GP mythbuster 95: Non-medical prescribing

Page last updated: 5 July 2022
Categories
Organisations we regulate

There is a growing number of non-medical prescribers (NMPs) in primary care.

Non-medical prescribing can:

  • enable quicker, more efficient access to medicines for people
  • make best use of the range of skills of healthcare professionals
  • help to address demand and workforce issues.

The role of a non-medical prescriber

In the UK, a range of non-medical healthcare professionals are able to qualify to be a non-medical prescriber. In general practice, most NMPs are pharmacists or nurses, but could also be paramedics or physiotherapists.

Non-medical prescribers can be either independent or supplementary prescribers. An independent prescriber is able to prescribe, on their own initiative, any medicine within their scope of practice and relevant legislation.

Independent prescribing

The prescriber takes responsibility for:

  • clinical assessment of the patient
  • establishing a diagnosis
  • clinical management
  • prescribing
  • relevant follow up, investigations and monitoring

Supplementary prescribing

This is a voluntary partnership between an independent prescriber and a supplementary prescriber. They implement an agreed clinical management plan (CMP) for a specific patient with the patient’s consent and patients specific details of the illness, medicine dose/strength and limitations.

You can only use supplementary prescribing after:

  • assessment and diagnosis by an independent prescriber – this must be a doctor or dentist
  • the independent and supplementary prescribers develop and share a written CMP together, which lists medicines that can be prescribed for the patient.

Qualifications and professional standards

Non-medical prescribers must:

  • be registered with the appropriate professional regulator
  • have their prescribing qualification annotated on the register.

To gain this, they must undertake an accredited non-medical prescribing programme at a higher education institution. These programmes provide the knowledge, skills and training to prescribe safely and competently.

Competency

Non-medical prescribers should work to the Royal Pharmaceutical Society’s 'A Competency Framework for All Prescribers'. They should not prescribe outside their competency. Practices should have systems to make sure they are working within the limits of their competency.

Practices must also provide staff with appropriate supervision and allocate an appropriate senior member of the primary care team to provide day-to-day supervision of all clinical staff. Health Education England has published guidance for employers on Workplace Supervision for Advanced Clinical Practice. The Health and Care Professions Council has also published guidance for allied health professionals on supervision standards.

Medical indemnity

All non-medical prescribers must have adequate professional indemnity that includes this role. This is part of the requirements of registration with their professional body.

The Clinical Negligence Scheme for General Practice in England and Wales covers everyone providing NHS services for general practice including non-medical prescribers.

The indemnity scheme does not cover non-NHS work and does not provide legal representation for inquests and disciplinary investigations.

When we inspect

Governance systems

We will expect practices to have systems or processes to assess, monitor and mitigate risks relating to the health, safety and welfare of patients. This expectation is irrespective of who holds the employment contract.

This relates to the Well Led Key Question and Regulation 17: Good governance.

Suitably qualified, competent and experienced staff

We expect practices to have made appropriate recruitment checks for professional registration, and to provide supervision and appropriate indemnity for all staff. This expectation is irrespective of who holds the employment contract.

This relates to the Effective Key Question and Regulation 18: Staffing.

Assessing the skills, knowledge and experience of staff

We will assess how providers ensure that staff have the skills, knowledge and experience to deliver safe and effective care.

This will include, but is not limited to systems for:

  • safe recruitment
  • job plans
  • induction
  • policies and procedures
  • communication of alerts and guidance
  • clinical supervision
  • consultation audits and random case reviews
  • complaints and significant events.

We will check how the provider has assured themselves that staff are capable, supported and provided with appropriate training for the role. We will also check that the provider maintains this ongoing supervision and training over time. This supervision may be carried out by any senior member of the primary care team.

Guidance

GP mythbusters:

Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice.

See all issues:


We review our mythbusters regularly. Contact us with your comments and suggestions.