Its functions will be divided among different bodies, with the work related to reporting and learning from serious patient safety incidents moving to the new NHS Commissioning Board, and the National Research Ethics Service being considered as part of a review of research regulation. The Health Protection Agency and National Treatment Agency for Substance Misuse are also to be abolished, with their functions transferring to the new public health service.

Matt Griffiths, ANP committee member and visiting professor of prescribing and medicines management at the University of the West of England, is concerned about these plans: “Medication safety is a huge, huge issue and should be high-profile - it needs to be considered as a whole. Enforcement and policy making should be informed by research, and it is vital that the expertise is on board to reduce the large number of medication-related hospital admissions and incidents each year”.

Another issue is that of conflict of interest, particularly between professionals and any private interest whose income depends on the professionals’ approval or prescription of their product - so including but not limited to the pharmaceutical industry. The author says that non-medical prescribers need a better understanding of the Association of the British Pharmaceutical Industry (ABPI) Code of Practice, and that perhaps there should be active policing of the Code and publication of case details. The article also points out how many drug trials, and how much nursing and medical education, are funded by the pharmaceutical industry and the impact this has. There is accumulating evidence that does not support the industry’s stance that education is the true intent of its programmes, argues the author, who says that there is now a body of thought that policies and guidelines are needed in this area.

Nurse prescribing extends beyond the therapeutic alliance into areas of research, human rights, policy, promoting change, financial issues and ethics. The author concludes by urging the Nursing and Midwifery Council (NMC) to set the highest standards, provide robust guidance for practitioners and show that it is willing to stand up to private industry.

Young A. Professionalism and ethical issues in nurse prescribing. Nurse Prescribing 2010; 8(6): 284-289.

Many or all  of the nurses felt that there were benefits for patient care through prescribing, that there were misunderstandings among practice staff about their role, that it is both ‘imperative and intuitive’ to follow appropriate guidance, that their role had changed as a result of prescribing, and that they were unwilling to prescribe outside their competence or boundaries. Some felt that workload had increased. It emerged during the interviews that minor illness is increasingly being incorporated into the role of these nurses. Although some GPs welcomed the change and were supportive, others were less happy about it and lacked understanding about the nurse prescriber’s role and competency.

The authors make some recommendations: all staff working with prescribing nurses should get full explanations of the circumstances in which they can prescribe; after the initial mentoring period, doctors or experienced nurse prescribers should provide a further period of mentoring and supervision, to further mutual respect and understanding; and a continued learning or system of monitoring could be introduced to help nurse prescribers demonstrate their credibility - as nurses’ roles extend, something like the GP performance monitoring system may become more appropriate. Clearly, as the authors point out, this is a small study and further work is needed.

Daughtry J. and Hayter M. A qualitative study of practice nurses’ prescribing experiences. Practice Nursing 2010; 21(6): 310-314.

[1] Adams E et al. Prescribing in Ireland: the National Implementation Framework. Nurse Prescribing 2010; 8(4): 182-188.

[2] Adams E et al. Nurse and midwife prescribing in Ireland: the Minimum Dataset. Nurse Prescribing 2010; 8(5): 234-241.

The answer, from Earl Howe (Department of Health Parliamentary Under-Secretary of State in the Lords), said that, “it is essential that the right person gives the right medication at the right time……… Nurse prescribing is a welcome development that can benefit patients significantly. She would agree that services should continue to look at what professional mix can best deliver safe, timely and effective treatments for patients.” No further details were given on progress with the legislation in his answer. Although the relevant changes were made to the Prescription Only Medicines (Human Use) Order 1997 in April 2008, changes to the Misuse of Drugs Regulations 2001 are currently with the Home Office.

The latest news is that these changes plus changes to the rules on patient group directions and mixing medicines where one or more controlled drugs is involved, may come through this summer. Watch this space!

Interestingly, the patients were able to demonstrate specific improvements in efficiency and access - for example, being able to get an appointment with a nurse at short notice. Nurses were seen as more flexible than doctors but doctors’ time was also perceived as more important! So, nurse prescribing had contributed to improving the service in ways which patients noticed and cared about.

Patients expected teamwork among health professionals, preferring to see doctors for conditions perceived to be more serious or undiagnosed, and expected nurses to have had the necessary training and experience, as well as specialist diabetes knowledge, if they were to prescribe. Confidence in their ability to prescribe was inspired by these attributes and also patients’ direct experience, nurses’ willingness to refer to doctors or others when unsure, good communication skills, and attention to detail.

Patients of the diabetes specialist nurses expected the nurse prescriber to prescribe new medication or equipment but only that related to diabetes. In contrast, some patients of the general practice nurses saw the role as monitoring and continuing to prescribe medication initiated by the doctor although others were happy for the nurse to prescribe medicines for co-morbidities - there was a varied range of views among these general practice patients.

The authors conclude that workforce planners need to include services provided by nurse prescribers alongside those of doctors.

Courtenay M, Stenner K and Carey N. The views of patients with diabetes about nurse prescribing. Diabetic Medicine; published online 8 June 2010.