Independent prescribers

Independent Prescriber, School of Pharmacy, University of Hertfordshire... 

Traditionally, the prescriber would have been a doctor or a dentist, but recent changes to healthcare legislation and the introduction of supplementary and independent prescribers mean that many other healthcare professionals, such as nurses and pharmacists, are now also permitted to prescribe (see Section 3.2). 

Part XVIIB(ii) - Nurse and pharmacist independent prescribing... 

This part provides information on nurse and pharmacist independent prescribing. Further details on independent non-medical prescribing can be found in Section 3.2.5. 

This part provides information on nurse independent prescribing, including the prescribing of controlled drugs by nurse independent pre-scribers. It is similar in composition to Part XVIIB(ii) of the Drug Tariff for England and Wales (see Section 2.4.1). Further details on independent non-medical prescribing can be found in Section 3.2.5. 

There are three types of nurse prescribers community practitioner nurse prescribers (sometimes called district nurses or health visitors) who may prescribe from a restricted list of items, nurses who are supplementary prescribers (see Section 3.2.4) and nurses who are independent prescribers (see Section 3.2.5). 

A voluntary prescribing partnership between an independent prescriber and a supplementary prescriber, to implement an agreed patient-specific clinical management plan with the patient s agreement. 

Supplementary prescribers are able to prescribe from a range of medicines for a broad range of medical conditions under the terms of a clinical management plan (CMP). The plan will be drawn up, with the patient s agreement, in consultation with an independent prescriber (the independent prescriber is a doctor or (less commonly) a dentist). 

In addition to supplementary prescribing by non-medical practitioners (see Section 3.2.4), independent non-medical prescribing has also recently been introduced. Currently this is limited to suitably qualified nurses and pharmacists, although as with supplementary prescribing, independent prescribing may be extended to other health professional groups in due time. 

Nurse independent prescribers are able to prescribe any licensed medicinal product including some controlled drugs. Pharmacist independent prescribers have similar prescribing rights however, currently they may not prescribe any controlled drugs (although this may change in the future). 

Committee on Borderline Substances (ACBS). A list of ACBS approved products and the circumstances under which they can be prescribed, can be found in part XV of the Drug Tariff. Although this is a nonmandatory list, Nurse Independent Prescribers should normally restrict their prescribing of borderline substances to items on the ACBS approved list. 

Community nurse Supplementary prescriber Independent prescriber... 

Supplementary and independent prescribers at present do not have the exemptions available to the practitioners listed above. 

Until recently, the numbers of individuals who may prescribe controlled drugs was fairly limited. However, with the onset of both supplementary and independent prescribing, the numbers of individuals who may prescribe controlled drugs has increased. 

Any supplementary prescriber may prescribe any controlled drug so long as it is in the clinical management plan specific to that patient and agreed between the independent prescriber, the supplementary prescriber and the patient. 

The pharmacist must be satisfied that the supply is being requested by a doctor, community practitioner nurse prescribes supplementary prescribes nurse independent prescriber or pharmacist independent prescriber. 

Some individuals have advocated that pharmacists be granted independent prescriptive authority—that is, authority to prescribe medications independent of a defined collaborative relationship with an individual physician or medical group. Indeed, the system operative in Florida represents a form of independent prescriptive authority for pharmacists, albeit limited to a select formulary of drugs. Others have argued that pharmacists should function in a dependent role where prescriptive authority is delegated by a physician or other independent prescriber to another health care professional whom that prescriber believes possesses the professional skills and judgment necessary to perform these delegated duties. 

Physicians exercise plenary independent prescribing authority. Plenary authority refers to the ability to prescribe all drugs, treatments, and devices, including controlled substances, without supervision, control, or oversight by another profession.Independent prescribing authority means that the prescriber has the sole authority to make treatment decisions and is wholly responsible for the resultant outcomes. 

Limited independent prescribing authority permits independent prescribing within the bounds of the prescriber s scope of practice or within the restrictions of a certain formulary of drugs. Doctors of dental surgery, doctors of veterinary medicine, and doctors of podiatric medicine have limited independent prescribing authority in every state this authority is limited to their scope or course of practice. 

A similar process occurred with podiatry, physiotherapy and radiography and led to extension of supplementary prescribing to these professions in April 2005. In a further development in 2006, nurses and pharmacists became eligible to train as independent prescribers. 

The history and development of non-medical prescribing is explained together with consideration of the different forms this can take, for example supplementary and independent prescribing. 

They may only be sold or supplied from a registered pharmacy, by or under supervision of a pharmacist in accordance with the prescription of a doctor, dentist or veterinary practitioner or other qualified prescriber. Nurse independent prescribers, pharmacist independent prescribers and supplementary prescribers can write prescriptions for POM. Given below are examples of the types of drug that are POM ... 

Extended formulary nurse prescribing was discontinued in 2006 and replaced by qualified nurse independent prescribing. Nurses can now prescribe any licensed medicine, including some controlled drugs, if they are qualified to do so. At the same time, pharmacists became eligible to train as pharmacist independent prescribers, being able to prescribe all licensed medicines but, as yet, no controlled drugs. 

Supplementary prescribers prescribe in partnership with an independent prescriber who must be a doctor or dentist. They are able to prescribe for the full range of medical... 

Following diagnosis of the patient by an independent prescriber and following consultation and agreement between the independent prescriber and the supplementary prescriber an individual CMP can be drawn up. This must be agreed with the patient before supplementary prescribing begins. 

In addition to the CMP the independent prescriber and supplementary prescriber must share access to a common patient record. Ideally, this would be electronic, but paper records or patient held records can also be used. 

The independent prescriber will determine the level of responsibility the supplementary prescriber has under the CMP. This will take into account the experience and expertise of the supplementary prescriber. 

The CMP would come to an end at any time at the discretion of either the independent prescriber or the supplementary prescriber or at the request of the patient. It must also be... 

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