Clinical Policy Non Medical Prescribing

Policy Manager

Non Medical Prescribing Leads Group

Policy Group Sub Group of Area Drug & Therapeutic Committee

Clinical Policy

Non Medical Prescribing

Policy Established

October 2007

Policy R eview Period/Expiry

May 2023

Last Updated

May 2021

This policy does not apply to Medical/Dental Staff

UNCONTROLLED WHEN PRINTED

Non Medical Prescribing Version Control

Version Number

Purpose/Change Author Date

2.0

Updated to reflect review period and impending change in legislation for Controlled Drug Prescribing

NMP Leads Group

Executive Lead: Dr M McGuire Nurse Director

Chair NMP Leads Group: Gillian Costello

November 2012

2.1 Updated to reflect NHS Tayside organisational endorsement for changes in practice for NMPs in respect of legislative changes

NMP Leads Group

Executive Lead: Dr M McGuire Nurse Director


October 2014

2.2 Format updated as per policy for corporate policies

Chair, NMP Leads Group

July 2015

3.0 Updated to reflect NHS Tayside organisational endorsement for changes in practice for NMPs

NMP Leads Group

Executive Lead: Gillian Costello Nurse Director


November 2016


NMP Leads Group

Executive Lead: Gillian Costello Nurse Director


December 2018


NMP Leads Group

Executive Lead: Claire Pearce Director of Nursing & Midwifery

Chair NMP Leads Group: Sarah Dickie

August 2020


NMP Leads Group

Executive Lead: Claire Pearce Director of Nursing & Midwifery

Chair NMP Leads Group: Sarah Dickie

May 2021

CONTENTS Section Title Page No. 1. PURPOSE AND SCOPE 1 2. AIMS AND OBJECTIVES 2 3. STATEMENT OF POLICY 3 4. PROTOCOL & PRACTICE 4.1 EDUCATION/TRAINING/CONTINUOUS PROFESSIONAL

DEVELOPMENT 4.1.1 Accessing Education and Training 4 4.1.2 Professional Registration & Continuing Professional 6 Development 4.2 ROLES & RESPONSIBILITIES 4.2.1 Role of Individual Practitioners 7 4.2.2 Role of Managers 11 4.2.3 Role of the Designated Prescribing Prac titioner 13 4.2.4 Role of the Non Medical Prescribing Pro fessional Leads 13 4.2.5 Role of Prescribing Administrators 14 4.2.6 Role of the NMP Network Members 15

4.3 REFERENCES AND USEFUL LINKS 15 APPENDICES Appendix I Course Criteria for Accessing Education Appendix II Non Medical Prescribing Process Flow-Chart Appendix III Request to Prescribe a Non Formulary Medicine Guida nce Notes Appendix IV Clinical Management Plan Appendix V NHS Tayside Protocols for Non Medical Prescribing (NMP) Administrative Processes Appendix VI Approval to Practice Form Appendix VII Annual Review/Appraisal Form Appendix VIII Generic Template for Non Medical Prescribing Audit Appendix IX NHS Tayside NMP Leads Group - Communication Reporti ng Structure Appendix X NHS Tayside NMP Professional Leads Contact Details Appendix XI NHS Tayside Policy Approval Checklist Appendix XII NHS Tayside Equality Impact Assessment

Document Control Document: Non Medical Prescribing Policy Version 6.0 Version Date: May 2021 Policy Manager: Non Medical Prescribing Leads Group 1 Review Date: May 2023

1. PURPOSE AND SCOPE

Purpose This policy is a dynamic document and is continually reviewed to ensure it provides a local framework reflecting national legislation and policy. As such there may be a timelag between changes in legislation and the policy. Locally, the policy should be used to guide practice for new developments.

The purpose of this policy is to set out the governance, administrative and procedural steps necessary to ensure patient safety and adherence to best practice guidance relating to non medical prescribing (NMP) within NHS Tayside. Background Modernisation of the NHS requires a fundamental shift in the way healthcare is delivered. Part of the agenda is ensuring that the contribution of all staff is maximised through role development. However, any role development needs to be implemented within a governance framework to reduce and manage risks to patients, healthcare staff and to the NHS Board. In the mid 1990s the Crown Report established principles and a framework for Non Medical Prescribing. Over time this has evolved through Extended Nurse Prescribing, Supplementary Prescribing and Independent prescribing. All prescribers now follow the Royal Pharmaceutical Society (RPS) Competency Framework for all Prescribers (2016-2020) Non Medical Prescribers include Nurses, Midwives, Pharmacists, Physiotherapists, Podiatrists, Paramedics, Therapeutic Radiographers and Optometrists. This list is not exhaustive and may be expanded following further legislative changes. Dieticians and Diagnostic Radiographers can only be supplementary prescribers. Prescribing rights have been extended to paramedics in 2018. Prescribing Controlled Drugs Legislation changed in 2012 to allow: • Nurse independent prescribers to prescribe any schedule 2-5 controlled drug within their

clinical competence, removing the previous limitations. • Pharmacist independent prescribers to prescribe any schedule 2-5 controlled drug within

their clinical competence. • Nurse and pharmacist independent prescribers, and supplementary prescribers when within

the terms of a clinical management plan, to mix schedule 2-5 controlled drugs for administration to a patient and provide written directions for others to do so.

• Nurse and pharmacist independent prescribers to possess, supply, offer to supply, administer and give directions for the administration of any controlled drug specified in schedule 2-5.

• Registered nurses and pharmacists to supply or offer to supply Morphine or Diamorphine under a PGD for the immediate and necessary treatment of a sick and injured person in any setting.

• These changes do not apply to the prescribing of Cocaine, Diamorphine or Dipipanone for the treatment of addiction (this is restricted to Scottish Government licensed doctors)

• IP Optometrists cannot prescribe any controlled drugs or medicines for parenteral administration.


Scope This Policy applies to all NHS Tayside Non Medical Registered Prescribers, Non-medical prescribers in training, potential Non Medical Prescribers, Designated Prescribing Practitioners and managers responsible for management of non-medical prescribers, service development and/or role development of staff.

This Policy must be used in conjunction with national guidance from professional and regulatory bodies, as well as local policies and procedures NHS Tayside has in place for safe and secure handling of medicines (http://www.nhstaysideadtc.scot.nhs.uk/SSHM/MAIN/Front%20page.htm) All Non Medical Prescribers must comply with current prescribing legislation and are accountable for their practice. Please refer to link in Section 4.3 - References and Useful Links. 2. AIMS AND OBJECTIVES The key aim of this policy is to outline the circumstances in which non medical prescribing practitioners can be educated and proceed to prescribe within NHS Tayside, and set out the systems and procedures that must be adhered to, to assure safe and effective non medical prescribing practice in order that:

• Patients benefit through improvements to the quality of care through timely assessment and

access to medicines. • Prescribing practice is compatible with the service development plans of the organisation

and clinical speciality and is an appropriate extension of a practitioner’s role. • Non Medical Prescribers are appropriately qualified for their role, work within agreed national

and local policy, and are identifiable in the organisation in order they are kept up to date on prescribing issues both locally and nationally.

• There is a local register of qualified non medical prescribers to facilitate communication and co-ordination of care and to support clinical and corporate governance.

• Non Medical Prescribers are supported in their role, have access to continuous professional development in respect of prescribing practice and are able to demonstrate an evidence portfolio within an annual appraisal system.

Non Medical Prescribers will participate in audit of their practice, at a minimum annually (Appendix VIII) to demonstrate continuous improvement and contemporary practice. Please refer to Section 4.3 for links to professional guidance. This policy does not address transcribing. Transcribing activities undertaken by individuals who are not qualified prescribing practitioners but change prescriptions must refer to locally agreed protocols. This policy does not address Patient Group Directio ns (PGDs) . The NHS Tayside policy for PGDs can be accessed via Staffnet (Our Websites > Pharmacy > Medicines Governance > Patient Group Directions).

http://www.nhstaysideadtc.scot.nhs.uk/SSHM/MAIN/Front page.htm

http://staffnet.tayside.scot.nhs.uk/OurWebsites/index.htm

http://staffnet.tayside.scot.nhs.uk/OurWebsites/Pharmacy/index.htm

http://staffnet.tayside.scot.nhs.uk/OurWebsites/Pharmacy/TaysideMedicinesGovernance/index.htm

http://staffnet.tayside.scot.nhs.uk/OurWebsites/Pharmacy/TaysideMedicinesGovernance/PatientGroupDirections/index.htm


3. STATEMENT OF POLICY NHS Tayside encourages and supports the growth and development of Non Medical Prescribing within the scope of this policy document. New prescribing roles may be introduced to deliver on local, and/or national policies, plans or priorities. The expansion of prescribing roles offers considerable scope for services to be redesigned to improve patient access, experiences and outcomes and to make more effective use of available skill-mix, with non-medical prescribing being integral to advanced practice roles. Whatever the background to the development it is important to ensure that it is fully integrated into the wider team delivery of healthcare and that common clinical, corporate and professional governance arrangements are in place. For the purposes of the policy, the term "prescribing" also includes de-prescribing.

The range of professionals eligible under legislation to issue an NHS prescription for medicines and/or appliances is increasing. Irrespective of their professional group the individual must: • Successfully complete an educational programme approved by the relevant professional

organisation, e.g. Nursing and Midwifery Council (NMC), Health & Care Professions Council (HCPC), General Pharmaceutical Council (GPhC) and General Optical Council (GOC).

• Be listed on a current professional register, maintained by their professional regulatory body in such a way as to signify that they hold an approved, current prescribing qualification.

• Be listed on the NHS Tayside Non Medical Prescribing (NMP) Register / Database. • Comply with this policy and other relevant policies within NHS Tayside that affect

prescribing, such as Safe and Secure Handling of Medicines and Promoting Use of Tayside Area Formulary (Incorporating Prescribing of Non-Formulary Medicines) Policy.

• Consider mentor support in their field of practice. https://www.nmc.org.uk/standards-for-education-and-training/standards-for-student-supervision-and-assessment/

• Bank and agency staff can undertake non medical prescribing where there is local service and NMP Lead agreement utilising a memorandum of understanding with the NHS Tayside Nurse Bank team.

• All NMP practitioners who hold an active prescribing role with an NHS Tayside contract, plus those employed in GP practices, community Optometrists and care home staff, have their details held within the NHS Tayside database and with that are required to demonstrate responsibility for working within the NHS Tayside NMP Policy and governance framework.

Non Medical Prescribers are individually and professionally accountable for their prescribing practice, as for any other area of practice, and must act at all times in accordance with the Code of Professional Conduct of their respective professional body. However, irrespective of their professional background, the same local governance principles must apply to all who prescribe. Non Medical Prescribers are professionally accountable for their own prescribing decisions including actions and omissions and cannot delegate this accountability to any other person. They must ensure that they are clear about the boundaries and accountability of their role and be able at all times, to demonstrate their ability, knowledge and competence to prescribe. Non Medical Prescribers must also understand and meet their obligations regarding corporate governance in terms of financial and budgetary management and policy, Health and Safety, and the management of risk. This obligation extends to ensuring that prescribing decisions are taken and reviewed with due regard to resource efficiency, budgetary management and antimicrobial stewardship principles. If a Non Medical Prescriber moves to another area of practice they must work within the requirements of the new role, which may, or may not, include a prescribing role. Where

https://www.nmc.org.uk/standards-for-education-and-training/standards-for-student-supervision-and-assessment/

https://www.nmc.org.uk/standards-for-education-and-training/standards-for-student-supervision-and-assessment/


prescribing is included, together with their manager, they must ensure that the necessary systems, processes and governance frameworks are in place and must only ever prescribe within their level of experience and competence. A job description needs to reflect the requirement to prescribe in that role. Managers and clinical leads must ensure budgetary arrangements are in place, as well as systems and procedures to assure safety, effectiveness, efficiency, appropriateness and acceptability. Managers also have accountability for ensuring, through annual appraisal processes and approval to practice, that prescribers are confident and competent for the role, are working within their level of competence and the necessary governance arrangements to support this policy are in place. Each professional group will have representation within the Non Medical Prescribing Leads Group, and ensure the necessary governance arrangements for NMP are operational. The Director or equivalent of their professional group will nominate the professional lead role. 4. PROTOCOL & PRACTICE

4.1 EDUCATION, TRAINING AND CONTINUOUS PROFESSIONAL DEVELOPMENT 4.1.1 Accessing Education and Training With the exception of pharmacists and optometrists the following application process applies:

• Managers should identify which staff require to complete non-medical prescribing education within the current or proposed model of service provision.

