Prescribing - General Practice Nurse
General practice is under enormous strain and we are all trying to look at alternative ways to provide patient care with the emphasis on safety for both the public and the profession. As nurses we need to ensure that we are working within our scope of practice and both competent and confident to undertake our role.
Please refer to our Guidance Document for NMPs in General Practice
Making changes to medication and issuing a prescription if not a Non-Medical Prescriber (NMP)
If as a nurse you are recommending making changes and or altering medication, then you are working as supplementary prescriber and should have a prescribing qualification.
For example, I would expect a nurse who is running an asthma clinic to have undertaken an asthma qualification and would have knowledge of appropriate inhalers, medication and base their care provided on national guidelines. Any changes and/or additions to the provision of care would be discussed with a GP/NMP. This would be clearly documented and recorded in the patients notes, the GP/NMP would take responsibly for signing the prescription and any potentially negative outcome. This would be the same for the management of all long-term conditions.
Changes to a patient’s medication
If the nurse is not a prescriber, then any changes to a patient’s medication should be authorised by a GP/NMP who is familiar with the patient. This should be undertaken within a specified time and not left until an ‘annual review’. Legally if a patient came to harm, the prescriber would be liable, but the nurse could be implicated if it is apparent that they are working outside their level of competence and scope of practice.
Ultimately the person who signs the prescription takes responsibility, they are making the final decision. One would hope that this is based on a clear description of events and plan of action from the nurse if not a NMP concerned and if necessary, the prescriber will have accessed the patients notes to ensure there are no contraindications and or allergies etc.
It is important to ensure that as nurses we clearly document and record in the patients notes the communication with the prescriber and if there is an initiation and or change to medication. In a court of law, we would need to be able to show evidence that a discussion took place.
Updated June 2019
NMC standards of proficiency for nurse prescribers. 2015.
This provides the standards and proficiency required to undertake the training to become an independent/supplementary prescriber. It also provides standards of conduct that nurses are required to meet as a registered prescriber. Please refer to page 6 for specialist areas of Practice.
Accountability (pg. 27) A nurse must only ever prescribe within your level of experience and competence acting in accordance with Clause 6 of the NMC Code.
Do contact your Medicines Management Team at the CCG for further advice on non-medical prescribing.
Other useful websites:
National prescribing centre www.npc.co.uk
Royal Pharmaceutical Society. A Competency Framework for all Prescribers. July 2016