Report Highlights Concern Over Nurse-Issued Prescriptions
A report in the specialist medical publication Pulse has caused medical practitioners to highlight their “serious concerns” in respect of the number of nurses now entrusted with the power to prescribe complex medicines. In 2006, the introduction of new rules granted nurses this distinction, but, since their advent, numbers involved have grown by 49 per cent. This has triggered a hot debate within medical circles as to whether the rights to issue complex pharmaceutical products should rest with pharmacists or nurses, especially when the factor of increasing the speed by which patients are provided with treatment is added into the equation.
One of those most incensed by the published findings is Professor Hugh McGavock, previously a member of the Committee on Safety of Medicines, who states: "Nurses' knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent to make a differential diagnosis. Only a country with not enough doctors would go down this cheapy line."
The General Secretary of the Royal College of Nursing, Dr Peter Carter, however, opposes this view. “Nurse prescribing has been a historic move for the nursing profession and it is one of the most successful parts of the current NHS reforms”, he states. “Far from being the problem Professor McGavock suggests, nurse prescribing has proved itself to be an important part of the solution in improving access to medicines and cutting waiting times for patients."
He continues: “Research shows that the majority of nurses who prescribe have at least 10 years' nursing experience before starting their prescribing training and must have either degree or masters-level education. Far from having a 'pathetically poor' knowledge of diagnosis, before they can even access a course, nurses have to be able to demonstrate that they have sufficient assessment and diagnostic skills in the specialist area they will prescribe in. Ultimately, every single nurse prescriber has to be 'signed off' by a doctor before they can begin prescribing. With well over 10,000 nurse prescribers currently practising, it appears there are at least 10,000 doctors who would disagree with Professor McGavock's concerns."
As from last year, when the nurse-prescription rules were implemented, nurses have been encouraged to take a post-graduate training course on prescribing. This includes a theory segment lasting for 26 days and tutored practice-runs for a further 12 days. Upon completion of this, nurses attain the rights to be able to prescribe for the likes of diabetes and asthma – a privilege previously reserved for GPs alone.
Less involved training is provided for so-called "community practitioner nurse prescribers", and, consequently, they are more restricted in respect of the drugs they are allowed to prescribe.
The Editor of Pulse magazine, Jo Haynes, is another to voice her concerns: "The whole nurse prescribing scheme has been rushed through with only the bare minimum of piloting and evaluation, and it won't be until academics start analysing the rates of adverse events and prescribing errors that we will know whether it has been a good or bad thing."
As per a spokesman from the Department of Health, the number of prescriptions currently being issued by nurses, as opposed to doctors, is actually pretty minimal. “GPs still account for 99% of the overall number of items prescribed but, by expanding traditional professional roles, the NHS can give patients easier access to medicines," he stated.
He continued: “Patient safety is our priority. That's why nurse prescribers are senior, experienced nurses who have undergone rigorous training before being able to prescribe - they have to successfully complete the relevant courses, be accredited by their respective regulatory bodies and had their qualifications noted on the professional register”.
"Once trained, they are required to keep their skills up to date. This ensures that patient safety is protected and that patients can be confident that they are receiving the highest standards of care."
Source – Pharmaceutical International’s Sub-Editor