• The manager should clearly identify a source of funding for the NMP education and have an agreement for funding in place before an application is submitted. There are now multiple sources of funding for the NMP module depending on area of work, so clarity about funding source for a practitioner or service is important.

• The Manager is responsible for assessing their service and patient need to inform which roles require staff development in prescribing. The manager is required to provide this within the application form to allow the application panel to understand the service and its requirement for practitioners with NMP qualification.

• The role requirement for any postholder to be a non-medical prescriber should be reflected within their job description before an application is made for prescribing education.

• Candidates and managers should consider contacting the NMP Lead for their area or their professional group if required for any support and guidance.

• The practitioner must complete a formal application and Course Criteria Form (Appendix I) using the Joint NHS Tayside/University of Dundee application form, which will be circulated prior to each NMP module being offered by the University of Dundee. Applicants are required to meet Course and NHS Tayside criteria before a place will be offered.

• Special consideration will be given to practitioners wishing to undertake programmes of study in other Higher Education Institutions (HEIs) if NHS


Tayside Course Criteria form is completed and other HEI institute application is included. These applications must be completed within the same timeframes as the University of Dundee application process and presented for the NMP short listing meeting.

• All individuals selected for prescribing programme, once their prescribing qualification has been added to the relevant professional register, must have the opportunity immediately to prescribe in the post that they will occupy.

• Applicants must provide evidence of eligibility to undertake prescribing.

• Approval will be subject to the individual meeting any necessary

professional requirements. Please refer to links for NMC and HCPC Professional Standards Documents in Section 4.3 - References and Useful Links.

• A Designated Prescribing Practitioner must be identified by the applicant,

to supervise and assess the competency of the practitioner.

• To meet Nursing & Midwifery Council (NMC) and Health & Care Professions Council (HCPC) Standards a named Practice Assessor and Practice Supervisor must be identified within the application form. These roles will align with experienced prescribers who meet criteria of being qualified as a prescriber for 3 years and are deemed to have appropriate skills in teaching and support.

• The standardised application process must be adhered to for each

professional group (as authorised by their NMP Professional lead).

Pharmacy Application Process Before pharmacists apply to the two Scottish Schools of Pharmacy to undertake the independent prescribing course they must first apply for funding via NHS Education Scotland (NES). The application process can be found on the NES webpage: https://www.nes.scot.nhs.uk/education-and-training/by- discipline/pharmacy/pharmacists/prescribing-and-clinical- skills/courses.aspx Prior to applying for funding applicants must seek formal approval from their line manager in relation to:

• Prescribing being an agreed development need • The clinical service applicant plans to deliver into as a pharmacist

prescriber • Release from the service for course dates and agreement to support

the applicant during the experiential learning period • Applicants must also identify a Designated Prescribing Practitioner to

who will support their training and resultant implementation of prescribing into clinical practice.

• Following receipt of applications and after the closing date of the course, NES Pharmacy will require approval for funding from the Health Board Director of Pharmacy (DoP). Further to approval of funding the applicant will receive communication from NES Pharmacy and then from the University of their choice. This will occur

https://www.nes.scot.nhs.uk/education-and-training/by-discipline/pharmacy/pharmacists/prescribing-and-clinical-skills/courses.aspx




approximately 4-6 weeks after the closing dates for applications to NES.

Optometry Application Process

Optometrists can apply to the prescribing course at Glasgow Caledonian which has places funded by NHS Education for Scotland. Contact [email protected]. IP courses are also available at Aston, City, Hertfordshire and Ulster University.

Optometrists must supply evidence that they have up-to-date knowledge

in the diagnosis and management of the eye conditions for which they train to prescribe. Evidence of prior practical experience in the diagnosis and management of eye conditions entails providing evidence of one of the following: showing evidence of working within Scottish GOS for an average of one day per week over the previous two years; a letter of support from an ophthalmologist whom the optometrist works alongside; undergoing a short set of placements under the supervision of an ophthalmologist; providing a portfolio of clinical case records; working under the PEARS/MECS scheme or equivalent. Hospital Optometrists

Practitioners will consult their Line Manager prior to submitting an application to undertake education and training leading to a prescribing qualification. It is recognised that Line Manager approval is not required by the individual in order to undertake this training, the Line Manager is responsible for assessing whether such a qualification would be compatible with proposed service and role development.

Practitioners are required to link with NMP Lead prior to submitting application. All applications relating to NHS Tayside Hospital Optometry staff require to be considered and endorsed by the NMP Leads group.

Community Optometrists

Practitioners to link with NMP Lead prior to submitting application.

4.1.2 Professional Registration and Continuing Prof essional Development

On successful completion of an approved programme of education and training, the individual must inform their NMP Administrator (please refer to contact details in (Appendix X) and manager. They must arrange for their entry in the register maintained by their Regulatory Body to be updated or annotated to confirm their status as a prescriber and must provide their NMP Administrator with evidence of professional registration before proceeding to undertake a prescribing role Application to the register should not be delayed by the practitioner if at all possible as failure to register could cause delay for the organisation and the practitioner at a later date. Applications are required to be placed on the NMC register within 2 years of completing the NMP programme.

mailto:[email protected]


Practitioners undertaking prescribing roles must act in accordance with the codes of conduct, standards and ethics set by their individual professional bodies.

Practitioners are professionally accountable for their own practice and for ensuring that they have the necessary up-to-date knowledge and skills to prescribe competently and safely.

Practitioners must ensure that they undertake Continuous Professional Development (CPD) activities that enable them to meet CPD obligations aligned to each regulatory body and that a record of training and other activities undertaken is documented.

Employers and Managers will include a review of CPD activities in relation to prescribing practice into the annual appraisal process and ensure that agreed development needs are incorporated into Personal Development Plans (PDP) and annual appraisal.

4.2 ROLES AND RESPONSIBILITIES

4.2.1 Role of Individual Practitioners

Newly qualified Non Medical Prescribers will adhere to the relevant flow chart outlined in Appendix II for the purposes of confirming NMP status and securing prescribing stationery.

Practitioners must only prescribe within the limits of their registration, field of practice and competence.

They must be aware of, and must comply with any statutory requirements applicable to their prescribing practice. If a prescriber moves to another area of practice they must consider the requirements of the new role and only ever prescribe within their level of experience and competence, have access to a relevant budget and with their new manager’s approval. See Appendix II for guidance.

Where practitioners have moved to a new service or NHS Board. See Appendix II for guidance. For further guidance and support please contact your local NMP professional lead.

It is good practice for the Non Medical Prescriber to secure mentor support in their new field of practice. Practitioners have an obligation to prescribe responsibly and in their patients’ best interests.


Clinical Responsibility

The Practitioner must: • Make an assessment of, and document, the patient’s condition and

current medicines OR satisfy themselves that this has been done as part of the multidisciplinary review of the patient and only make a prescription change to meet the patient’s clinical needs.

• Carry out and document any relevant physical examinations/clinical

assessment of patients competently and with respect to the patient’s dignity and privacy.

• Communicate and document with patients / carers in a way that allows

them to understand the patient’s needs, concerns and expectations about their medicines and enables the patient to make an informed choice about their treatment, including the risks and benefits.

• Communicate any medication changes with the patients GP to ensure

contemporaneous records. It is recognised that medication changes during a hospital admission will be communicated at point of discharge.

• Prescribe within their level of competence, scope of professional practice

and field of practice as per Appendix VI. • Consider the status of a person with regard to the Mental Health Act

before prescribing for an individual. Non medical prescribers cannot prescribe for a person detained under the Mental Health Act. Also, for patients receiving medication covertly refer to NHS Tayside Covert Medication (Adults) Policy (link available in Section 4.3 : References and Useful Links).

• Prescribe safely, appropriately and cost-effectively in accordance with

NHS Tayside’s formulary and Promoting Use of Tayside Area Formulary (Incorporating Prescribing of Non Formulary Medicines) (policy link available in Section 4.3 : References and Useful Links). Further guidance to request to prescribe a non-formulary medicine is available in Appendix III.

• Ensure separation of the prescribing, dispensing and/or administration of

medicine processes wherever possible. Where the above processes cannot be separated a local governance arrangement must be agreed to ensure accurate record keeping.

• Demonstrate duty of candour in their practice in line with professional

standards

• Indicate their NMP designation when signing prescriptions by endorsing with the appropriate annotation according to profession.

• Consider and apply the principles of shared decision making in

prescribing decisions

• Consider and apply the principles of de-prescribing in relation to polypharmacy and medicine related harm.


• Consider and apply the principles of antimicrobial stewardship in prescribing decisions which incorporates:

- Right reason, right route, right dose, right frequency, right duration, right documentation;

- Refer to NHS Tayside Antimicrobial Guidelines and clearly document

indication and duration/review dates in notes and, for in-patients, on Tayside Prescription Administration Record (TPAR) or Hospital Electronic Prescribing and Medicines Administration (HEPMA) system where available.

• Document known or suspected adverse drug reactions in the appropriate patient record and via the Yellow Card System (www.yellowccard.gov.uk).

Professional Responsibility

• Ensure strict information governance when accessing password protected electronic prescribing systems such as Vision/EMIS, Electronic Patient Record (EPR), HEPMA, OPCOM and electronic discharge document systems

• Concerns regarding inappropriate access to electronic information systems

should be reported to the individuals Line Manager and appropriate action taken

• NMPs should not prescribe for themselves or anyone else with whom they

have a close personal relationship (e.g. family and friends), other than in emergency/ exceptional circumstances, where there are no other reasonable options available without compromising patient care.

• Prescribe only within the limits of their competence, as agreed with Line

Manager.

• Not direct prescriptions they have written to any particular pharmacy unless where necessary due to the nature of medication.

• Recognise prescribing pads flat bed paper and prescription stamps are

treated as controlled stationery and all Non Medical Prescribers are responsible for ensuring the safe and secure storage of their prescribing stationery at all times. Controlled stationery, in the wrong hands, could be used to obtain medicines fraudulently.

• Hospital Based Prescription (HBP) pads that have a carbon copy must be

kept for 2 years after the last prescription has been issued. Safe and secure storage of completed pad should be agreed with the NMP Professional Lead.

• Any breach in this responsibility will be viewed as a serious matter and, as

part of formal proceedings that would ensue, the fitness of the prescriber to continue to be recognised by NHS Tayside as a prescriber may be reviewed.

• If a prescription pad is lost or stolen, the Non Medical Prescriber must

contact their manager, and their Non Medical Prescribing Lead immediately for advice. It is recommended that a Standard Operating


Procedure (SOP) is in place within local areas to support loss of prescribing stationery.

• All unused stationery should be returned as soon as possible to the appropriate Non Medical Prescribing Administrator.

• Not ask for or accept any inducement, gift or hospitality, which may affect,

or be seen to affect, their judgement when making a prescribing decision. • Comply with local policies and declare interest in line with the Code of

Corporate Governance.

• It is recommended that non medical prescribers ensure that they have professional indemnity insurance. They are strongly advised to contact their professional body to ensure that their indemnity insurance covers them for the scope of their prescribing practice.

• Each non medical prescriber is responsible for his/her individual practice,

and must undertake regular reviews and ensure audit of practice at minimum yearly.

• Where appropriate, individuals can access mentor or peer review of

their prescribing practice and ensure documentation is in place to support reflection and learning from experience in practice.

• Ensure their prescribing details are accurate and any changes notified to

their NMP Professional Lead Governance Arrangements for Controlled Drug P rescribing

• Practising NMPs will be identified within eligible areas by line managers. • Controlled Drug Prescribing will not proceed without prior discussion and

authorisation provided by line manager on the Approval to Practice Form (Appendix VI).

• Competency for practice must be added to each prescriber’s appraisal/

personal development plan and a portfolio of evidence will be required to support self directed learning via the appraisal process.

• Line Managers will require to be assured that NMPs within their service are

competent and are demonstrating fitness to practice.

Record Keeping

• Document clearly and appropriately, in relevant patient records, any prescribing advice offered.

