Muhammad Siddiqur Rahman describes how clinical pharmacists became involved in prescribing and how their skills are increasingly being used in general practice

RAHMAN_Siddiqur_1

Muhammad Siddiqur Rahman

Read this article to learn more about:

  • how and why prescribing rights were extended to non-medical healthcare professionals
  • the Clinical pharmacists in general practice programme
  • the Royal Pharmaceutical Society competency framework for all prescribers.

 

Prescribed medication is the most common healthcare intervention that patients receive;1 in 2015 alone, over 1 billion prescription items were supplied in England.2 In 2000, The NHS Plan outlined a vision for healthcare professionals to devise and improve ways of working with the wider multidisciplinary team (MDT) while upholding the main principle of the NHS, namely free healthcare at the point of delivery.3 A year later, through section 63 of the Health and Social Care Act, the Government extended prescribing rights to other healthcare professionals (HCPs), including pharmacists.4 This aimed to best utilise the varied skill mix of HCPs, improve access to medicines, and increase patient choice, without compromising safety.5

By 2003, suitably trained pharmacists were allowed to prescribe as supplementary prescribers within the framework of a clinical management plan (CMP) that was agreed between an independent medical prescriber (doctor or dentist) and the patient for any chronic condition within their competence.6 This was hailed as a landmark for the pharmacy profession, but uptake was limited by funding problems, the need to involve another medical prescriber, and a lack of support from the medical profession.7

Legislation was passed in 2006 that allowed pharmacists to independently prescribe any medication in the British National Formulary (BNF) (except certain controlled drugs) within their scope of practice.5,8 By November 2015, 3944 pharmacists were annotated prescribers on the General Pharmaceutical Council (GPhC) register, of whom 2567 were independent prescribers, 425 were supplementary prescribers, and 952 were both independent and supplementary prescribers.9 A summary timeline of developments in non-medical and pharmacist prescribing is shown in Figure 1.

Timeline

Figure 1: A timeline of non-medical prescribing

Pharmacists in general practice

The Clinical pharmacists in general practice  programme was launched as a pilot scheme in 2016. Over 450 clinical pharmacists were placed in general practices to utilise their pharmacological skills and knowledge to manage chronic conditions and ease workload pressures in primary care.10,11 The initial pilot proved to be a success and subsequently the General practice forward view announced funding for a further 1500 clinical pharmacists to be placed into general practices by 2020.12,13 For this initiative to be a success, the ability for pharmacists to prescribe independently was key, although non-prescriber clinical pharmacists still add immense value to general practices. Non-prescriber clinical pharmacists utilise their pharmacological and clinical skills for a wide variety of tasks such as medication reviews, audits, actioning alerts and recalls issued by the Medicines and Healthcare products Regulatory Agency, monitoring high-risk drug medications, delivering training sessions to other healthcare professionals and non-clinical staff, administering influenza vaccinations, and much more.

Competency framework for prescribers

The Royal Pharmaceutical Society (RPS) has published a prescribing competency framework for all prescribers to uphold their responsibilities and expectations to deliver high standards of care.14 Working within a multidisciplinary setting can cause confusion over accountability between healthcare professionals15 but the RPS framework defines accountability to the individual prescriber.14 It also gives useful guidance on prescribing safely and professionally to ensure that confidence and competence in prescribing is maintained. Prescribing pharmacists follow this framework within their scope of practice to maintain a strict code of conduct and professional responsibility for their patients.

Muhammad Siddiqur Rahman

Clinical practice-based pharmacist prescriber, trainee Advanced Clinical Practitioner, Court View Surgery, kent

Board Member of the Pharmacist Cooperative

References

  1. NICE. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE Guideline 5. NICE, 2015. Available at: www.nice.org.uk/ng5
  2. Health and Social Care Information Centre. Prescription cost analysis—England 2015. HSCIC, 2016. Available at: content.digital.nhs.uk/catalogue/PUB20200/pres-cost-anal-eng-2015-rep.pdf (accessed 8 March 2019).
  3. Department of Health. The NHS plan: A plan for investment, a plan for reform. London: DH, 2000. Available at: webarchive.nationalarchives.gov.uk/20121102184221/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118522.pdf
  4. Health and Social Care Act 2001. Available at: www.legislation.gov.uk/ukpga/2001/15/contents
  5. Department of Health. Improving patients’ access to medicines: a guide to implementing nurse and pharmacist independent prescribing within the NHS in England. London: DH, 2006. Available at: webarchive.nationalarchives.gov.uk/20130105033522/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4133747.pdf
  6. Department of Health. Supplementary prescribing by nurses, pharmacists, chiropodists/podiatrists, physiotherapists and radiographers within NHS in England—a guide for implementation. London: DH, 2005. Available at: webarchive.nationalarchives.gov.uk/20070306020119/http://www.dh.gov.uk/assetRoot/04/11/00/33/04110033.pdf
  7. Cooper R, Anderson C, Avery T et al. Nurse and pharmacist supplementary prescribing in the UK—a thematic review of the literature. Health Policy 2008; 85  (3): 277–292.
  8. Cooper R, Guillaume L, Avery T, et al. Nonmedical prescribing in the United Kingdom: developments and stakeholder interests. J Ambul Care Manage 2008; 31 (3): 244–252.
  9. General Pharmaceutical Council. Prescribers survey report. London: GPhC Society, 2016. Available at: www.pharmacyregulation.org/sites/default/files/gphc_prescribers_survey_report.pdf
  10. Snow-Miller R. Building the workforce—the new deal for general practice. London: Royal College of General Practitioners, British Medical Association, NHS England, and Health Education England, 2015. Available at: www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/01/building-the-workforce-new-deal-gp.pdf
  11. Mann C, Anderson C, Avery A et al. Clinical pharmacists in general practice: pilot scheme—independent evaluation report: full report. University of Nottingham, 2018. Available at: www.nottingham.ac.uk/pharmacy/documents/generalpracticeyearfwdrev/clinical-pharmacists-in-general-practice-pilot-scheme-full-report.pdf
  12. NHS England, Royal College of General Practitioners, Health Education England. General practice forward view. London: NHS England, 2016. Available at: www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf
  13. NHS England. Clinical pharmacists in general practice. London: NHS England, 2016. Available at: www.england.nhs.uk/gp/gpfv/workforce/cp-gp
  14. Picton C. A competency framework for all prescribers. London: Royal Pharmaceutical Society; 2016, Available at: www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-02-13-163215-030
  15. Savage J, Moore L. Interpreting accountability—an ethnographic study of practice nurses, accountability and multidisciplinary team decision-making in the context of clinical governance. London: Royal College of Nursing Institute, 2004. Available at: www.rcn.org.uk/professional-development/publications/pub-002249