Should professional indemnity insurance be compulsory?
March 22, 2013 by admin
Should all members of regulated healthcare professions have an appropriate indemnity or insurance, as a condition of their registration with the relevant regulator? The Department of Health has launched a consultation on indemnity insurance for healthcare professionals, with a closing date of 17 May 2013.
The consultation is UK-wide. The proposed change would implement part of an EU Directive about patients’ rights in cross-border healthcare, which requires that systems of professional liability insurance or similar are in place by 25 October 2013. The Government also wants to implement the recommendations of a 2010 review.
So, the consultation says that these aims can be achieved by, “requiring statutorily regulated healthcare professionals to hold insurance or indemnity cover as a condition of their registration”. It adds that indemnity arrangements provided by employers will be sufficient to meet the requirement. The four health departments believe that it is not acceptable that individuals who have suffered harm because of negligence by a member of a regulated profession may not have access to compensation.
There are eight statutory healthcare professional regulatory bodies covered by the UK Parliament: six already have a statutory requirement in place or on its way. Two do not have a requirement or guidance, of which the Nursing and Midwifery Council (NMC) is one - although it does recommend registrants have indemnity cover. So the new provisions would include an enabling framework for these two bodies to give them the power to make the relevant rules.
GMC issues updated prescribing guidance
March 22, 2013 by admin
The General Medical Council has updated its prescribing guidance for doctors, in Good practice in prescribing and managing medicines and devices (2013).
Some of the information is relevant for non-medical prescribers:
- The guidance sets out the information sources that doctors should use to improve prescribing safety: the Medicines and Healthcare products Regulatory Agency’s (MHRA) Drug Safety Update; the the National Prescribing Centre, now part of NICE Medicines and Prescribing Centre and the electronic Medicines Compendium (eMC). It also sets out the sources of clinical guidelines that doctors should take account of. See here and here for ways in which medicines information is changing (Bill please add links to articles 3 and 4 for “here” and “here”)
- It includes the updated GMC stance on remote prescribing of Botox and other injectable cosmetic products. The Nursing and Midwifery Council (NMC) advice is here.
- A section on raising concerns, very interesting in the light of recent news saying, “You must protect patients from risks of harm posed by colleagues’ prescribing, administration and other medicines-related errors. You should question any decision or action that you consider might be unsafe. You should also respond constructively to concerns raised by colleagues, patients and carers about your own practice.”
- The section on unlicensed medicines says that some medicines are routinely used outside their licenses, and that in some situations, “it may not be practical or necessary to draw attention to the licence” - for example in emergencies or if realistically there is no alternative and the information is likely to be distressing. The NMC circular on nurse and midwife prescribing of unlicensed medicines from 2010 says that one of the conditions for prescribing is that, “The patient or client agrees to the prescription in the knowledge that the medicine is unlicensed and understands the implications of this.” The GMC points out two useful sources, if explaining about unlicensed medicines: the Medicines for Children leaflets including one on unlicensed medicines; and a British Pain Society leaflet on using medicines beyond their license.
- A section on sports medicine that deals with performance enhancement.
The NMC standards of proficiency for nurse and midwife prescribers were issued in 2006, with several circulars addressing prescribing issues and changes issued since.
Future of off-label prescribing: wet AMD and the regulatory bodies
June 12, 2012 by admin
The General Medical Council (GMC) is halting plans to loosen its guidance on doctors prescribing off-label and unlicensed medicines, and is seeking further legal advice, according to papers of a recent Council meeting. This follows a legal challenge by Novartis, which manufactures ranibizumab (Lucentis) over the off-label prescribing in some areas of the country of the cheaper drug, bevacizumab (Avastin), for wet age-related macular degeneration (AMD). Bevacizumab is licensed as a cancer drug but not for the treatment of wet AMD.
The Nursing and Midwifery Council (NMC) is planning to review prescribing standards, although it announced recently that the review of medicines management standards would not be going ahead, so this issue may face the nursing regulatory body very soon.
Press coverage has talked about far-reaching consequences, depending on what legal advice is forthcoming: current GMC guidance allows off-label prescribing where the medicine will “better serve” the patient than the appropriately licensed alternative. The proposed change would have also allowed unlicensed or off-label prescribing where the medicine was “as safe and effective” as the appropriately licensed alternative, on the basis of authoritative clinical guidelines. The proposal was in response to the very high costs of licensed drugs for rare conditions, and to avoid doctors being unable to follow both GMC guidance and NICE/employer guidance simultaneously.
The difference in costs can be dramatic - the BMJ reported recently that using bevacizumab instead of ranibizumab for wet AMD could save the NHS £84 million annually, and that new data suggest similar performance.
Nurse prescribers can prescribe unlicensed medicines following a change in the law in 2010 and the NMC has set out certain conditions, one of which is that an alternative, licensed medication would not meet the patient’s needs. For off-label prescribing, the medicine must “better serve” the patient’s needs than the appropriately licensed alternative.