• Make a contemporaneous, comprehensive and clear record of their

assessment and consultation and prescription for an individual patient in the medical record. This record may include medical notes, Vision/ EMIS, the EPR (electronic patient record) or in-patient prescription chart. Where this is not possible, the prescriber will make a contemporaneous record, which is then added to the patient record in line with professional standards for record keeping.


• Write prescriptions clearly and legibly and ensure that they are identifiable as the non medical prescriber indicating NMP designation when issuing prescriptions. This includes when using electronic forms of communication.

• Ensure that only approved documentation is used. If in doubt about

appropriate record keeping contact your Line Manager.

Adverse Incidents

• Ensure that all incidents or errors in their prescribing practice are reported to their line manager immediately and immediate action is taken to ensure the safety and well being of patients /clients, in line with NHS Tayside Safe and Secure Handling of Medicines Manual

• Any incidents involving independent contractor prescribers must be

reported to the appropriate NMP professional lead. • Where prescribing performance causes concern line manager must link

with NMP Professional Lead. Prescribing issues may be identified via a number of sources. The line manager will arrange an urgent meeting to initially review the information with relevant personnel and a decision will be made in relation to allowing or ceasing of prescribing whilst a review is undertaken.

• Document known or suspected adverse drug reactions in patient notes and

via the Yellow Card System ( www.yellowcard.gov.uk). • Adhere to NHS Tayside adverse event reporting systems, and inform their

line manager and NMP Lead of all prescribing incidents/near misses via DATIX or alternative route of escalation, identifying the incident as a non medical prescribing event.

In addition to the above Supplementary Prescribers will: • Prescribe according to the Clinical Management Plan (CMP) agreed with

the Independent Medical Prescriber, for an individual patient using NHS Tayside template (Appendix IV).

• Refer all individual patient circumstances that fall outside the CMP, or

outside the Supplementary Prescriber’s competency, to an Independent Medical Prescriber who is responsible for that patient’s care.

• Develop an effective professional relationship with the Independent

Medical Prescriber. • Ensure that CMPs are reviewed annually or more frequently as

appropriate.

4.2.2 Role of Managers Managers must:

• Be actively involved in the decision to develop new prescribing roles and take accountability for ensuring that any such developments are fully

http://www.yellowcard.gov.uk/


compliant with local and national clinical, corporate and staff governance standards, policies, guidelines and principles.

• Discuss with all key stakeholders any new Service Developments requiring

Non Medical Prescribers prior to the implementation of any such services. Managers must have written agreement regarding budgets prior to staff applying for prescribing courses.

• Ensure that all potential Prescribers are eligible for Non Medical

Prescribing Education before nomination and ensure prescriber applications are endorsed by NHS Tayside Non Medical Prescribing Group.

• Ensure funding is available to support NMP education prior to application.

• Ensure that staff undertaking prescribing roles are registered as

prescribers on their professional register and have the necessary competencies, are clear of the boundaries and accountability associated with their role and that they are able, continually, to demonstrate their ability, knowledge and competence to undertake prescribing.

• Complete and submit the Approval to Practice Form annually and ensure a copy is retained in the practitioner’s personnel file (Appendix VI).

• Ensure that NMP administrators are informed of any changes required to the local Register of Non Medical Prescribers.

• Adhere to NHS Tayside systems to ensure that all non medical prescribers

have access to the necessary information, equipment and support to allow them to practice safely.

• Ensure NMP are supported in their requirements to meet continuous

professional development requirements.

• Ensure that within the NMP’s Annual Review/Appraisal (Appendix VII) that their Personal Development Plan includes:

- The area of practice to which their prescribing relates. - Agreement on, and documentation of, the parameters/scope of their

prescribing roles (e.g. BNF chapters). - Assurance of current professional registration as a prescriber. - Details of relevant CPD. - Assurance that appropriate arrangements for mentor, peer

review and clinical supervision are in place. - A reflective review from the practitioner’s mentor, as appropriate. - A portfolio of evidence is aligned with appraisal.

• Ensure that arrangements are in place to give assurance regarding the security of prescription pads and other controlled stationery

• Ensure that a process is in place to record relevant details in a stock

control system to aid reconciliation and audit trail

• Ensure that prescription pads and paper are retrieved from any NMP who leaves/changes their employment, prior to their leaving the department or


organisation (please refer to link for Safe and Secure Handling of Medicines Guidance in Section 4.3 - References and Useful Links).

• It is recommended that a Standard Operating Procedure (SOP) is in place

within local areas to support loss of prescribing stationery. • Ensure that the appropriate NMP Professional Lead, through the NMP

administrator, is informed whenever staff leave/change their employment or whenever the scope and/or range of an individual practitioner’s prescribing role changes.

• Ensure that all necessary resources are in place to allow the practitioner to

proceed to prescribing in practice. • Ensure that all incidents or errors in an individuals’ prescribing

practice are investigated fully and that required actions are carried out in line with NHS Tayside Safe and Secure Handling of Medicines and the relevant Human Resource Policy.

• Inform Non Medical Prescribing Lead of all incidents/errors associated with non medical prescribing practice errors via DATIX to ensure review and continuous improvement of systems and processes.

• Ensure Non Medical Prescribers within an inpatient setting have recorded

their details on the Ward Prescribing Register, where these are available, as a Non Medical Prescriber, and ensure a copy of their signature is supplied.

• Ensure audit of practice is taking place at minimum annually.

4.2.3 Role of the Designated Prescribing Practition er

The Designated Prescribing Practitioner will: • Be familiar with local Higher Education institution requirements and

the guidance from RPS (2019) Designated Medical Practitioner, A Competency Framework for all Prescribers 2016 and NMC (2018)/HCPC (2019) Standards Including Prescribing and Assessment & Supervision.

• Be an experienced and active prescriber registered with their appropriate

professional body • In collaboration with required regulatory bodies, assess and verify that

all necessary learning outcomes are met and that the practitioner is competent to assume the prescribing role by the end of the period of supervised practice.

4.2.4 Role of the Non Medical Prescribing Profe ssional Leads

• Represent their profession and locality at the NMP Leads group • Provide advice and support to applicants and line managers.

• Lead in the development and implementation of prescribing for their

profession.


• Advise about the governance infrastructure in place to support Non Medical Prescribing within NHS Tayside.

• Be responsible for professional support elements of NMP.

• Identify, prioritise, select and support candidates to undertake the approved

courses. • Assure processes for ordering supply and management of prescribing

stationery and other necessary prescribing tools (BNF issues, Scottish Drug Tariff etc), in support of the NMP Administrators.

• Advise staff regarding indemnity issues and regulatory frameworks. • Monitor and review all prescribing incidents/near misses in accordance with

NHS Tayside risk management systems and take action to continuously improve non medical prescribing practice, systems and processes.

The structure supporting non medical prescribing practice is illustrated in

Appendix IX with the Group contact details being provided in Appendix X.

In addition to the above, AHP / Nurse NMP Prescribing Leads will: • Provide support to local network members to support practitioners throughout their prescribing education and training. • Ensure that registration processes are adhered to on qualification in

collaboration with NMP Administrators. • Undertake an annual review of all prescribing incidents/near misses in

accordance with NHS Tayside risk management systems and identify further education requirements.

• Support and advise Line Managers in respect of investigations into non

medical prescribing incidents/ errors. 4.2.5 Role of Prescribing Administrators

• Maintain a database of all Non Medical Prescribers across Tayside for designated professional groups.

• Confirm professional registration status of Non Medical Prescribers at point

of qualification and/or commencement of employment with NHS Tayside. • Ensure that the NMP Professional Lead is informed whenever staff

leave/change their employment or whenever the scope and/or range of an individual practitioner’s prescribing role changes.

• Be registered as an authorised signatory for NHS Tayside to allow the

ordering of prescribing stationery on receipt of Manager approval/ signature.

• Collate PSD1/HBP forms and pass to Information Statistics Division (ISD)

of the Common Services Agency for processing.


• Liaise with Practitioner Services Division (PSD) as appropriate in relation to prescription pads.

• Adhere to flow charts developed by NMP Professional Prescribing Leads. • Distribute BNFs, Bulletins, the Tayside Prescriber, and prescribing

information/legislation to NMPs. • Support and manage the administrative infrastructure for ordering, security,

issue and destruction of prescription pads (see Appendix V).

4.2.6 Role of NMP Network members

NMP Network groups are available for all professional groups and in each locality to ensure communication and governance channels with the NMP Leads Group. .

• Make a commitment to attend the relevant local NMP network meetings regularly or provide a deputy

• To provide support for prospective NMP students from own area of practice

with the application process

• To have a good awareness of NMP policy

• To provide support to practitioners throughout NMP education, training and practice

• Each individual member will be accountable to ensure that agreed actions

are disseminated, implemented at service level and respond back to the group

• Act as a link between NMP Leads groups and practice areas, to take

forward agreed actions as identified in NMP Leads Group workplan. 4.3 REFERENCES AND USEFUL LINKS

HCPC (2019) Standards for Prescribing. Available from: https://www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing/ {Accessed 25/5/20} NES(2019) A National Framework for Practice Supervisors, Practice Assessors and Academic Assessors in Scotland. Available from: https://www.nes.scot.nhs.uk/media/4337236/national_framework_for_practice_supervisors__practice_assessors_and_academic_assessors_in_scotland_09_08_2019.pdf. { Accessed 25/05/20}. NMC (2018) Standards for Prescribing Programmes: Available from: https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/standards-for-prescribing-programmes/ {Accessed 25/05/19}. NMC (2018) Standards for Supervision & Assessment. Available from: https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/standards-for-prescribing-programmes/ {Accessed 25/05/20}.

https://www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing/

https://www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing/

https://www.nes.scot.nhs.uk/media/4337236/national_framework_for_practice_supervisors__practice_assessors_and_academic_assessors_in_scotland_09_08_2019.pdf

https://www.nes.scot.nhs.uk/media/4337236/national_framework_for_practice_supervisors__practice_assessors_and_academic_assessors_in_scotland_09_08_2019.pdf

https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/standards-for-prescribing-programmes/





NMC (2018) Standards framework for Nursing and Midwifery education. Available from: https://www.nmc.org.uk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/. {Accessed 25/05/20}. Royal Pharmaceutical Society (2019) A Competency framework for Designated Prescribing Practitioners (DPP). Available from: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/DPP%20Framework/DPP%20competency%20framework%20Dec%202019.pdf?ver=2019-12-18-150746-160. {Accessed 25/05/20}.

Royal Pharmaceutical Society Competency Framework for All Prescribers. Available from:

https://www.rpharms.com/resources/frameworks/prescribers-competency-framework NMC The Code 2018 www.nmc.org.uk/standards/code/ NPC A Single Competency Framework for all Prescribers https://www.associationforprescribers.org.uk/images/Single_Competency_Framework.pdf NHS Tayside Safe and Secure Handling of Medicines www.nhstaysideadtc.scot.nhs.uk/SSHM/MAIN/Front%20page.htm National Institute for Health & Care Excellence – Medicines and Prescribing. Available from:- https://www.nice.org.uk/about/nice-communities/medicines-and-prescribing Chartered Society of Physiotherapy Prescribing Website www.csp.org.uk/professional-union/practice/medicines-use-prescribing Chartered Society of Physiotherapy Publications www.csp.org.uk/professional-union/csp-publications HCPC Medicines and Prescribing Website www.hpc-uk.org/aboutregistration/medicinesandprescribing/ College of Optometrists Prescribing Website www.college-optometrists.org/en/CPD/Therapeutics/index.cfm General Pharmaceutical Council

www.pharmacyregulation.org/

NES Pharmacy Prescribing Courses www.nes.scot.nhs.uk/education-and-training/by-discipline/pharmacy/pharmacists /prescribing-and-clinical-skills.aspx NHS Tayside Covert Medication (Adults) Policy NHS Tayside Covert Medication (Adults) Policy NHS Tayside Promoting Use of Tayside Area Formulary (Incorporating Prescribing of Non Formulary Medicines) Promoting Use of Tayside Area Formulary NHS Tayside Request to Prescribe a Non Formulary Medicine Form Request to Prescribe a Non Formulary Medicine Form (See guidance also in Appendix III)

https://www.nmc.org.uk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/

https://www.nmc.org.uk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/

https://www.rpharms.com/Portals/0/RPS document library/Open access/Professional standards/DPP Framework/DPP competency framework Dec 2019.pdf?ver=2019-12-18-150746-160



https://www.rpharms.com/resources/frameworks/prescribers-competency-framework

http://www.nhstaysideadtc.scot.nhs.uk/SSHM/MAIN/Front page.htm

https://www.nice.org.uk/about/nice-communities/medicines-and-prescribing

http://www.csp.org.uk/professional-union/practice/medicines-use-prescribing

http://www.csp.org.uk/professional-union/csp-publications

http://www.college-optometrists.org/en/CPD/Therapeutics/index.cfm

http://www.pharmacyregulation.org/

http://www.nes.scot.nhs.uk/education-and-training/by-discipline/pharmacy/pharmacists /prescribing-and-clinical-skills.aspx

http://www.nes.scot.nhs.uk/education-and-training/by-discipline/pharmacy/pharmacists /prescribing-and-clinical-skills.aspx

http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=PROD_226900&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1

http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=PROD_192637&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1


