Trained UK RNs Can Write Rx

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Laurie Barclay, MD - Nov. 21, 2005

On Nov. 10, UK Health Secretary Patricia Hewitt announced that the UK Department of Health would expand prescribing powers for nonphysician healthcare professionals. Although UK nurses have long been prescribing drugs for minor injuries, experienced nurses and pharmacists who undergo specific training will be able to prescribe a much broader range of drugs, beginning in the first half of 2006.

"As part of government policy, the [UK Department of Health] proposed the extension of prescribing rights to other healthcare professionals for a number of reasons, The Department of Health wished to make better use of existing skilled professionals and ensure more flexible multidisciplinary working," Dr. Tully said. "It was seen as one way to improve the quality of services to patients, whilst maintaining patient safety, increasing patient choice, and improving access to healthcare."

"The Royal College of Nursing (RCN) has been lobbying for nonmedical prescribing for around 20 years," RCN national prescribing adviser Matt Griffiths, RGN, FAETC, IESP, told Medscape. He cited a 1986 government report, known as the Cumberlege report, showing that "this highly trained group of professionals were having their time wasted by waiting for doctors to sign prescriptions for drugs that they were competent to prescribe."

"The new legislative changes last week allow suitably trained nurses and pharmacists to act as independent prescribers, with responsibility for 'the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing,' " Dr. Tully said. "Acting within their professional competence, they will be able to prescribe any drugs, other than controlled drugs, without having a patient-specific CMP agreement by an independent prescriber in advance. Prescribing complex medication regimens at hospital admission or discharge, for example, are not, and never have been, amenable to the constraints of CMPs."

Nurses wishing to prescribe according to the new policy must be registered nurses, with a minimum of three years postregistration experience. This should not present a significant obstacle for most; a recent evaluation showed that about 90% of UK registered nurses had more than 10 years of postregistration experience.

Other requirements are that they should already have the specialist skills, qualifications, and experience within their own field; they must be seconded with managerial support; and they must complete a 38- to 40-day course over six months, under the supervision of a medical mentor. The course is at degree level, and assessments include written examinations, essays, and objective structured clinical examinations.