Non Medical Prescribing Policy

Policy Number

MM11002 version 2

Title of Policy

Non Medical Prescribing Policy

Author

Lucianne Ricketts

Head of Medicines Management

Approved at Locala Policy Group

Responsible Director: Director of Clinical and Operational Services

Date Ratified: Original - Sept 2011

Amendment - June 2012

Ratified By: Executive Management Group (EMG)

Review Date: November 2013

Contents

Contents

Section Page

1 Introduction 1

2 Associated Polices and Procedures 1

3 Aims and Objectives 1

4 Scope of the Policy 2

5 Accountabilities and Responsibilities 2

6 Forms of Non Medical Prescribing 2 7 PATIENT AND PUBLIC INVOLVEMENT

7.1 Patient Information 7.2 Patient Consent

3 4 4

8 TRAINING FOR NON MEDICAL PRESCRIBING 8.1 Nurses and Midwives 8.2 Pharmacists 8.3 Allied Health Professionals 8.4 All Applicants 8.5 Mentors 8.6 Support from an Experienced Non Medical Prescriber 8.7 The Course

4 4 5 5 5 6 7 7

9 QUALIFICATION AS A NON MEDICAL PRESCRIBER 9.1 Actions by the Individual Non Medical Prescriber 9.2 Actions by the Line Manager 9.3 Actions by the Non Medical Prescribing Lead or Community Services Pharmacy Manager 9.4 Actions by Human Resources 9.5 Employment of a Non Medical Prescriber

7 8 8 9 9 9 9

10 PRACTICING AS A NON MEDICAL PRESCRIBER 10.1 Support for Non Medical Prescribing 10.1.1 Prescribing Across Organisational Boundaries 10.2 Accountability and Responsibility of a Non Medical Prescriber 10.2.1 Vicarious Liability/Indemnity Insurance 10.2.2 Continuing Professional Development (CPD) 10.2.3 Performance and KSF Development Review 10.2.4 Audit 10.2.5 Change of Role Within the Organisation 10.2.6 Return to Practice as a Non Medical Prescriber 10.2.7 Leaving a Non Medical Prescribing Role within LCP

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10 11 12 13 13 14 14 15 16

11 PRESCRIBING PRACTICE 11.1 Principles of Prescribing 11.2 What Non Medical Prescribers can Prescribe 11.3 Prescribing Unlicensed Medicines 11.4 Prescribing Licensed Medicines for Use Outside Product License (Off Label) 11.5 Mixing Medicines in Clinical Practice 11.6 Controlled Drugs 11.7 Issuing Prescriptions 11.8 Prescription Writing 11.9 Reporting Arrangements and Record Keeping 11.10 Handling Adverse Drug Reactions (ADRs) and Medication Incidents

17 17 18 19 20 20 22 22 23 24

Contents

Section Page 12 GENERAL GUIDANCE

12.1 Recording and Security of Prescription Forms 12.2 Ordering and Supply of Prescriptions 12.3 Requirements for Handling Prescription Pads at Locality Bases 12.4 Ordering Prescription Pads 12.5 Loss or Suspected Theft of Prescriptions

24 24 25 25 26 27

13 Equality Impact Assessment 28

14 Training Needs Analysis 28 15 Monitoring Compliance 28

16 References 28

Appendices A Definitions 30

B Key Stakeholders 31 C Equality Impact Assessment Tool 32

D Sign Off Sheet 33 E CPNP Intention to Prescribe Form 34

F Independent Prescribing Proforma 35/36 G Independent Prescribing Additions Form 37/38

H Supplementary Prescribing Clinical Management Plan (CMP) 39/40

I Community Nurse Prescribers and Nurse/Pharmacist Independent Prescribers Hand Held Prescription Pad Order Form (FP10/C)

41

J Prescription Record Sheet for Non Medical Prescribers 42/43 K Application for Approval to Undertake Non-Medical Prescribing Course 44

L Course Details, Yorkshire and Humber SHA 45/52

M Good Practice Guidelines for the Safe and Secure Handling of Prescription Forms for Non-Medical Prescribers

53

N Service Level Agreement 54/58

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POLICY STATEMENT

Locala Community Partnerships Community Interest Company (LCP) will develop non-medical

prescribing practice to fulfil all statutory, organisational and best practice requirements.

1. INTRODUCTION This policy provides operational procedures and a clinical governance framework to support non-medical prescribing within LCP.

The policy covers:

Community Practitioner Nurse Prescribers

Nurse Independent/Supplementary Prescribers

Pharmacist Independent/Supplementary Prescribers

Optometrist Independent/Supplementary Prescribers

Allied Healthcare Professional Supplementary Prescribers (Physiotherapists, Podiatrists, Radiographers and Optometrists).This list may expand to cover other Health Care Professionals given prescribing rights by the Department of Health.

This policy is a stand alone policy and is also referenced in the LCP Medicines Management Policy.

2. ASSOCIATED POLICIES, PROCEDURES AND GUIDANCE

This policy should be read in conjunction with the following policies and procedures:

• Medicines Management Policy • Incident Reporting Policy • Patient Group Direction (PGD) Policy

Controlled Drug Policy

Relevant professional and ethical standards for non-medical prescribers as defined by the appropriate professional body e.g. NMC, RPSGB etc.