COURSE CRITERIA FOR THE MANAGER/PRACTITIONER Please sign and submit these details and return with the compl eted University of Dundee

Non Medical Prescribing (NMP) application form

Summary Notes (to be detailed) Date

Proposed Clinical Field of Prescribing Practice

Prescribing Budget Identified Insert Code:

Identified funding source for course fee Lead Nurse/HoN/Line Manager to provide confirmation of funding:- Central NES funding Self funding Clinical Care Group/H&SCP Service Funding

What category of drug(s) are anticipated being prescribed by the applicant on completion of the module

Applicant capable of studying at degree level

Has the applicant previously been accepted onto any NMP module which they failed or did not complete

YES / NO (delete as appropriate)

Clear and obvious evidence is provided of the necessary skills, knowledge and experience to undertake the programme, including inclusion of recent certificates and CPD attendance relevant to present area of practice

Once qualified, must have opportunity to prescribe immediately

Confirmation of allocation of a suitable Practice Assessor/Educator

Competent to diagnose within their role

Evidence of Minimum of 1 year post NMC/HCPC registration experience

Theoretical Part of the module: Study leave agreed: 10 days protected learning time in addition to the 11 University days

GDPR STATEMENT: The personal information that you provide within your application will be held secure ly, and processed in line with GDPR and the Data Protection Act 2018. NHS Tayside’s legal basi s for processing is that it is necessary for the pu rposes of our legitimate interests as an organisati on. Relevant and proportionate parts of your data may b e shared with our partner organisations for adminis trative purposes. You have the right to request a copy of the information that we hold about you. Yo u can find more information about how we handle you r data on our Staff Data Protection Notice available via Staffnet.

Signature of Line Manager: Signature of Lead Nurse/Head of Nursing/ Clinical Service Manager / Equivalent: Signature of Practitioner:

…………………………………………… …………………………………………… ……………………………………………

Appendix I

[[

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Appendix II

FLOWCHART (1) TO SUPPORT MANAGERS WHERE NON MEDICAL PRESCRIBERS ARE TRANSFERRING TO

A SIMILAR ROLE/SPECIALITY/PATIENT GROUP WITHIN NHS TAYSIDE

Yes No ** See Appendix X of the NHS Tayside Non Medical Prescribing Policy for information on Designated Leads and Administrators

Please note that this process can also be used for independent contractors who are NMPs in Tayside working across different settings, e.g Gene ral Practice Nurses (GPNs), optometry, pharmacy

Is the NMP transferring to a similar role/speciality/patient group within NHS Tayside

Complete Approval to Practice form in new role/speciality/patient group and

consider any relevant local policies and IT systems aligned to new practice

setting

Please refer to Flowchart 2 - To Support Managers where Non Medical Prescribers are Transferring to a Different Role/Speciality/Patient Group within NHS Tayside

Request reference from current Line Manager to confirm contemporary NMP Practice at point of transfer

Please refer to Flowchart 3 - Endorsement of Prescribing Rights for Prescriber Transferring to NHS Tayside from another NHS Board

Send to NMP Lead and Administrator for the designated area along with NMC

Statement of Entry for Approval to Practice amendment to NHS Tayside database **

FLOWCHART (2) TO SUPPORT MANAGERS WHERE NON MEDICAL PRESCRIBERS ARE TRANSFERRING TO A DIFFERENT

ROLE/SPECIALITY/PATIENT GROUP WITHIN NHS TAYSIDE

Yes No ** See Appendix X of the NHS Tayside Non Medical Prescribing Policy for information on Designated Leads and Administrators

Is the NMP transferring to a different role/speciality/patient group within NHS Tayside

Complete Approval to Practice form

Send to NMP Lead and Administrator for the designated area along with NMC

Statement of Entry for Approval to Practice amendment to NHS Tayside database **

Please refer to Flowchart 1 - To Support Managers where Non Medical Prescribers are Transferring to a Similar Role/Speciality/Patient Group within NHS Tayside

Review knowledge of any new formulary implications, local policies and IT

systems pertinent to the new role/speciality/patient group e.g work shadowing/case study/self directed

leaning

Please refer to Flowchart 3 - Endorsement of Prescribing Rights for Prescriber Transferring to NHS Tayside from another NHS Board

Request reference from current Line Manager to confirm contemporary NMP Practice at point of transfer

FLOWCHART (3) TO SUPPORT MANAGERS WHERE NON

MEDICAL PRESCRIBERS ARE TRANSFERRING TO NHS TAYSIDE OR CHANGING SERVICE AREA WITHIN

NHS TAYSIDE

Yes YES NO

Is the NMP transferring to NHS Tayside or changing service area within NHS Tayside

Pause from Non Medical Prescribing

Is the NMP changing speciality/group of patients

Assess ability to diagnose/assess within different speciality/patient group

e.g. use of competence framework for diagnosis/case study below for Nurse Independent

Prescribers

Assessment and Diagnosis Competency tool (2).doc

Review knowledge of new formulary of medicines e.g. work shadowing/case study/

self directed learning

Review knowledge of NHS Tayside formularies, local policies and IT systems relevant to new role e.g. Non Medical Prescribing Policy / case study /

self directed learning / work shadowing

Complete 'Approval to Practice' form

Complete statement of competence to prescribe in new role

Send to NMP Lead along with NMC Statement of Entry for amendment to register. For changes of

board or service area forward for approval as per NHS Tayside NMP Policy


Appendix III

REQUEST TO PRESCRIBE A NON-FORMULARY MEDICINE GUIDANCE NOTES

This is incorporated into the NHS Tayside Promoting Use of Tayside Area Formulary (Incorporating Prescribing of Non Formulary Medicines) Policy. Please refer to NHS Tayside Request to Prescribe a Non-Formulary Medicine link available in Section 4.3: References and Useful Links.

Requests to prescribe a non-formulary medicine (Categories 1, 2 and 4) should be considered by the relevant group as follows: • Secondary Care – relevant Clinical Group

• Oncology and Haematology requests – Oncology & Haematology Medicines Management Group (OHMMG)

• Mental health, Care of the Elderly, General practice requests – relevant Clinical Group

The Clinical Group/OHMMG must consider whether there are overriding factors that make the decision not to prescribe unreasonable in the particular circumstances.

Guidance on specific questions:

Requested medicine (Q.5) The approved (generic) and brand name should be entered

Anticipated duration of treatment (Q.8) Length of treatment should the unlicensed/new medicine be approved for use in this patient e.g.

one course of 7 days; life-long; or duration of trial period, if that is what is intended.

Please Note: • Secondary care clinicians who wish a patient to receive a medicine that is unlicensed or

has not been submitted to SMC advice should make a case to their Clinical Group, as well as complete the proforma in Appendix 3 of the Policy. Prescribing approved by the Clinical Group and/or non-formulary panel remains the clinical and financial responsibility of secondary care i.e. such medicines should normally be supplied from hospital. Primary care should only be asked to continue prescribing if: This is the best care delivery method for the patient AND an adequate secondary care trial of medication has established tolerability and benefit of treatment AND a shared care agreement/ Individual Patient Treatment Plan is in place where appropriate AND the arrangement has been agreed by the patient’s GP.

• A separate form should be completed for each case, this process is not to be utilised for treatment of groups of patients where it is known at the time a group exists. For groups of patients a submission should be made to the Medicines Advisory Group after approval of the appropriate clinical group if in secondary care.

• Following discussion by the Clinical Group/OHMMG, completed forms should be forwarded to the relevant Principal or IJB Lead Pharmacist . The non-formulary database should also be completed.

• Appeals should be submitted as outlined in section 7 of the policy, seek early advice from the appropriate Principal/Lead Pharmacist if required.


Cost (Q.9) The NHS cost for a relevant treatment period e.g. per course or per 28 day treatment

period.

Reason for request (Q.11) If the medicine is continued from another health board then details of that approval would be helpful

to the application but NHS Tayside will make an independent decision. Treatment continuation (Q.12) If secondary care wishes to transfer the liability of prescribing to primary care on the basis that this is necessary for the patients optimal care, the appropriate approval of primary care must be sought, confirming to Primary Care that a PACS is in place, see notes above.

Previous treatment options and alternatives (Q.13 & 14) Provide details of previous treatment options the patient has received. State any alternative medicines also licensed for the indication and reasons why they are not being used in this case.

Clinical evidence (Q.15) Provide details of clinical outcomes associated with this unlicensed/new medicine in this patient group e.g. increase in disease free survival, overall survival and quality of life. Indicate the quality of evidence to support use, attach relevant references. For Category 1, unlicensed medicines, evidence of safety is vital to construct a risk: benefit argument supporting use. If the medicine represents a financial liability then evidence of cost effectiveness will usually be required, such as alterative costs saved, hospital admissions reduced etc.

Treatment outcomes and timescales (Q.16) In order to ensure financial governance clear timescales for treatment trial, duration and exit strategies will need described. Objective measures of treatment success and failure resulting in treatment stopping will usually need to be described, it is also desirable for this to explained to the patient if clinically appropriate.

Service Implications (Q.17) Describe any service pressure that will result, such as additional expensive tests/monitoring. Describe any service savings if not previously described.

Exceptionality (Q.18) In this section you must explain why this patient’s clinical circumstances and potential response to treatment with this medicine would be significantly different from the patient group/population considered by SMC/NHS QIS or NHS Tayside. The significant benefit you expect this patient to gain must be clearly explained and how you expect to measure/demonstrate this.

Timelines (Q. 21) Please describe the timescale within which a decision is needed. It is very difficult to hold frequent panels, NHS Tayside will endeavour to hold in-person panels for these requests. Should an urgent decision be clinically necessary please indicate this and why. A decision will be taken via the most appropriate communication means to meet the clinical deadline.

Declaration (Q.22) It is important to describe this process to the patient/carer, and to explain that the request may be rejected so as not to raise false hope/expectation if this is clinically appropriate. Ensure also you provide the patient/carer with the described leaflet, the hyperlink to which is on the electronic form (See NHS Tayside Request to Prescribe a Non-Formulary Medicine (link available in Section 4.3 : References and Useful Links).


This form should be completed by the clinician* who wishes the patient to receive a non-formulary medicine in any of the following circumstances:

Unlicensed

Category 1 Unlicensed medicines requests, including special formulations

Licensed

Category 2 ‘Off-label’ medicines requests, i.e. use out with their licensed indications

Category 3 PACS requests use separate National form at Appendix 4

Category 4 Non-formulary requests out with NHS Tayside Drug and Therapeutics Committee advice. This includes medicines that are accepted by SMC but are not listed in the formulary/specialist list or local protocols.

* Note that a Specialist recommending treatment should complete this form and submit to the relevant Clinical Pharmacist.

1. Clinical Group/IJB:

2. Clinical Team/Speciality:

3. Requesting Clinician:

4. Patient CHI:

5. Requested Medicine:

6. Indication the medicine is to be used for:

7. Dose (including strength, form and frequency):

8. Anticipated duration of treatment:

9. Treatment Cost:

Annual Cost:

10. Excep tion Category: (please tick)

Category 1: Unlicensed medicines requests, including special formulations (NB: Read Policy Section 3)

I have read and understood Section 3 – Signed: ………………………………………………………………………

Category 2: ‘Off-label’ medicines requests, i.e. use out with their licensed indications and/or medicines not submitted to SMC

Category 3: Use separate form at Appendix 4 (PACS)

Category 4: Non-formulary requests out with NHS Tayside Drug and

Therapeutics Committee advice. This includes medicines that are accepted by SMC but are not listed in the formulary/specialist list or local protocols.