Consultation on healthcare regulators
March 30, 2012 by admin
If you are interested in how nurses and other healthcare professionals are regulated in the UK, you might like to read and respond to the Law Commission’s consultation on the subject (it also applies to social workers in England).
It proposes significant changes to the legal framework for bodies such as the Nursing and Midwifery Council (NMC), with the many different pieces of legislation being repealed and replaced with a single Act. The idea here is that this will impose consistency across regulators where necessary but at the same time give them greater autonomy. The aim to make the regulatory system more transparent and responsive, and to simplify and modernise a set of rules that have evolved in a piecemeal fashion. Role changes such as nurse prescribing are cited as one of the drivers for change. The consultation covers education, training and professional conduct and practice.
New website for NMC
May 30, 2010 by admin
The Nursing and Midwifery Council (NMC) has launched a new website, with a prescribing section under ‘Nurses and Midwives’. It is asking for feedback on what users think of the site now.
Unlicensed medicines: green light and standards updated
March 23, 2010 by admin
The Nursing and Midwifery Council (NMC) has now issued a circular (04/2010) that permits nurse and midwife independent prescribers to prescribe unlicensed medicines, following legislative changes in December.
The circular updates the “Standards of proficiency for nurse and midwife prescribers“, setting out the requirements for this type of prescribing. The prescriber must be satisfied that an alternative, licensed medication would not meet the patient’s needs and that there is sufficient evidence and/or experience to demonstrate efficacy and safety for that individual; the prescriber must take responsibility for prescribing the unlicensed medicine and for overseeing care; the patient must understand the implications of being prescribed an unlicensed medicine and agree to this; the reasons for choosing this medication must be documented in the patient’s notes; professional advice must be obtained as necessary; and adverse drug reactions must be reported via the Yellow Card scheme. The guidance stresses that nurse and midwife prescribers should pay particular attention to the risks associated with unlicensed medicines, and says that the NMC will consider it best practice to have policies and systems in place to monitor and manage the clinical risks.
A second circular (03/2010) requires approved educational institutions to amend the content and learning outcomes of V300 programmes to reflect the legislative changes. Programmes must conform by 1 February 2011.
Advanced practice roles to be regulated
March 11, 2010 by admin
Advanced nursing practice should be regulated by the Nursing and Midwifery Council (NMC), according to the final report by the Prime Minister’s Commission on the Future of Nursing and Midwifery in England. The report said that there is little consistency in job content, title, scope of practice or credentials in advanced practice nursing roles, and that the NMC should record advanced practitioners on the register and ensure that they have the required competencies. This is one of 20 recommendations, including the controversial pledge, in the report. NMC Chief Executive and Registrar, Professor Dickon Weir-Hughes, commented that this was a ‘clear mandate’ to regulate advanced nursing practice.
NMC consults on pre-registration nursing education
February 14, 2010 by admin
What standards should nursing students be able to meet at the point of registration? The Nursing and Midwifery Council (NMC) has launched an online survey to obtain views on the proposed new standards. They include both standards for competence (the knowledge, skills and attitudes that all graduate nurses need to demonstrate at registration) and standards for education (the requirements that pre-registration nursing programmes must meet). To complete the survey, or find out more, see here.
Taking stock of attitudes
December 13, 2009 by admin
This feature article looks at how, in the face of opposition from the medical profession, non-medical prescribing has been introduced in stages. The predicted problems and disasters have not materialised: one, and only one, case of inappropriate prescribing has come before the Nursing and Midwifery Council’s (NMC’s) fitness to practice panel and Molly Courtenay points out that there is no evidence that nurses work outside their competence or make clinically inappropriate decisions. Her work has shown that doctors now seem to be happy about the nurses that they work with and know prescribing, but are more worried about nurse prescribing in general - and the possibility of ‘loose cannons’.
Bill Beeby, who chairs the prescribing subcommittee of the BMA’s General Practitioners Committee, is quoted as saying that all prescribers have to work within their knowledge and competencies and as long as nurse prescribers do that, then there are no issues.
Hawkes N. Handing over the prescription pad. BMJ 2009; 339:b4835.
Nurses and swine flu: prescribing, NMC statement, and DH tools
June 21, 2009 by admin
Up-to-date information on prescribing Tamiflu and Relenza for nurse prescribers can be found here.
The NMC has made clear that all nurses and midwives must practice within their competency levels and should seek advice or supervision from a “competent practitioner” if faced with an aspect of practice outside their competency or registration area: they remain answerable at all times for their actions and omissions. The full NMC position statement on the role of registered nurses and midwives during an influenza pandemic can be found here - it also states that nurses and midwives will not be professionally compromised “provided they are competent (and have been assessed as such) to carry out duties being requested by the employer”.
The Department of Health has issued a swine flu clinical package containing a set of tools that can be used by frontline healthcare professionals in a pandemic.
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Recent Posts
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- Should professional indemnity insurance be compulsory?
- GMC issues updated prescribing guidance
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