Latest News for Nurse Prescribers

NICE publishes PGD case scenarios

October 30, 2014 by admin 

NICE has published six Patient Group Directions (PGDs) case scenarios to show how the recommendations from Patient Group Directions, NICE medicines practice guideline 2 (MPG2), can be applied in practice. For example, they cover situations such as whether a district nurse can administer an injection supplied by a clinic nurse using a PGD to supply injections for self-administration and how a commissioning support unit could develop PGDs for several clinical commissioning groups.

Commissioners not using pharmacist prescribing skills

May 13, 2014 by admin 

Pharmacists have told online pharmacy magazine C+D that “lack of will” on the part of commissioners is leading to independent prescribers’ skills being wasted. This follows publication of a workforce survey by the General Pharmaceutical Council (GPhC), which found that 74% of pharmacist prescribers have prescribed at some point, with 61% prescribing in the previous year. The reasons given for not prescribing included lack of opportunities, changing circumstances and personal reasons.

NMC confirms review of prescribing standards

May 13, 2014 by admin 

The NMC has confirmed to the ANP that it is now evaluating its prescribing (2006) and medicines management (2007) standards and will be revising them. The standards were due for review anyway, but the regulator says the large number of fitness to practise cases in this area will inform the process. The GMC updated its prescribing guidance for doctors last year.

Much has changed since the NMC’s standards were produced, highlighting the difficulty of keeping standards up to date as legislation, technology and practice change, and professional boundaries shift.

Law Commission has recommended that a single legal framework apply to the nine different bodies

April 10, 2014 by admin 

The Law Commission has recommended that a single legal framework apply to the nine different bodies including the Nursing and Midwifery Council (NMC) that regulate healthcare professionals and, in England, social workers. This would mean all existing governing legislation for these bodies gets repealed and a single Act passed replacing it. The plan has been welcomed by the regulators but criticised by the Professional Standards Authority (PSA).

The Law Commission has published a draft Bill that it says would provide a ‘clear, modern and effective legal framework for the regulation of health and social care professionals.’ One major change is that the regulatory bodies will have greater flexibility to change the rules about issues such as registration, standards and continuing professional development without government of parliamentary approvals, to avoid delays. This fits with a wider theme - that regulators will have greater autonomy to deliver their functions in ways that suits the profession concerned; at the same time, the Bill will impose greater consistency where necessary, for example fitness to practice hearings.

The draft Bill reforms the statutory grounds on which fitness to practice can be impaired - the proposed grounds include disgraceful misconduct, insufficient proficiency in English, and another regulator deciding fitness to practice is impaired.

Both the NMC and the  General Medical Council (GMC) have welcomed the plan, with the GMC calling it a ‘once in a generation’ opportunity to get medical regulation right, pointing out that the ability to modernise independently will allow regulators ‘to be more directly responsible for meeting the legitimate expectations of patients, the public and the professionals they regulate’.

NMC Chief Executive and Registrar Jackie Smith is also clear about the benefits of the draft ‘potentially revolutionary’ Bill, pointing out that the Prime Minister made a commitment to ’sweeping away the Nursing and Midwifery Council’s outdated and inflexible decision-making processes’, as part of his response to the Francis inquiry in February 2013. She urges the government to timetable this Bill for the last parliamentary session, stressing how long the process can take.

The PSA, which oversees the regulators, says that the plans would be a ‘backwards step for public protection’ and that the proposals do not deliver what Francis called for - patients being at the centre of care, greater professional accountability and greater openness.

Latest updates from NICE

March 14, 2014 by admin 

NICE has published some more new medicines evidence summaries, including ones on empagliflozin in Type 2 diabetes and the fluticasone furoate/vilanterol (Relvar Ellipta) combination inhaler in asthma, and some summaries on unlicensed/off label medicines including one on oral ketamine for chronic pain.

MPS highlights risk of prescribing in general practice

March 14, 2014 by admin 

Prescribing is one of the top five risks in general practice, according to assessment and analysis from the The Medical Protection Society (MPS). It says that uncollected prescriptions account for 53% of prescribing risks, and suggests making a note on the records when a patient has not collected their prescription. Poor repeat prescribing protocols are another source of risk.

Indemnity insurance for nurses and midwives

March 14, 2014 by admin 

The NMC has now published its final information on professional indemnity insurance (scroll down to the middle of the page - the NMC has confirmed that this is the final version, published in February 2014, although it is dated July 2013).