11. Reason for Request: Continuation of medicine initiated in primary care: Go to Section 22 (If previous authorisation not granted: supply may be refused) Continuation of previous hospital supply: Go to Section 22 (If previous authorisation not granted: supply may be refused) Continuation of medicine approved in other health b oard: New treatment decision:

12. Will treatment continue: Only in hospital Hosp ital, then in primary care If to be continued in primary care: Individual Patient Treatment Plan written* *Seek advice from Principal Pharmacist.

13. Prev ious treatments that the patient has received:

14. Explain why available licensed and formulary medici nes are not appropriate in this case:

15. Summary of peer reviewed evidence for use in this i ndication in terms of safety, clinical and cost effectiveness if available (attach relevant references): NB: If for Category 1 or 2 then safety evidence is necessary to enable a risk/benefit assessment.


Evidence Quality (Please tick)

I RCTs

II Case control or cohort studies

III Non-analytic studies e.g. case reports, case series

IV Expert opinion

16. Treatment Outcomes and Timescales: Please note that treatment will only be authorised if agreed outcomes and timescales are clear. If approved, circumstances in which treatment may cease should be explained to the patient or carer by the prescriber. Please indicate clearly circumstances in which treatment will be stopped.

17. Service Implications (if any):

18. Approval Rationale Example: Explain how the patient is expected to gain significantly greater benefit from this drug than the normal treatment group considered by SMC or NHS Tayside policy for this drug.

19. Monitoring requirements for treatment: If required of primary care, an individual patient treatment plan is needed (seek advice from pharmacy)

20. Details of all discussions relevant to this case: Example: Advised by national experts, second opinions, colleagues etc.

21. Timeliness ( Please indicate timeframe, if relevant, in which decision is needed - this must be realistic and clinically relevant):


22. Declaration: I declare I have completed a conflict of interest f orm that I have explained this process to the patient or carer and that approval is not guarantee d. Signed: ……………………………………… Name (BLOCK CAPITALS): ………………………………….. E-Mail Address: …………………………………………………….…………… Page: ……………..………… Any request needs to be supported by the relevant C linical Lead or Associate Medical Director By signing you are confirming that you have discuss ed this with the requesting Clinician and support the application. Clinician in support of application :

Signature: Name (BLOCK CAPITALS): Date: Clinician in support of application :

Signature: Name (BLOCK CAPITALS): Date: Pharmacist in support of application :

Signature: Name (BLOCK CAPITALS): Date:

AUTHORISATION:

To be completed by the Principal Clinical Pharmacis t/Lead Pharmacist

I have reviewed the request and the evidence for safety, clinical and cost effectiveness. Request Approved Clinical Service Manager notified Request referred to Clinical Group/IJB level Request referred to non-formulary panel Request rejected Name: Signature: Date:

Yes N/A


NB: Ensure original is returned to medical notes and a copy forwarded to patients GP.

Rationale behind decision:


AUTHORISATION:

To be completed by Chair of the decision-making pan el

Decision and supporting statement:

(Including any conditions such as duration, evidence of outcomes, etc.)

NB: Ensure original is returned to medical notes an d a copy forwarded to patients GP.

Name: Signature: Date:


Appendix IV

CLINICAL MANAGEMENT PLAN

PATIENT NAME: CHI NUMBER: DOB:

ADR/sensitivities: Process for

reporting ADRs:

Co-morbidities Goals of therapy Guidelines or protocols supporting CMP

Details of medicines that may be prescribed by SP

Monitoring Circumstances for referral back to IP

Agreed by independent prescriber: (Sign & Print)

Date: Agreed by supplementary prescriber: (Sign & Print)

Date: Agreed with patient – date:

Date for implementation

Frequency of review by independent prescriber:

Frequency of review by supplementary prescriber:

Joint review date / frequency

Shared record to be used by IP and SP


Appendix V

NHS TAYSIDE NON MEDICAL PRESCRIBING

PROTOCOLS FOR NON MEDICAL PRESCRIBING (NMP) ADMINISTRATIVE PROCESSES


Protocol for Non Medical Prescribing (NMP)Module Applications

Protocol for Activating/De-Activating Prescribing Rights for NMPS

Protocol for Prescription Pad Ordering and Delivery

Appendices

Prescription Order Form (Form A).

Prescription Delivery Log Sheet (Form B) Prescription Pad Confirmation of Delivery Slip (Form C) Destruction of Prescription Sheets/Pads (Form D) Report of Lost/Stolen NMP Prescription Pad Checklist (Form E) Letter to Tayside Pharmacists/Counter Fraud Services (Letter A)

CONTENTS


• NMP Module application packs to be emailed to Senior Charge Nurses/Service Managers

(Nurses/AHPs) each May (for September cohort) and August (for January cohort). Application pack to include:-

- NHS Tayside Application letter – letter to be adapted for each area, e.g. signature of NMP Lead and return details - University of Dundee Application Pack (V150 or V300) - NHS Tayside Course Criteria Form - Assessment & Diagnosis Competency Tool

• 2 meetings arranged per year for NMP Leads to shortlist applications (July for September cohort and October for January cohort). • NMP Leads/Administrators to forward any application forms received to NHS Tayside Centralised Database Administrator prior to date of NMP Leads Shortlisting Meeting. • NHS Tayside Centralised Database Administrator compiles a list of applicants and provides copies of application forms for each member of the Shortlisting Panel. Application Shortlisting Template Sheet is completed for each applicant. • Chair of Shortlisting Panel to complete Application Shortlisting Template for each applicant, noting outcome.

• NHS Tayside Centralised Database Administrator drafts outcome letters to applicants and forwards to Chair for signature. Copy of letters to be sent to relevant Leads and Administrators.

• Each NMP Lead to be contact for providing feedback on outcome for applicants from their respective areas.

• Successful application forms to be forwarded to Post Qualifying Cohort Administrator, University of

Dundee, Airlie Place, Dundee for processing. Photocopy of application retained for student’s file.

Exemptions to Standard Application Process/Eligibility Criteria:-

Programmes of Education Outwith NHS Tayside/University of Dundee (Nurse/AHP) In recognition of Non Medical Prescribing modules delivered by other Universities, all applications relating to NHS Tayside staff require to be considered and endorsed by the Non Medical Prescribing Leads Group. This refers to stand alone modules of education and Masters level studies. Practitioners to link with NMP Lead prior to submitting application or commencing studies.

Independent Contractors Practitioners to link with NMP Lead prior to submitting application.

PROTOCOL FOR NON MEDICAL PRESCRIBING MODULE APPLICA TION PROCESS


Pharmacist application process

Application for the Prescribing courses at both Universities in Scotland is an online process.

Prior to applying for the course applicants must seek formal approval from their line manager in relation to:

• Prescribing being an agreed development need

• The clinical service applicant plans to deliver into as a pharmacist prescriber

• Release from the service for course dates and agreement to support the applicant during the experiential learning period

Applicants must also identify a medical practitioner to act as their Designated Medical Practitioner who will support their training and resultant implementation of prescribing into clinical practice.

Following receipt of applications and after the closing date of the course, NES Pharmacy will require approval for funding from the Health Board Director of Pharmacy (DoP). Further to approval of funding the applicant will receive communication from NES Pharmacy and then from the University of their choice. This will occur approximately 4-6 weeks after the closing dates for applications to NES.

Applicants should contact their NES Regional Practice Education Coordinator, NHS Tayside Principal Pharmacist Education or Lead for Prescribing and Clinical Skills, if they require any additional information in regard to these courses.

• Newly qualified prescriber to contact NMP Administrator to advise of successful completion of

NMP module and provide photocopy of Regulatory Body Statement of Entry. • Approval to Practice form emailed to prescriber for completion and return. Signed approval to

practice form to be received from new prescriber or their line manager. • Once Regulatory Body status is verified email the new prescriber a Prescription Order Form (if

required (Form A). Order form to be signed by Manager for every order (i.e. Team Leader/Practice Manager, Head of

Service or GP).

• On receipt of Form A Administrator to complete the following forms (as required) and email to EVADIS [email protected]:

- PHS(P)1 form (for Community Practitioner/Independent/Supplementary Nurse Prescribers) - PHS(NMP)1 form (for Non Medical Prescribers/Allied Health Professional Prescribers) - PHS(HBP)1 form (for hospital based prescribers) - PHS(OPT)1 form for Community Optometric Prescriber

Above forms are available for download from ISD website https://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Prescriber-Codes/

Forms to be signed by NMP Administrator.

PROTOCOL FOR ACTIVATING PRESCRIB ING RIGHTS FOR NEWLY QUALIFIED NON MEDICAL PRESCRIBERS

http://nes.scot.nhs.uk/education-and-training/by-discipline/pharmacy/about-nes-pharmacy/our-team/regional-practice-education-co-ordinators.aspx


https://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Prescriber-Codes/

https://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Prescriber-Codes/


• Unique Prescribing Codes (UPCs) are not required for hospital based prescribers (T(4 digit) codes

are used dependant on area). If new code is required NMP Administrator should complete PHS(HBP)1 form and submit to EVADIS ([email protected]).

• Once Unique Prescribing Code (UPC) is issued for prescriber if appropriate, NMP Administrator to

record prescriber’s details and UPC on local NMP database ensuring that details are also emailed to NHS Tayside NMP Centralised Database Administrator to allow updating of centralised database. New prescriber’s details to be added to locally held mailing lists and labels.

• If more than one code is requested for prescribers working across various practices, all additional

codes should be recorded in local NMP database. • NHS Tayside NMP Centralised Database Administrator to email centralised databases to NMP

Administrators bi-annually for checking with local databases to ensure accurate details are held.

• Data Manager, Information Services, National Services Scotland to be sent updated list of NHS Tayside Prescribers names/addresses every 6 months.

• EVADIS to be notified by NMP Administrator when prescribers leave the service or for any other

change of circumstances. Relevant PHS forms to be completed with notification of change and emailed to [email protected]. Ensure details are also copied to NHS Tayside Centralised Database Administrator to allow updating of centralised database.

• Prescribers leaving the service or changing bases must return their unused pads to relevant NMP

Administrator for destruction. Unused pads to be personally handed in to NMP Administrator or returned in secure mail bags.

• Unused pads should be shredded and serial numbers recorded on the Destruction of Prescription

Sheet/Pad Form (Form D) and electronically on spreadsheet. Destruction of pads should be witnessed by another member of staff.

• Prescribers details to be removed from local NMP database, mailing lists and labels. Ordering of Prescription Pads • NMP Administrator completes prescription pad request on relevant order form:

- PSD 1 GP10N (for Practice Based Community Practitioner/Independent/Supplementary Nurse Prescribers).

- PSD HBP (for Hospital Based Nurse Prescribers). - PSD 7 GP10NMP (for Supplementary Prescribers – Podiatrists, Radiographers, Physiotherapists, Dieticians and Paramedics. - PSD 8 (for Computer & Non Personalised Stationery). - PSD 9 GP10OP (Independent Optometric Prescriber)

Above forms are available for download from Practitioner Services website: https://nhsnss.org/services/practitioner/pharmacy/prescriptions/prescription-form-ordering/

Forms to be signed by NMP Administrator..

• Part printed pads can be ordered on PSD1/PSD 7 order forms for prescribers working over various practices. Only one set of part printed pads (4 pads) should be ordered.

PROTOCOL FOR DE-ACTIVATING PRESCRIBING RIGHTS FOR NON MEDICAL PRESC RIBERS

PROTOCOL FOR PRESCRIPTION PAD ORDERING AND DELIVERY




• All orders to be logged on Prescription Delivery Log Sheet (Form B). • Order forms then emailed to Practitioner Services [email protected], copied to Stores, Stracathro Hospital ([email protected]). NHS Tayside Centralised NMP Administrator to be copied in to correspondence for checking against NHS Tayside Centralised NMP Database. • Computerised prescriptions can be ordered on a PSD 8 form and delivered directly to the NMP Administrator. • If order is not received on expected delivery date NMP Administrator should contact Practitioner Services for update to ensure enquiries in regard to missing prescriptions can be made at an early stage. Delivery of Prescription Pads • Prescription pads are delivered via Stores, Stracathro Hospital who will forward on to relevant NMP Administrator or, in the case of independent contractors, directly to their place of work. • On receipt of pads NMP Administrator checks prescriber details are correct, returns delivery note to Stores Department, logs receipt on Prescription Delivery Log Sheet and adds details to Confirmation of Delivery Slip (Form C). • Administrator should ensure that all prescription p ads are securely locked away if not immediately issued to prescribers. • Administrator should contact prescriber to inform them of either of the following:-

- that their prescription pads have been received and are now available for collection.

