Community Practitioners' and Health Visitors' Association

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CPHVA'S Response to the Consultation on Proposals To Extend Nurse Prescribing

The Community Practitioners' and Health Visitors' Association welcomes this opportunity to comment on the extension of nurse prescribing document.

The CPHVA, as a professional body for community practitionersí and health visitorsí, has many members who already have prescribing rights. Many members are specialist practitioners in health visiting and district nursing. The CPHVA would like to see prescribing rights extended to other groups of nurses, for example; practice nurses and school nurses.

1. Principles
The CPHVA agrees with the principles outlined in the document and that extension on nurse prescribing should be driven by patient need and local service need.

The CPHVA feels we need to consider the circumstances where the patient would benefit from the nurse being able to prescribe. Nurse prescribing brings value to practices where a nurse is working autonomously assessing and planning care. Where nurses are assessing patients, they will need to have physical assessment skills. Nurse prescribers need to be fully aware of accountability issues and recognise their limitations.

 2. Medical conditions

The CPHVA agrees with the examples laid down in ANNEX A, but see many other areas where the patient will benefit from a nurse being able to prescribe.

For example:-

ante-natal- maternal health -- antacids-- vaginal infections.
Common neonatal conditions -- eye infections -- thrush.
Infections (Within a locally agreed policy.)
Stoma care products.

The CPHVA supports the facility to enable appropriate practitioners prescribing rights in paediatric care and in the area of mental health.

3. Which option?
If Nurse Prescribing is going to be extended, it needs to be a workable option. Different formularies for different nurses would be too complicated. Therefore the CPHVA favour option 5 as the most appropriate formulary.

The CPHVA also has the view that there may be situations when nurses need to prescribe controlled drugs. For example with mental health nurses and nurses working in palliative care.

Nurse prescribing powers should be extended to all those who are eligible and they should have access to the entire formulary in the same way as doctors and dentists do now. Nurses who can and want to prescribe should be encouraged to do so within their competency.

We need to look at nurse prescribing in a wider context within a framework of clinical governance and within the new NHS plan.

4. Which Nurses?
The CPHVA feels that if nurse prescribing is extended only to nurses with a specialist practitioners status, many experienced nurses (nurse consultants/clinical nurse specialists/ nurses in walk-in centres/ nurses in minor injury units) who are educated to degree or masters level will be excluded.

It would be more appropriate for individual nurses, with the agreement of their employer, to apply to train as nurse prescribers. If assessment criteria for the training is adequate, only those who pass will be able to prescribe.

5. Education and Training
The Education and Training of the nurse prescriber will be the key to implementation being safe. The CPHVA feels very strongly that preparation must be comprehensive and that a knowledge of pharmaco-dynamics and pharmaco-kinetics is essential (preferably at level 3). The more you know the more aware you become of how little you know . The educational preparation will be much more than required by current nurse presrcibers.

How will existing nurse prescribers feel if they have to undertake more training?

There are pharmacology modules running at some universities already, for example, as part of masters courses in advanced practice. There may be a possibility of using an existing module rather than writing something completely new.

Education should emphasise medico-legal and safety aspects of prescribing activities; pre-reg programmes should include an introduction to prescribing principles.

The formulary must be accessed according to patient need and individual competence on the part of the practitioner.

There needs to be statutory continuous professional development for nurses prescribers. There also needs to be a period of mentorship for new prescribers.

6. Other points

The CPHVA has concerns about how the funding will be allocated. There are huge financial implications involved. With the move to computerised prescriptions, will nurses have access to the appropriate equipment? Hand written prescriptions are time consuming and open to error.

The CPHVA would like to point out that the timescale is very short to put training in place by September 2001, especially in view of the new Nursing and Midwifery Council coming later this year.


Professional Office/Practice Nursing
January 2001