Non-medical Prescribing in the United Kingdom

Non-medical prescribing is the process by which healthcare professionals who are not doctors can prescribe medicines for patients. This includes nurses, pharmacists, physiotherapists, and other healthcare professionals who have undergone additional training and qualifications to become non-medical prescribers.

Non-medical prescribing was introduced in the UK in 1992 to improve patient access to medicines and reduce the workload of doctors. The Department of Health’s Cumberlege Review of Neighbourhood Nursing in 1986 established the framework for requesting prescribing rights by Registered Nurses with a specialist community practice credential (health visitors, district nurses, and some practice nurses). Since then, non-medical prescribing has evolved to support efficient service delivery and cost reduction

The legal and regulatory framework for non-medical prescribing in the UK is set out by the Department of Health. Non-medical prescribers are identified by an annotation next to their name in the relevant professional register. Independent prescribers are practitioners responsible and accountable for the assessment of patients with previously undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing. They are recommended to prescribe generically, except where this would not be clinically appropriate or where there is no approved non-proprietary name. Supplementary prescribing is a partnership between an independent prescriber (a doctor or a dentist) and a supplementary prescriber to implement an agreed Clinical Management Plan for an individual patient with that patient’s agreement.

There are several types of non-medical prescribers in the UK. These include nurses, pharmacists, physiotherapists, and other healthcare professionals who have undergone additional training and qualifications to become non-medical prescribers. Nurse Independent Prescribers (formerly known as Extended Formulary Nurse Prescribers) can prescribe any medicine for any medical condition. Pharmacists must complete an accredited course in prescribing practice³.

To become a non-medical prescriber in the UK, healthcare professionals must undergo additional training and qualifications. The specific requirements vary depending on the profession and the type of prescribing involved. For example, nurse independent prescribers must complete a Nursing and Midwifery Council (NMC) Community Practitioner Nurse Prescribing course (also known as a v100 or v150 course) and register as a CPNP with the NMC. Most nurses who have done this course are district nurses and public health nurses, community nurses and school nurses.

Non-medical prescribers in the UK are required to undertake continuing professional development (CPD) to maintain their prescribing qualification. The specific requirements vary depending on the profession and the type of prescribing involved. For example, nurse independent prescribers must complete a minimum of 12 hours of CPD related to prescribing every year.

Non-medical prescribing has been shown to have many benefits for patients, healthcare professionals, and the health system. Some of these benefits include improved patient satisfaction, convenience, access, choice, and outcomes; increased professional autonomy, confidence, skills, and knowledge; enhanced inter-professional collaboration and communication; reduced waiting times, referrals, and costs; and improved quality and safety of care. However, there are also some challenges and barriers that need to be addressed to ensure the optimal use of non-medical prescribing. Some of these challenges include legal and ethical issues, scope of practice limitations, lack of support and supervision, inadequate resources and infrastructure, variable education and training standards, resistance from some stakeholders, and insufficient evidence base.

Non-medical prescribing is a key component of modern healthcare delivery in the UK. It has enabled healthcare professionals to provide more holistic, patient-centred, and efficient care for a range of conditions. However, it also requires ongoing evaluation, regulation, education, and research to ensure its quality, safety, effectiveness, and sustainability.

Practitioners who have completed the V300 course, should complete a yearly update. Practitioner Development UK’s virtual Annual V300 Update course helps meet this requirement. 

Course content includes:

• Discuss current NMP updates and clinical governance.
• Examine current laws and legislation related to independent and supplementary prescribing.
• Discuss medico-legal issues and relate this to NMP clinical practice.
• Critically discuss practical and ethical issues in prescribing.
• Discuss common pitfalls in prescribing and prescribing errors.
• Examine adverse drug reactions and how to reduce errors.
• Discuss prescribing support resources.
• Assess clinical decision-making skills in relation to evidence-based practice.

Further information, along with an application form, can be found on the Practitioner Development website. 

References:

Graham-Clarke E., Rushton A., Noblet T., Marriott J., Non-medical prescribing in the United Kingdom National Health Service: A systematic policy review , PLoS ONE 14(7): e0214630 (2019).

Department of Health (DH), Improving patients’ access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England [8], DH Publications (2006).

 Franklin P.M., Non-medical Prescribing in the United Kingdom 3, Springer International Publishing (2017).

 Nursing & Midwifery Council (NMC), Standards for Prescribing Programmes [9], NMC Publications (2018).

 Royal College of Nursing (RCN), Nurse Prescribing [10], RCN Publications (2019).

Latter S., Blenkinsopp A., Smith A., Chapman S., Tinelli M., Gerard K., Little P., Celino N., Granby T., Nicholls P., Dorer G., Evaluation of nurse and pharmacist independent prescribing [11], DH Publications (2011).

Courtenay M., Carey N., Stenner K., Lawton S., Peters J., Non-medical prescribing leads views on their role and the implementation of non-medical prescribing from a multi-organisational perspective [12], BMC Health Services Research 11:142 (2011).