No news is bad news on CD changes
January 26, 2012 by admin
After hopes were raised in the autumn (see here), the Home Office said on 9 January that it is still unable to provide a date for the long-awaited amendments to the Misuse of Drugs Act about independent prescribers and controlled drugs. The statement was made in correspondence with pharmacist prescriber Mark Hutton, who specialises in the management of chronic pain, in the East Midlands, and who has been pursuing the Home Office since 2008 about these amendments. He said,’It is ridiculous that I cannot prescribe a drug such as co-codamol yet a patient can purchase it in a pharmacy, and that as a qualified independent prescriber, I have to use supplementary prescribing to prescribe controlled drugs for patients. There is a shortage of pain consultants compared with the number of people with chronic pain, and the Home Office has given no reason for the delays in allowing non-medical prescribers to provide a better service to patients in pain.’
Matt Griffiths, visiting professor of prescribing and medicines management at the University of the West of England, who has also been urging the Home Office to act and highlighting the consequence of delay for some years, had this to say:
‘We have been promised these changes since 2008. As well as non-medical prescribers and their patients, this also affects nurses who want to mix medicines that include a controlled drug, as these amendments will be made at the same time. There are daily restrictions on my practice, where legislation has not kept up with the needs of the modern day health service. I can work as a visiting clinician on a daily basis. I can prescribe certain controlled drugs for palliative care patients, but I can’t carry them out to their homes unless it is on a named patient basis. Despite correspondence with Lord Henley, the Home Office minister responsible, and earlier promises from the Home Office, no date has been given, and the reasons behind the delays of nearly four years do not justify them. I believe that Secretary of State for Health Andrew Lansley, or Prime Minister David Cameron need to intervene as patient care is being affected on a daily basis’.
The statutory instrument was most recently promised for the end of October 2011 (see here) and will allow nurse and pharmacist prescribers to prescribe controlled drugs, within their competence, as well as making the promised changes on mixing medicines, where one or more is a controlled drug (see here).
ANP Chair Barbara Stuttle, who wrote to David Cameron about this issue last year, points out the anomaly involved in this long delay: ‘We keep being told about the £20 billion that needs to be saved in the NHS but something that could so easily address some efficiency concerns - but relies on Ministers - is constantly delayed! All the relevant bodies agree about these legislative changes: all it needs is the statutory instrument. If the government is serious about supporting clinicians to work efficiently and effectively, then I urge the Home Office to make these legislative changes urgently. This will enable nurses to do their job and look after patients by providing the right care at the right time.’
CD changes promised by end of October
October 20, 2011 by admin
The Home Office says it is finalising the long-planned regulatory changes to the Misuse of Drugs Regulations 2001 about controlled drugs (see here and here) and that the appropriate statutory instrument will be laid before parliament by the end of October. The changes would then be expected to come into effect in November.
The most recent parliamentary answer can be seen here and Fiona Culley of the NMC told the ANP at its annual meeting on 19 October that she had received similar assurances from the Home Office. Professor Matt Griffiths, who has been pursuing this matter over the years, has told the ANP that he, too, has been given this information. So…..watch this space!
DH consults on independent prescribing by podiatrists and physiotherapists
October 20, 2011 by admin
Should independent prescribing be extended to podiatrists and physiotherapists? The Department of Health and MHRA have published two consultations with these proposals, which can be found here. The deadline for responses to both is 8 December 2011.
The physiotherapist consultation proposes that physiotherapists can become independent prescribers and that physiotherapist independent prescribers should be able to mix medicines before administration, and direct others to do so, and to prescribe some specified controlled drugs independently. Those physiotherapists who are currently supplementary prescribers would have to undergo additional training to become independent prescribers. The proposals would need changes to the Misuse of Drugs Regulations 2001, as well as to the Medicines Act 1968. Independent prescribing of unlicensed medicines is not included in either document.
The consultation sets out the list of options, ranging from prescribing for any condition from the complete formulary, to prescribing for specified conditions from a specified formulary. The proposals for podiatrists are similar and both consultations give examples of areas where independent prescribing could be useful.
An analysis of the responses to last year’s engagement exercise (see here) is included in the consultations, and shows a lot of support for the option of prescribing for any condition from the full formulary (option 5). The most limited extension - independent prescribing for specified conditions from a specified formulary - found support with the BMA and the Royal College of Physicians, among others. The more limited versions are likely to require frequent revisions to the lists of conditions and/or formularies, a process that those nurses who were prescribing before the formulary was opened up will remember only too well!
Controlled drugs rules change: SI being prepared?
September 28, 2011 by admin
The latest news on the long-delayed but promised changes to the Misuse of Drugs Regulations is that the Home Office is said to be preparing a statutory instrument that will both allow non-medical prescribers to prescribe all controlled drugs within their competence and regularise the practice of mixing of medicines that include controlled drugs before administration. This information - although still no date - was given in a written answer to a question asked in the House of Commons by David Mowat MP which can be seen here for the discussion at last year’s ANP conference of this issue.
ANP urges Prime Minister to act on controlled drugs legislation
April 28, 2011 by admin
“We can therefore see no reason for continuing delay” in making the necessary changes to controlled drugs legislation (see here), writes ANP Chair Barbara Stuttle recently in a letter to the Prime Minister, David Cameron. She points out that all political parties and all professional groups support the changes and that, until they are implemented, very seriously ill people are facing delays in getting adequate pain relief. One consequence can be unnecessary hospital admission.
CDs: Another question asked in Lords
July 14, 2010 by admin
Post election, what has happened to the long-awaited legislation about controlled drug prescribing by nurse and pharmacist prescribers (see here)? On 7 July, during a House of Lords short debate on pain control services, Baroness Emerton raised the question, asking whether the current situation could be untangled. She pointed out that nurse prescribers can prescribe some controlled drugs for specified conditions (for example, in palliative care or myocardial infarction) but not for chronic pain, which is a very frustrating position for all concerned. Matt Griffiths, ANP committee member and visiting professor of prescribing and medicines management at the University of Northampton and the University of the West of England, says that this can mean patients with chronic back pain, for example, waiting for several hours to see a doctor, who may then ask the specialist pain nurse running the clinic for advice on what to prescribe.
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!
CD legislation timetabled for December
December 19, 2009 by admin
The changes to allow nurse and pharmacist independent prescribers to prescribe controlled drugs within their competence are now scheduled for this month, according to a list of secondary legislation published by the Home Office. So the New Year should bring this long awaited change!
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