Prescriptions can only be collected by the named pr escriber.

- that their prescription pads have been sent by secure mail.

On collection Prescribers should: • Show photo ID • Check details and serial numbers on pads and sign the Confirmation of Delivery Slip to

confirm receipt NMP Administrator to log delivery details on to Prescription Delivery Log Sheet

NMP Administrators should:- • Enclose prescription pads and Confirmation of Delivery Slip within pharmacy mailing bag ensuring that bag is sealed and serial number of tag is recorded on locally held NMP database • Log delivery details on to Prescription Delivery Log Sheet

On receipt Prescribers should:-

- Record tag serial number on Confirmation of Delivery Slip - Check details and serial numbers on pads and sign the Confirmation of Delivery Slip to

confirm safe delivery - Return the Confirmation of Delivery Slip to address noted on slip

Confirmation of Delivery Slips to be returned within 14 days. If not received within timescale NMP Administrator to contact prescriber to chase up. If not returned NMP Administrator to issue request to Prescriber’s manager.


Computer Prescription Paper • Computerised prescriptions are delivered direct to the NMP Administrator who will forward on to

prescriber within 6 weeks as per PSD delivery times. To be sent in secure mail bags or personally collected from NMP Administrator.

• NMP Administrator to record serial numbers on local NMP database and supply prescriber with a

small quantity of prescription sheets (approx 6 months supply) • NMP Administrator to log delivery details on to Prescription Delivery Log Sheet • Prescriber to check details/serial numbers, sign the Confirmation of Delivery Slip to confirm safe

delivery and return to relevant NMP Administrator within 14 days as per instructions for prescription pads.

• NHS Tayside staff - Non Medical Prescriber to report the loss or theft of prescription forms/pads to

their Manager and Non Medical Prescribing Lead for their area. • Independent contractor -must notify the appropriate individual in the company they work for

and the Director of Pharmacy (and NMP lead for information). • NHS Tayside staff - NMP Lead to notify NHS Tayside Director of Pharmacy and alert NHS Tayside

NMP Leads Group Administrator. • NHS Tayside staff - NMP Leads Group Administrator or Contractor to complete NMP Lost/Stolen

NMP Prescription Pad Checklist (Form E) and standard letter (Letter A) immediately. Early Warning Telephone List (Cascade System) to be activated immediately after Form E and letter A above has been completed. The community pharmacy emergency early warning telephone cascade process must be initiated by the most appropriate person in the sector affected e.g. Secondary Care Nursing, Secondary Care AHP, TSMS, Independent Contractor, or the actual NMP to alert community pharmacist to the incident providing them with the incident details on form E / letter A verbally. The community pharmacy emergency early warning telephone cascade can be found at http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pharmacy/documents/documents/prod_199445.pdf Where a controlled drug is involved the CD team must be notified immediately (see Form E for contact details). A copy of Form E and letter A must be emailed to the Director of Pharmacy confirming that the community pharmacies have been notified through the emergency cascade process. The Director of Pharmacy will arrange for the information to be sent out to all community pharmacists by email the same or following working day. Each area must have a process in place for dealing with such notifications

PROTOCOL FOR LOST/STOLEN PRES CRIPTIONS

http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pharmacy/documents/documents/prod_199445.pdf

http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pharmacy/documents/documents/prod_199445.pdf


NHS TAYSIDE

NON MEDICAL PRESCRIBING PRESCRIPTION ORDER FORM (FORM A)

SECTION 1 Name of Prescriber: DOB: Job Title: Exam Pass

Date:

Prescriber’s Address: (Address & Post Code) Prescriber’s Main Base:

Will you be prescribing from locations other than main YES / NO (Please delete as appropriate) base? Contact Tel No: Start Date with

Employer:

SECTION 2

Type of Pads: HBPN (Hospital Based) PSD 1 (Practice Based) Type of Prescriber : (if part printed pads required please also tick either the Supp/Ind or CPNP SUPP/IND CPNP PART PRINTED PADS

Type of Prescriptions Required: (please tick box(es) below as appropriate) Single Sheet Hand Held Pads Unique Identifier Code (if applicable):

NMC PIN I confirm that, in accordance with NMC Guidance and as agreed with my manager, I am competent to prescribe Prescribers Signature: ……………………………………………………………… Date: ………………………………. SECTION 3 I confirm that all of the above details are correct , that the prescriber is registered and their presc ribing status is recorded with the appropriate professional body. Manager Signature: Date: Please note: Managers signature required for every order


NON MEDICAL PRESCRIBING - PRESCRIPTION DELIVERY LOG SHEET (FORM B)

Date Ordered

Prescriber Name/Designation

Pad Type / Amount Ordered

Date Received

Amount Received

Received By: (name) Serial numbers

Date sent to Prescriber

Method of Delivery (i.e. collected or secure mail)

Serial Number of Bag Seal (if mailed)

Date to Stores/ Signature

Date Confirmation Slip Signed/ Returned by Prescriber

Qty: From: Date:

Type:

To:

Qty: From:

Type:

To:

Qty: From:

Type:

To:

Qty: From:

Type:

To:

Qty: From:

Type:

To:

Qty: From:

Type:

To:


NHS TAYSIDE

NON MEDICAL PRESCRIBING

PRESCRIPTION PADS CONFIRMATION OF DELIVERY SLIP (FORM C)

Date: ……………. Tag Serial No: ………..

CONFIRMATION OF RECEIPT OF PRESCRIPTION PADS/SHEETS Prescribers Name: ……………………………………………………….. Surgery/Hospital Address: ………………………………………………………. ………………………………………………………………………………………. Type of Prescription: ……………………………………………………………… Prescription Serial Nos:

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

Please confirm numbers are correct and sign for receipt:-

Prescribers Signature: …………………………… Date: ……………………… Please return form at your earliest convenience to: ……………………………………………………………….. ……………………………………………………………….. ……………………………………………………………….. If there are any prescription pads/sheets missing p lease contact the administrator above immediately , by telephone or email (using “For Urgent Action ” as the heading). Please see NHS Tayside Non Medical Prescribing Policy for further actions required.

Issued by: ………………………………………. Designation: ……………………………..

If Not Personally Collected


NHS TAYSIDE NON MEDICAL PRESCRIBING

DESTRUCTION OF PRESCRIBING SHEET/PADS (FORM D)

DETAILS OF DESTRUCTION OF PRESCRIPTION SHEET/PADS ( FORM D)

Prescribers Name: ……………………………………………………….. Surgery/Hospital Address: ………………………………………………………. Serial Nos:-

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

I have checked that the above details are correct and that I have witnessed the appropriate destruction of the above prescriptions: Destroyed by: …………………………… Print Name: ……………………………… Designation: ……………… Reason for destruction: …………………………………………………… Date: ………………… Witness Signature: …………………….. Print Name: ……………………………… Designation: ……………..

DETAILS OF DESTRUCTION OF PRESCRIPTION SHEET/PADS ( FORM D) Prescribers Name: ……………………………………………………….. Surgery/Hospital Address: ………………………………………………………. Serial Nos:-

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

From: …………………… To: …………………..

I have checked that the above details are correct and that I have witnessed the appropriate destruction of the above prescriptions: Destroyed by: ………………………….. Print Name: ……………………………… Designation: ………………… Reason for destruction: …………………………………………………… Date: ………………… Witness Signature: …………………… Print Name: ……………………………… Designation: …………………


REPORT OF LOST/STOLEN NON MEDICAL PRESCRIBER (NMP) PRESCRIPTION PAD

CHECKLIST (FORM E)

1. Is the prescription/prescription pad being reported:- a) a single, signed & issued prescription? Please complete No. 2 onwards

b) a blank, unused full/part prescription pad? Please complete No. 3 onwards

2. If report is in relation to 1(a)\above):

i) What is the name of the NMP who signed the prescription?

ii ) What is the NMPs unique prescriber code and professional regulation number?

UPC: Prof Regulation No:

iii) Serial number of prescription lost (if known)

iv) Date Prescription Issued:

v) Date prescription due to be dispensed

Record:

iii) Name of patient:

.

iv) Patient's date of birth:

v) Patient's address:


vi) Exact details of drugs prescribed:

(also whether tablets or capsules etc.)

vii) Whether another prescription been issued?

i) If yes - What actions have they taken to identify the duplicate.

ii) If no - Request that if a duplicate is to be issued, then it is written in red ink.

3. IF report is in relation to 1 b (above)

i) Records prescription pad serial numbers lost -

ii) Request that the NMP writes all prescriptions in red ink for the next month.

iii) Enquire if the police have been informed. If not, advise the NMP that this will be done from the “agreed central point” and that they should advise the appropriate NMP Lead for their area.

iv) Request a telephone number for contact with NMP should any further information be required.

4. NMP Lead/Administrator Action:

i) Phone pharmacists on Early Warning (Cascade System). Telephone list is held by NMP Leads Group Administrator

ii) Complete template letter and email to NHS Tayside Director of Pharmacy, Head of Controlled Drugs Governance (if controlled drug) and Counter Fraud Services ([email protected])

From: ………………………… To: ……………………………



Nursing & Midwifery Directorate

Level 9 Ninewells Hospital Dundee DD1 9SY Telephone Number: 01382 660111 www.nhstayside.scot.nhs.uk

Date Your Ref Our Ref SD/AW/NMPlostprescletter Enquiries to Allison White Extension 36196 Direct Line 01382 660111 Ext 36196 Email [email protected]

(LETTER A) TO: NHS Tayside Director of Pharmacy Head of Controlled Drugs Governance Counter Fraud Services Dear Sir/Madam LOST/STOLEN PRESCRIPTION FORMS NHS Tayside has been informed that *a prescription form/s *has/have been stolen/lost. Details are as listed below.

Name and Address To Whom Prescription(s) Refer(s) To

Non Medical Prescriber Name, Contact Details & Unique Prescriber Code (UPC)

Prescription Pad Serial Numbers Range

From To

Action Being Taken

.

Drug Prescribed

The above information has been cascaded to Community Pharmacists via NHS Tayside Early Warning Telephone List (Cascade System) Yours sincerely Sarah Dickie Associate Nurse Director/ Chair of Non Medical Prescribing Leads Group


Appendix VI NHS TAYSIDE NON MEDICAL PRESCRIBING

APPROVAL TO PRACTICE FORM

FULL NAME: …………………………………………………………………………………………………. (PRINTED CAPITALS) DESIGNATION: ……………………………………………………………………………………………… PRESCRIBING QUALIFICATIONS: ………………………………………………………………………. DATE OF QUALIFICATION: ……………………………………………………………………………….. REGISTERING BODY (GPhC/NMC NUMBER): …………………………………………………………... AREA OF PRACTICE: ………………………………………………………………………………………. PRESCRIBING BUDGET: ………………………………………………………………………………….. APPROVED TO PRESCRIBE AS (Nurse independent/supplem entary prescriber or AHP

prescriber): …………………………………………………………………………………………………... DOES YOUR ROLE REQUIRE THE PRESCRIBING OF CONTROLLE D DRUGS? YES / NO IF YES PLEASE STATE TYPES AND (SCHEDULES 2-5): ………………………………… ……... ………………………………………………………………………………………………………………….. APPROVED TO PRESCRIBE FOR (E.G. GROUP OF PATIENTS O R SPECIALTY): ………………………………………………………………………………………………………………….. PRESCRIBING WILL BE IN ACCORDANCE WITH NHS TAYSIDE SAFE & SECURE HANDLING OF MEDICINES POLICY AND NHS TAYSIDE NON MEDICAL PRESCRIBING POLI CY

SIGNATURE: ……………………………………………………………………………………………………………..

CONTACT NUMBER: ……………………………………………………………………………………………………

DATE: ……………………………………. APPROVED BY LINE MANAGER

NAME (please print): ………………………………………………………………………………………………..

