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Nigel's surgery 95: Non-medical prescribing
The number of non-medical prescribers (NMPs) in primary care is increasing.
Non-medical prescribing can:
- give patients quicker, more efficient access to medicines
- make best use of healthcare professionals’ skills
- help address demand and workforce issues.
We look at how NMPs work in a GP practice when we consider these key lines of enquiry:
The NMP role
In the UK, a range of non-medical healthcare professionals can qualify as NMPs. In general practice, most NMPs are pharmacists or nurses but they could, for example, be paramedics or physiotherapists.
NMPs can be independent or supplementary prescribers.
The prescriber takes responsibility for:
- clinical assessment of the patient
- establishing a diagnosis
- clinical management
- prescribing correctly
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 that patient’s agreement.
You can only use supplementary prescribing after:
- assessment and diagnosis by an independent prescriber, who must be a doctor or dentist
- the independent and supplementary prescribers develop a written CMP together. This contains the list of medicines that can be prescribed for the patient.
Qualifications and professional standards
- be registered with the relevant professional regulator
- have their prescribing qualification annotated on the register
To gain this annotation, NMPs must undertake an accredited non-medical prescribing programme, delivered by a Higher Education Institution (HEI). These programmes provide the knowledge, skills and training to prescribe safely and competently.
NMPs, like all prescribers, should demonstrate their competency against the Royal Pharmaceutical Society’s 'A Competency Framework for All Prescribers'. NMPs should not prescribe outside their competency. Practices should have mechanisms in place to make sure NMPs are working within their competence.
All NMPs must have adequate medical indemnity. This is part of the requirements of registration with their professional body. This indemnity should include their NMP role.
When we inspect
If you employ NMPs in a prescribing role you should be able to show:
- make sure they are and continue to be competent
- have systems in place to audit all prescribing, including NMPs. You should have evidence of outcomes and learning from these audits available
- support NMPs continuing professional development
- are appropriately qualified
- have their entry annotated on their professional body register
- have adequate indemnity cover for their NMP role
- A Competency Framework for All Prescribers 2016: Royal Pharmaceutical Society
- British National Formulary 77: NICE
- Guidance for Physiotherapist Supplementary and/or Independent Prescribers in the Safe Use of Medicines (4th edition) 2018: Chartered Society of Physiotherapy Practice
- Human Medicines Regulations 2012: Department of Health
- Non-Medical Prescribers: Royal College of Nursing
- Practical Guide for Independent Prescribers: Royal Pharmaceutical Society
- Medicines and independent perscribing: College of Paramedics
- Standards for Prescribers 2013: Health & Care Professions Council
- Last updated:
- 15 August 2019