This chapter describes the development of non-medical prescribing across the different healthcare professional groups. Prescribing by community nurses is described and its expansion to include independent prescribing by other first-level registered nurses and later pharmacists and allied health professionals. Supplementary prescribing and how it is used is also outlined along with the educational preparation for the independent/supplementary prescribing role.

In the UK, the education and training landscape for healthcare students has changed considerably in the last few years. This is largely because of key governmental policies introduced in response to the wider workforce issue in the UK National Health Service. In this chapter, we discuss recent UK policies and standards relevant to non-medical prescribing and reflect on the potential implications they may have on the provision of future education and training for undergraduate and prescribing course providers and students. We also highlight opportunities for providers that will help future-proof programmes

The introduction of non-medical prescribing has meant that nurses, pharmacists, allied health professionals and optometrists have had to expand their practice and so acquire new knowledge and skills in a number of fields. This new knowledge has had to be applied to the many issues surrounding prescribing in the practice setting. There are currently few books available that provide these prescribers with information to help them in this role. As the number of non-medical prescribers grows and as other healthcare professionals take on this role, the need for such information will increase. This book is aimed at those non-medical professions involved in prescribing medicines.

Chapter 1 provides a general overview of non-medical prescribing and describes the current education and training available for extended independent and supplementary prescribers. Chapters 2 to 5 examine non-medical prescribing within a multiprofessional team context, the different models of consultation that might be used by prescribers and the legal and ethical aspects surrounding prescribing. The psychology and sociology of prescribing, applied pharmacology and monitoring skills are explored in chapters 6 to 8. Chapters 9 to 12 deal with promoting concordance, evidence-based prescribing, prescribing within a public health context and the calculation skills required by prescribers. Chapter 13 describes how prescribing can be implemented for practitioners working in the area of dermatology. It is hoped that insights gained from this chapter can be applied to other practice settings.

In 1986, recommendations were made for nurses to take on the role of prescribing. The Cumberlege report, Neighbourhood nursing: a focus for care (Department of Health and Social Security (DHSS) 1986), examined the care given to clients in their homes by district nurses (DNs) and health visitors (HVs). It was identified that some very complicated procedures had arisen around prescribing in the community and that nurses were wasting their time requesting prescriptions from the general practitioner (GP) for such items as wound dressings and ointments. The report suggested that patient care could be improved and resources used more effectively if community nurses were able to prescribe as part of their everyday nursing practice, from a limited list of items and simple agents agreed by the DHSS.

Following the publication of this report, the recommendations for prescribing and its implications were examined. An advisory group was set up by the Department of Health (DoH) to examine nurse prescribing (DoH 1989). Dr June Crown was the Chair of this group.

The following is taken from the Crown report:

A medication safety incident is defined by the National Patient Safety Agency (NPSA) as:

‘any unintended or unexpected incident which could have or did lead to harm for one or more patients’ (NPSA, 2007:9).

These incidents can occur at each stage of the process involved in the delivery of medicines to patients, i.e. prescribing (including transcribing or physician ordering), dispensing, preparation, administering and monitoring (NPSA, 2007). Medication incidents have been reported as accounting for 10%–20% of all Adverse Events (AE) (Department of Health (DoH), 2004), i.e. an event that causes an unintended injury to a patient that either prolongs hospitalization or produces disability (Karson & Bates, 1999).

The impact of medication safety incidents on patient outcomes includes increased length of stay, disability and mortality (Vincent et al., 2001). Across the UK, about two and a half million medicines are prescribed across hospitals and the community every day (DoH, 2004) and an indicator of quality, adopted to demonstrate medication safety, is the incidence of medication errors (DoH, 2004). The Government has committed to reducing the incidents of medication errors in prescribed drugs by 40% (DoH, 2004).

Between January 2005 and June 2006, 60 000 medication incidents were reported to the NPSA via the National Reporting and Learning System (NRLS) (NPSA, 2007). Although most medicine-related activity is carried out in the community, over 80% of the incidents reported to the NPSA were from the hospital setting. The majority of these incidents (over 80%) did not result in harm.