The NMC confirms that the Code will be amended once the legislation requiring all healthcare professionals to hold an appropriate indemnity arrangement is in place. The ‘large majority of nurses and midwives will already meet the new requirement and will not need to take any further action’, says the NMC, confirming that employees in the NHS or the independent sector will normally be covered by their employer’s arrangements (although outside the NHS, arrangements do vary, so nurses should check). Self-employed, or partly self-employed, nurses will need their own cover, which may be as part of membership of a professional body or trade union, from a commercial provider, or a combination of the two. The NMC says that it cannot provide advice about the level of cover that registrants require; they should seek advice from their professional body, trade union, or insurer as appropriate. NHS Employers has published some useful Q and As on the new requirements.

The RCN’s recent announcement that it is withdrawing indemnity cover from employed and aesthetic nurses has continued to generate some debate.

RCN withdraws indemnity cover from employed nurses and aesthetic practice

February 17, 2014 by admin 

The RCN’s indemnity scheme covering members against clinical negligence claims is about to change again.  From 1 July 2014, it will exclude work undertaken as part of a contract of employment, and it will exclude aesthetic practice. The RCN says the vast majority of its members will not be affected by this change, and reiterates that it will continue to provide workplace and NMC support and representation.

The RCN says that all employers - the NHS (including for bank or agency work), GP practices, independent sector, out-of-hours providers and so on - “have vicarious responsibility for the actions of their staff” and should cover the costs of any claims of clinical negligence. Its says RCN cover is not needed to cover employed members for work undertaken as part of their contract of employment as their employer is liable, so it is closing what it calls a loophole by making some “small, technical changes”. Education placements, good Samaritan or charitable nursing work and voluntary work are still covered.

According to the RCN, some employers have been attempting to shift their costs onto the RCN, “even insisting that their staff have personal indemnity cover”. The NHS does not do this, and nor can GP practices since the rules were changed in 2011, amidst some controversy, but some out-of-hours providers and other organisations are still trying to do so.

Most self-employed members are covered by the scheme but should check their specific circumstances, as there are some exclusions. In addition, from 1 July 2014, aesthetic practice will no longer be covered by the RCN, as there is a high risk of claims.

Chief Executive and General Secretary of the RCN, Dr Peter Carter,  said: “Most members won’t notice a change at all, but this ensures that the responsibility for claims rests with those who should be paying - namely the employer - so that we can focus on protecting, representing and supporting members in other work-related and professional legal areas. This means that neither our members nor the RCN will pay the price for underperforming employers.”

Unison says it is examining the rationale behind the decision but that its indemnity insurance stays in place for now. Christina McAnea, Unison Head of Health, said, “It should, however, be crystal clear that employers are responsible for ensuring that their staff are covered.”

The issue of indemnity, particularly for nurses in extended roles given recent legal changes, was discussed at the November ANP conference. The NMC is still preparing its final information about the new legislation that makes indemnity insurance compulsory for all healthcare professionals but is clear that nurses working for the NHS already have appropriate arrangements; that nurses working for other employers should be covered by their employer’s scheme - but should check the detail; and that self-employed nurses will need their own cover. In its draft information, the NMC says it cannot offer advice on what level of cover is appropriate.

Dr Barbara Stuttle CBE, ANP Chair, said, “The changes highlight the fact that responsibility for indemnity for employed nurses acting within the terms of their contract lies with their employers. Nurses working in advanced or extended roles such as prescribing should check that their job description states that their role includes prescribing, and that their employer’s indemnity covers these roles. Both employed and self-employed nurses must check they are covered - ignorance will be no excuse!”

NICE publishes PGD competency frameworks

February 17, 2014 by admin 

In January, NICE published a competency framework for health professionals using Patient Group Directions (PGDs), explaining that it is an implementation tool to be used alongside the published guidance. It has also  developed frameworks for people developing and/or reviewing and updating PGDs and for people authorising PGDs.

New PGD FAQs published

January 15, 2014 by admin 

Three new frequently asked questions (FAQs) about Patient Group Directions (PGDs) were published on the NHS PGD site in December. They cover: whether prescription charges and exemptions apply when patients receive medicines under a PGD (they do); whether PGDs relate to specific locations (they don’t); and whether if a medicine is not included in existing exemptions  to the Medicines Act, a PGD is required for the supply of P and GSL medicines.

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