SIGNATURE: …………....................................... ..........................................................................................

DATE: …………………………………

Adopted with thanks from Torbay and Southern Devon NHS Health and Care NHS Trust ORIGINAL COPY TO: Personal File COPY TO: Non Medical Prescribing Leads Administrator


Appendix VII

NON MEDICAL PRESCRIBERS ANNUAL REVIEW/APPRAISAL Name

Date:

Type of Prescriber

Professional Registration

Area of Prescribing Practice

Parameters of Prescribing role (e.g. BNF Chapters)

Details of CPD i.e . Evidence of last 3 years continuous professional development

Attendance of Peer Review / Clinical Supervision

Check Security of pads (locked)

Critical Incident / Near misses

Active / Non-Active

Date left NHS Tayside

Action Plan Required

• Copy to NMP Personal Development file and inform NM P Administrator of completion date


Appendix VIII GENERIC TEMPLATE FOR NMP AUDIT FOR ADAPTING TO NEED S OF LOCAL AREAS NMP Prescribing Audit: Date: ___________________ Audit of: _________________________________ Audited by: ______________________________________ Medication Prescribed:

RECORD KEEPING

Is the prescription written legibly?

In black ink?

Using Electronic Prescribing and flatbed printer paper?

Using generic name?

If not prescribing generically, rationale given?

Using correct formulation?

Using correct strength?

Using correct route of administration?

Is the dose correct?

Is the frequency and duration of treatment appropriate?

Has the prescription been signed?


Medication Prescribed:

PATIENT CENTRED

Has an assessment of the patient been recorded in patient record?

Is there a clinical indication for the medication?

Has the patient been involved in and consented to the treatment choice?

APPROPRIATE USE

Is the use of the prescribed medicine for the clinical indication in line with local formulary?

Is the use of the prescribed medicine in line with local protocol?

Is the medicine licensed?

If unlicensed, has this been discussed with the patient and recorded in the notes?

If use is unlicensed, off-label or non-formulary, is this supported by local/national guidelines or has this been approved through an individual-patient-treatment-request (IPTR) process, discussed with the patient and recorded in the notes?

Is the drug prescribed within the agreed scope of prescribing practice of the NMP?

NOT APPLICABLE FOR ALL AREAS

Is the drug a Controlled drug?


NON MEDICAL PRESCRIBING LEADS GROUP Appendix IX

COMMUNICATION REPORTING STRUCTURE

NHS Tayside Board

Director of Nursing & Midwifery

(Claire Pearce)

HEI/ DUNDEE UNIVERSITY

(Suzanne Bell, Programme Lead;

Colette Henderson, Programme Team)

NON MEDICAL PRESCRIBING LEADS GROUP

Representation from: NHS Tayside Board, Health & S ocial Care Partnerships, Operating Unit, Pharmacy, AHP, Nursing Directorat e, HEI, Opticians

NHS Tayside Area Drug & Therapeutics

Committee

Chair of NMP Leads Group (Sarah Dickie)

ACUTE SERVICES NON MEDICAL PRESCRIBING

NETWORK

(June Finnie/Roy Hann/Faith Kelley-

Clunie) Acute Services NMP

Network Leads)

NURSING & MIDWIFERY

DIRECTORATE

(Sarah Dickie, Associate Nurse Director/Chair of

NMP Leads Group)

(Sandra Gourlay, Deputy Associate Nurse Director/ Deputy Chair of

NMP Leads Group)

(Cheryl Harvey, Head of Nursing & Midwifery Education)

H&SCPs

(Fiona Barnett, NMP Lead, Dundee

HSCP)

(Dawn Wigley, NMP Lead, P&K

HSCP)

(Karen Fletcher, NMP Lead, Angus

HSCP)

PHARMACY

(Karen Lowdon,/ Arlene

Coulson/Diane Robertson,

Specialist Clinical Pharmacist

Leads)

AHP

(Nicola Richardson/ Alison Reid

Allied Health Professional

Leads)

OPTOMETRY

(Stuart McConnachie,

Community Optometry Lead) – from 26th July 2021

(Claire Black, & Claire Brown,

Hospital Optometry Leads)

SCOTTISH AMBULANCE

SERVICE

(Stephen Hughes, Clinical

Lead - Advanced

Practice for East of Scotland & Advanced Paramedic

Practitioner in Urgent &

Primary care)


Appendix X NHS TAYSIDE NMP PROFESSIONAL LEADS CONTACT DETAILS

NHS TAYSIDE Sarah Dickie Associate Nurse Director Chair Non Medical Prescribing Leads Group Level 9 Ninewells Hospital and Medical School Dundee DD1 9SY Tel: 01382660111 Ext 40478 Email: [email protected] Sandra Gourlay Deputy Associate Nurse Director/ Deputy Chair Non Medical Prescribing Leads Group Management Offices

Perth Royal Infirmary

Taymount Terrace, Perth PH1 1NX Tel: 01738 473141

Email: [email protected] Cheryl Harvey Head of Nursing and Midwifery Education Nursing and Midwifery Directorate Level 9 Ninewells Hospital Dundee DD1 9SY Tel: 01382 660111 Ext 34588 Email: [email protected] DUNDEE HEALTH & SOCIAL CARE PARTNERSHIP Fiona Barnett Clinical Co-Ordinator NMP Lead (Dundee H&SCP) Roxburgh House Jedburgh Road Dundee, DD2 1SP Tel: 01382 423134 Email : [email protected] PERTH & KINROSS HEALTH & SOCIAL CARE PARTNERSHIP Dawn Wigley Senior Nurse (RN-Mental Health) NMP Lead (P&K H&SCP) Health Centre, Level 2 HMP Perth 3 Edinburgh Road Perth PH2 8AT Tel: 01738 458148 Email : [email protected]






ACUTE SERVICES Faith Kelley- Clunie Hospital at Night Practitioner/ NMP Acute Network Lead HAN Office, Level 4 Perth Royal Infirmary Tel 01382 660111 Ext 54399 Email : [email protected] Roy Hann Hospital at Night Practitioner/ NMP Acute Network Lead HAN Office Ninewells Hospital Tel: 01382 660111 Ext 33145 Email : [email protected] June Finnie Advanced Nurse Practitioner, Neurosurgery/ NMP Acute Network Lead Ward 23b Ninewells Hospital Tel: 01382 425723 Email: [email protected] ANGUS HEALTH & SOCIAL CARE PARTNERSHIP Karen Fletcher

Lead Nurse / Registered Nurse NMP Lead (Angus H&SCP) Angus Health & Social Care Partnership

Angus House, Orchardbank Business Park FORFAR DD8 1AN Tel: 01307 492547 Email : [email protected] ALLIED HEALTH PROFESSIONS Nicola Richardson AHP Practice Education and Teaching/NMP Lead AHP Directorate Kings Cross Hospital Dundee DD3 8EA

Tel : 01382 424035 ext.71035 Email : [email protected] Alison Reid Advanced Physiotherapy Practitioner/ NMP Lead AHP Directorate Stracathro Hospital Brechin DD9 7QA Tel : 01356 665155 Email : [email protected]






UNIVERSITY OF DUNDEE Suzanne Bell Programme Lead: Non Medical Prescribing School of Nursing and Health Sciences University of Dundee (Fife Campus) Forth Avenue Kirkcaldy KY2 5YS Tel : 01382 385919 Email : [email protected] Colette Henderson Lecturer (Adult Nursing) and Programme Lead MSc Adv anced Practice School of Nursing and Health Sciences University of Dundee Tel : 01382 385907 Email: [email protected] OPHTHALMIC SERVICES Stuart McConnachie Specialist Optometrist/ Community NMP Lead ( from 26 th July 2021 ) Ophthalmology Ninewells Hospital Dundee DD1 9SY Tel : 01382 632348 Email : [email protected] Claire Black/Claire Brown Optometrist Specialists/ Hospital NMP Leads Ninewells Hospital Dundee DD1 9SY Tel : 01382 632348 Email : [email protected]/[email protected] t PHARMACY Karen Lowdon Arlene Coulson Specialist Clinical Pharmacist Lead Clinical P harmacist Pharmacy Department Specialist Services and Surgery Ninewells Pharmacy Department Tel: 01382 660111 Ext 35282 Ninewells Email: [email protected] Tel: 01382 660111 Ext 35463 Email: [email protected] SCOTTISH AMBULANCE SERVICE Stephen Hughes Clinical Lead - Advanced Practice for East of Scotl and/ Advanced Paramedic Practitioner in Urgent & Primary Care Scottish Ambulance Service, East Central Division Headquarters (TAYSIDE) 76 West School Road, Dundee, DD3 8PQ Tel: 01382 882400 Email: [email protected]


mailto:[email protected]/




NMP ADMINISTRATORS Allison White Administrator for NMP Leads Group & Non Medical Prescribing (Acute) Nursing & Midwifery Directorate Level 9, Ninewells Hospital Tel : 01382 660111 Ext 36196 Email : [email protected] Karen Adams Administrator for Non Medical Prescribing (Angus H& SCP) Pharmacy Department Stracathro Hospital By Brechin DD9 7QA Tel : 01356 665042 Email : [email protected] Aileen Beattie Administrator for Non Medical Prescribing (Dundee H &SCP) AHP Directorate Kings Cross Hospital Clepington Road Dundee DD3 8EA Tel : 01382 424150/1 or Ext 71150/71151 Email : [email protected] Sandra Dudek Administrator for Non Medical Prescribing (Perth & Kinross H&SCP) Pharmacy Office – Management Offices Perth Royal Infirmary Taymount Terrace PERTH PH1 1NX Tel : 01738 473967 / 01738 473573 Email : [email protected] /[email protected] Wendy Meldrum AHP Support Officer AHP Directorate King Cross Hospital, Clepington Road Dundee DD3 8AE Tel : 01382 424151 Email : [email protected] Eileen Waddell Optometry Admin Support Officer Primary Care Services Kings Cross Hospital,Clepington Road Dundee DD3 8AE Tel : 01382 424178

Email : [email protected] Kath Meikle PA to Director of Pharmacy NHS Tayside Kings Cross Dundee DD3 8EA Tel: 01382 425685 Email : [email protected]




mailto:/[email protected]





Appendix XI

NHS TAYSIDE – POLICY APPROVAL CHECKLIST

This form must be completed by the Policy Manager a nd this checklist must be completed and forwarded with the policy to the Executive Team, Cl inical Quality Forum or Area Partnership

Forum for approval and to the appropriate Committee for adoption. POLICY AREA: Clinical POLICY TITLE: Non Medical Prescribing POLICY MANAGER: Non Medical Prescribing Leads Group

Why has this policy been developed?

To refresh the former policy and enable contemporary policy statements to support Non Medical Prescribing Practice.

Has the policy been developed in accordance with or related to legislation? – Please give details of applicable legislation.

1990s the Crown Report

Has a risk control plan been developed and who is the owner of the risk? If not, why not?

Various checks are in place through line management assessment of experience and skills prior to a candidate’s application for study; the inter-organisational selection process for applications for study and the various pathways/flowcharts illustrated at the end of the policy.

Who has been involved/consulted in the development of the policy?

NMP Leads Group Local NMP Networks Managers (through local networks) Medicines Policy Group Area Drug & Therapeutic Committee

Has the policy been Equality Impact Assessed in relation to:- Has the policy been Equality Impact Assessed not to disadvantage the following groups:-

Age Disability Gender Reassignment Pregnancy/Maternity Race/Ethnicity Religion/Belief Sex (men and women) Sexual Orientation

Please indicate Yes/No for the following: Yes Yes Yes Yes Yes Yes Yes Yes

People with Mental Health Problems Homeless People People involved in the Criminal Justice System Staff Socio Economic Deprivation Groups Carers Literacy Rural Language/Social Origins

Please indicate Yes/No for the following: Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Does the policy contain evidence of the Equality Impact Assessment Process?

Yes

Is there an implementation plan? Which officers are responsible for implementation?

Non Medical Prescribing Group

When will the policy take effect?

Immediately

Who must comply with the policy/strategy?

All NHS Tayside staff linked with non medical prescribing practice

How will they be informed of their responsibilities?

Through launch of policy The NMP annual education event Line Management structure Local NMP networks

Is any training required?

