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Nigel's surgery 95: Non-medical prescribing
There have been no specific changes to this guidance during the COVID-19 pandemic. Organisations need to conduct staff risk assessments. They should take appropriate steps to assure safety.
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. They could also be for example, 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
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.
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 a written CMP together. The CMP lists 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, NMPs 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.
NMPs should work to the Royal Pharmaceutical Society’s 'A Competency Framework for All Prescribers'. NMPs should not prescribe outside their competency. Practices should have systems 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.
The Clinical Negligence Scheme for General Practice in England and Wales covers everyone providing NHS services for general practice. This includes non-medical prescribers. The indemnity scheme does not cover non-NHS work. It does not provide legal representation for inquests and disciplinary investigations.
When we inspect
If you employ NMPs in a prescribing role you should be able to show how you:
- 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 prescribing: College of Paramedics
- Standards for Prescribers 2013: Health & Care Professions Council
- Clinical Negligence Scheme for General Practice 2019
- Who can prescribe what? (PSNC)
- Last updated:
- 09 September 2020