Supplementary prescribers

You are a supplementary prescriber working in a diabetes clinic when John Stephens comes in to see you. He is still overweight despite being on the maximum dose of metformin and gliclazide. His HbAlc is 9.0% and on examination he has neuropathy developing in his feet. He is also on ramipril 10 mg, simvastatin 40 mg and aspirin 75 mg daily. His blood pressure was 130/80 mmHg and his total cholesterol was 4.0 mmol/L (reading from three months ago). There is no microalbuminuria present. 

This introduces the different NHS prescribers (for example, doctor, dentist, nurse, supplementary prescribes etc.) within the community. Following on from this are details of the dispensing process to be followed when supplying medicines against NHS prescription forms, along with a collection of worked examples. 

FP10SS Green General practitioners, hospital-based prescribers, nurses, pharmacists and supplementary prescribers... 

GP10P Blue Pharmacists supplementary prescribing (community)... 

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). 

Recently, the Department of Health has introduced supplementary prescribing, which is described as ... 

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. 

A number of different health professional groups may qualify as supplementary prescribers and are able to prescribe medicinal products on the NHS. Different supplementary prescribers are able to prescribe different medicinal products depending on their area(s) of expertise. 

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). 

Health professionals who may qualify as supplementary prescribers currently include individuals from the following groups (although other health professional groups may be added to this list in due time) ... 

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. 

Community nurse Supplementary prescriber Independent prescriber... 

Supplementary prescribers (see Section 3.2.4) via clinical management plans ... 

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. 

Any person can administer any controlled drug in accordance with the directions of a supplementary prescriber (acting under and in accordance with the terms of a clinical management plan). 

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. 

Over the next few years, supplementary prescribing by nurses and pharmacists was introduced and legislation to allow this was changed in April 2003. 

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 following case study is of a patient who might be seen in a podiatry clinic and who might be a suitable case for supplementary prescribing under a clinical management plan. 

You may need to refer to Chapter 14 for details of supplementary prescribing and the use of clinical management plans. 

Do you think this patient would be suitable for supplementary prescribing with a clinical management plan and why ... 

Do you think Mr Pritchard would be a suitable patient for treatment under supplementary prescribing ... 

Certain analgesics can be accessed and supplied by podiatrists in the course of their professional practice, some of which are prescription-only medicines. Any health care professional who trains to be a supplementary prescriber could prescribe prescription-only analgesics if it was appropriate to the individual clinical management plan. 

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 ... 

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