No

If yes, attach a training plan

N/A


Are there any cost implications?

Prescribing budgets are already allocated within relevant services – not required for launch of the policy

If yes, please detail costs and note source of funding

Who is responsible for auditing the implementation of the policy? Non Medical Prescribing Group What is the audit interval? Yet to be determined Who will receive the audit reports? Area Drug & Therapeutic Committee When will the policy be reviewed and provide details of policy review period (up to 5 years)

May 2023

POLICY MANAGER: NMP Leads Group Chair DATE: APPROVAL COMMITTEE TO CONFIRM: Medicines Policy Group ADOPTION COMMITTEE TO CONFIRM: Area Drug & Therapeutic Committee


Appendix XII EQUALITY IMPACT ASSESSMENT Name of Policy, Service Improvement, Redesign or St rategy: Non Medical Prescribing Policy

Lead Director of Manager: Claire Pearce, Director of Nursing & Midwifery

What are the main aims of the Policy, Service Impro vement, Redesign or Strategy? The key aim of this policy is to outline the circumstances in which non medical prescribing practitioners can be educated and proceed to prescribe within NHS Tayside, and set out the systems and procedures that must be adhered to, to assure safe and effective non medical prescribing practice in order that:

• Patients benefit through improvements to the quality of care through timely assessment

and access to medicines. • Prescribing practice is compatible with the service development plans of the organisation

and clinical speciality and is an appropriate extension of a practitioner’s role. • Non Medical Prescribers are appropriately qualified for their role, work within agreed

national and local policy, and are identifiable in the organisation in order they are kept up to date on prescribing issues both locally and nationally.

• There is a local register of qualified non medical prescribers to facilitate communication and co-ordination of care and to support clinical and corporate governance.

• Non Medical Prescribers are supported in their role, have access to continuous professional development in respect of prescribing practice and are able to demonstrate an evidence portfolio within e-KSF.

• This policy does not address Patient Group Directio ns (PGDs) . The NHS Tayside policy for PGDs can be accessed via Staffnet (Our Websites > Pharmacy > Medicines Governance > Patient Group Directions) • This Policy does not address transcribing/transposi ng – NHS Tayside does not currently support transcribing practice.

Description of the Policy, Service Improvement, Red esign or Strategy – What is it? What does it do? Who does it? And wh o is it for? The purpose of this Non Medical Prescribing Policy is to outline the Governance, Administration and Procedural steps necessary to ensure patient safety and quality of care of patients related to Non Medical Prescribing NHS Tayside. The policy must be used in conjunction with National Guidance from Professional and Regulatory Bodies, as well as Local Policy and Procedures NHS Tayside has in place for Safe and Secure Handling of Medicines.

http://staffnet.tayside.scot.nhs.uk/OurWebsites/index.htm

http://staffnet.tayside.scot.nhs.uk/OurWebsites/Pharmacy/index.htm



http://staffnet.tayside.scot.nhs.uk/OurWebsites/Pharmacy/TaysideMedicinesGovernance/PatientGroupDirections/index.htm


What are the intended outcomes from the proposed Po licy, Service Improvement, Redesign or strategy? – What will happen as a result of it?- W ho benefits from it and how? NHS Tayside, as an organisation, encourages and supports the growth and development of Non Medical Prescribing within the scope of this policy document. New prescribing roles may be introduced to deliver on local, and/or national policies, plans or priorities. The expansion of prescribing roles offers considerable scope for services to be redesigned to improve patient access, experiences and outcomes and to make more effective use of available skill-mix. Whatever the background to the development it is important to ensure that it is fully integrated into the wider team delivery of healthcare and that common clinical, corporate and professional governance arrangements are in place.

Name of the group responsible for assessing or cons idering the equality impact assessment? This should be the Policy Working Group or the Proj ect team for Service Improvement, Redesign or Strategy. Non Medical Prescribing Leads Group/Medicines Policy Group


SECTION 1 Part B – Equality and Diversity Impacts Which equality group or Protected Characteristics d o you think will be affected?

Item Considerations of impact Explain the answer a nd if applicable detail the Impact

Document any Evidence/Research/Data to support the consideration of impact

Further Actions required

1.1 Will it impact on the whole population? Yes or No. If yes will it have a differential impact on any of the groups identified in 1.2. If no go to 1.2 to identify which groups

No .


Item Considerations of impact Explain the answer a nd if applicable detail the Impact



1.2 Which of the protected characteristic(s) or groups will be affected?

• Minority ethnic population (including refugees, asylum seekers & gypsies/travellers)

• Women and men • People in religious/faith

groups • Disabled people • Older people, children

and young people • Lesbian, gay, bisexual

and transgender people • People with mental

health problems • Homeless people • People involved in

criminal justice system • Staff • Socio- economically

deprived groups

All groups have the potential to be affected, however Non Medical Prescribing will only proceed following clinical assessment of individual patients

• Nursing and Midwifery Council Standards of Proficiency for Nurse and Midwife Prescribers (2006)

• Royal Pharmaceutical Society A Framework for all Prescribers (2016)

• NHS Tayside Safe & Secure Handling of Medicines Policy


Item Considerations of impact Explain the answer and if applicable detail the Impact



1.3 Will the development of the policy, strategy or service improvement/redesign lead to

• Discrimination • Unequal opportunities • Poor relations between

equality groups and other groups

• Other

No • Nursing and Midwifery Council Standards of Proficiency for Nurse and Midwife Prescribers (2006)




SECTION 2 – Human Rights and Health Impact. Which Human Rights could be affected in relation to article 2, 3, 5, 6, 9 and 11. (ECHR: European Conv ention on Human Rights)




2.1

On Life (Article 2, ECHR) • Basic necessities such as

adequate nutrition, and safe drinking water

• Suicide • Risk to life of / from others • Duties to protect life from risks by self / others • End of life questions

A Non Medical Prescriber requires to assess the individual needs of any patient prior to proceeding to prescription




2.2

On Freedom from ill -treatment (Article 3, ECHR) • Fear, humiliation • Intense physical or mental suffering or anguish • Prevention of ill-treatment, • Investigation of reasonably

substantiated allegations of serious ill-treatment

• Dignified living conditions









2.3 On Liberty (Article 5, ECHR) • Detention under mental health law • Review of continued justification of detention • Informing reasons for detention





2.4 On a Fair Hearing (Article 6, ECHR) • Staff disciplinary

proceedings • Malpractice • Right to be heard • Procedural fairness • Effective participation in

proceedings that determine rights such as employment, damages / compensation









2.5 On Private and family life (Article 6, ECHR) • Private and Family life • Physical and moral integrity

(e.g. freedom from non-consensual treatment, harassment or abuse

• Personal data, privacy and confidentiality

• Sexual identity • Autonomy and self-

determination • Relations with family,

community • Participation in decisions

that affect rights • Legal capacity in decision

making supported participation and decision making, accessible information and communication to support decision making

• Clean and healthy environment









2.6 On Freedom of thought, conscience and religion (Article 9, ECHR) • To express opinions and

receive and impart information and ideas without interference


2.7 On Freedom of assembly and association (Article 11, ECHR) • Choosing whether to belong

to a trade union


2.8 On Marriage and founding a family • Capacity • Age


2.9 Protocol 1 (Article 1, 2, 3 ECHR) • Peaceful enjoyment of possessions



SECTION 3 – Health Inequalities Impact Which health and lifestyle changes will be affected ?




3.1 What impact will the function, policy/strategy or service change have on lifestyles?

For example will the changes affect:

• Diet & nutrition • Exercise & physical activity • Substance use: tobacco,

alcohol or drugs • Risk taking behaviours • Education & learning or

skills • Other





3.2. Does your function, policy or service change consider the impact on the communities?

Things that might be affected include:

• Social status • Employment (paid/unpaid) • Social/family support • Stress • Income









3.3 Will the function, policy or service change have an impact on the physical environment? For example will there be impacts on:

• Living conditions • Working conditions • Pollution or climate change • Accidental injuries/public

safety • Transmission of infectious

diseases • Other

A Non Medical Prescriber requires to assess the individual needs of any patient prior to proceeding to prescription Non Medical Prescribing staff require to work within the auspices of NHS Tayside;

• Healthcare Acquired Infection Policy and Procedures

• Health & Safety Procedures

• Management of Risk Policy & Procedures




• Healthcare Acquired Infection Policies

• Health & Safety Legislation & Procedures

• Adverse Event Management Policy (2014)

3.4 Will the function, policy or service change affect access to and experience of services? For example

• Healthcare • Social services • Education • Transport • Housing

Yes, the Policy is aiming to improve service delivery where Non Medical Prescribing is eligible

N/A


Item Considerations of impact Explain the answer and if

applicable detail the Impact Document any Evidence/Research/Data to support the consideration of impact


3.5 In relation to the protected characteristics and groups identified:

• What are the potential impacts on health?

• Will the function, policy or

service change impact on access to health care? If yes - in what way?

• Will the function or policy

or service change impact on the experience of health care? If yes – in what way?

Modernisation of the NHS requires a fundamental shift in the way healthcare is delivered. Part of the agenda is ensuring that the contribution of all staff is maximised through role development. However, any role development needs to be implemented within a governance framework to reduce and manage risks to patients, healthcare staff and to the NHS Board.


SECTION 4 – Financial Decisions Impact How will it affect the financial decision or propos al? Item

Considerations of impact Explain the answer and if applicable detail the Impact



4.1

• Is the purpose of the financial decision for service improvement/redesign clearly set out

• Has the impact of your financial proposals on equality groups been thoroughly considered before any decisions are arrived at

Non Medical Prescribing cannot proceed without the manager of each service firstly having identified the prescribing budget and ensuring this is documented within a Non Medical Prescribing Application

4.2 • Is there sufficient information to show that “due regard” has been paid to the equality duties in the financial decision making

• Have you identified methods for mitigating or avoiding any adverse impacts on equality groups

• Have those likely to be affected by the financial proposal been consulted and involved

Yes, procedures have been amended to ensure the prescribing budget is identified and documented in each Non Medical Application. Yes, consultation about this Policy has been completed





5. Involvement, Consultation and Engagement (IEC) 1) What existing IEC data do we have?

• Existing IEC sources • Original IEC • Key learning

2) What further IEC, if any, do you need to undertake?

This Policy has been considered by: NMP Leads Group Local NMP Networks Managers (through local networks) Medicines Policy Group Area Drug & Therapeutic Committee

Endorsed by: Medicines Policy Group and Area Drug & Therapeutic Committee





6. Have any potential negative impacts been identified?

• If so, what action has been proposed to counteract the negative impacts? (if yes state how)

For example: • Is there any unlawful

discrimination? • Could any community get

an adverse outcome? • Could any group be

excluded from the benefits of the function/policy?

(consider groups outlined in 1.2) • Does it reinforce

negative stereotypes? (For example, are any of the groups identified in 1.2 being disadvantaged due to perception rather than factual information?)

None





7. Data & Research • Is there need to gather

further evidence/data? • Are there any apparent

gaps in knowledge/skills?

No

8. Monitoring of outcomes • How will the outcomes

be monitored? • Who will monitor? • What criteria will you use

to measure progress towards the outcomes?

Monitoring of practice will be achieved through: • Staff Appraisal • Peer Review • Team Audit • Non Medical Prescribing

Leads • Risk Management System:

Datix

9.. Recommendations State the conclusion of the Impact Assessment

The Impact Assessment Review recommends supporting individual patient assessment and person centred care delivery by Non Medical Prescribers





10. Completed function/policy • Who will sign this off? • When?

Medicines Policy Group

11. Publication

NHS Tayside Staffnet


Conclusion Sheet for Equality Impact Assessment

Negative Impacts (Note the groups affected)

None

Conclusion Sheet for Equality Impact Assessment

Positive Impacts

(Note the groups affected)

All patient groups where individual need has been assessed

Negative Impacts (Note the groups affected)

None

What if any additional information and evidence is required

None

From the outcome of the Equality Impact Assessment what are your recommendations? (refer to questions 5 - 10) NHS Tayside Non Medical Prescribing Policy is published to enable contemporary governance and guidance for Non Medical Prescribing practice This conclusion sheet should be attached to the relevant committee report. MUST BE COMPLETED IN ALL CASES Manager’s Signature Sarah Dickie, Associate Nurse Director Date