cannot even spell drug names correctly. To have to go to such a person for permission to make simple changes to therapy would have been absurd. The consultant who was my tutor for the prescribing course was particularly unamused at the prospect of me bleeping him for permission to cross off senna tablets!

Now that there are more NMPs in the trust, we have tackled this issue. A list was drawn up detailing actions that NMPs could not undertake independently if the policy continued. The list included, among other things, deleting newly prescribed items to which a patient had a history of allergy and changing antiemetics from “as required” to regular (and vice versa) according to patient need. The nurse consultant presented this information to the relevant committee, and the sentence was removed from the policy.

Similar battles are going on around the country. As more doctors see benefits from the work of NMPs, this will help. Medicines management issues must be addressed so that they do not block progress. If we all keep chipping away we will get there in the end.

Citation: Clinical Pharmacist URI: 11102023

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