3. AIMS AND OBJECTIVES The primary aim of this policy is to ensure that non-medical prescribing is delivered in a safe and effective manner within LCP. Implementation will improve access to medicines without compromising patient safety and further utilise the skills of a range of practitioners resulting in increased flexibility of multidisciplinary working.

The purpose of this policy is to provide guidance for non-medical prescribers and to inform LCP staff and those contracted to provide services for LCP of the organisational processes involved. This includes:

Forms of Non Medical Prescribing

Selection/ identification of those to be trained

Qualification as a Non Medical Prescriber

Practice as a Non Medical Prescriber

Accountability

2

Prescription writing requirements and processes

Record keeping

Adverse Reactions

Prescription queries

Prescription pad security

Continuing Professional Development/Competencies

Administration and Management Processes for NMP

4. SCOPE OF THE POLICY

This policy will apply to all qualified non-medical prescribers (NMPs), employed within LCP who carry out the duties of independent/supplementary or formulary prescribing in their clinical role. Prescribing should be reflected as a key result area in an individual’s job description. Primary Care Contractors and their staff may also use this policy as a means of adopting good practice.

All LCP employees including those on temporary or honorary contracts, bank staff and students who are developing policy, procedural and guidance documents must follow the process set out in this document.

Independent Contractors are responsible for the development and management of their own documents and for ensuring compliance with relevant legislation and best practice guidelines.

5. ACCOUNTABILITIES AND RESPONSIBILITIES

The Chief Executive has overall responsibility for the strategic and operational management of the organisation, including ensuring that LCP Policies comply with all legal, statutory, and good practice guidance requirements.

The Director of Clinical and Operational Services has overall accountability for the safe and secure handling of medicines, supported by the Head of Medicines Management and the Medicines Management Committee.

All non medical prescribers employed by LCP must familiarise themselves with the correct procedures contained within this policy. Those in charge of services are responsible for ensuring that their staff, particularly new starters and locums, follow the procedures in this policy. Hard copies of the policy will be available to all staff through service leads and line managers. An electronic version will also be available via the NHS Kirklees website under the Locala section.

The procedures also apply to non medical prescribers who are contracted to work for LCP on a sessional basis. Managers who contract for these services must make it explicit within the written contract that these sessional staff MUST follow the procedures described in this policy.

All professionals are required to work within their Professional Code of Practice and terms of service.

6. FORMS OF NON-MEDICAL PRESCRIBING

Non-medical prescribing is the term used to describe prescribing by health care professionals other than doctors and dentists. Non medical prescribers must comply with the current legislation for prescribing and be accountable for that practice.

Non Medical Prescribers include:

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Community Practitioner Nurse Prescribers

Nurse Independent Prescribers

Pharmacist Independent Prescribers

Optometrist Independent Prescribers

Supplementary prescribers

Further details on the mechanisms for non-medical prescribing can be found at:

http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Background/index.htm

Furthermore the Department of Health (2006) guidance1 should be referred to for Independent Nurse and Pharmacist Prescribing at:

http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4133747.pdf

Finally for guidance on Supplementary Prescribing the Department of Health (2005)2 should be consulted at:

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4110032&chk=c4V6nR

7. PATIENT AND PUBLIC INVOLVEMENT

The DH (2006) asserts that non-medical prescribing provides benefits to patients as follows:

Improved patient care without compromising patient safety;

Easier and quicker access for patients to the medicines they need;

Increased patient choice in accessing medicines;

Better use of the skills of health professionals;

Non-medical prescribing assists the provision of more patient-centred services. It enables rapid access to medicines with the use of less health care professionals in the patient journey, thus enhancing the patient experience.

LCP is committed to effective communications with patients and local people and will ensure that the patient experience is constantly being evaluated and improved upon. Furthermore the patient experience of non-medical prescribing will be captured by the audit arrangement of non-medical prescribing described in section 10.2.4 of this policy.

1 Department of Health (2006) Improving Patients Access To Medicines: A Guide to Implementing Nurse and Pharmacist

Independent Prescribing within the NHS in England. London: DH

2 Department of Health (2005) Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists,

Physiotherapists and Radiographers within the NHS in England: a guide for implementation. London: DH

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7.1 Patient Information Non Medical Prescribers must ensure that patients are aware they are being treated by a Non-Medical Prescriber and the scope of their prescribing practice may mean referral onto another health care professional if necessary.

Information leaflets on non-medical prescribing should be produced in different presentational formats to meet the differing language and visual needs of patients.

7.2 Patient Consent

Patients must be informed of the status of those prescribing medicines to them and provide their consent before a non-medical prescriber should proceed. This consent must be recorded in the patient’s notes.

8. TRAINING FOR NON-MEDICAL PRESCRIBING

Before individual non-medical prescribers apply for training to become a non-medical prescriber, they and their supporting manager must confirm the following criteria.

8.1 Nurses and Midwives

To undertake the preparation programme to prescribe as a community practitioner nurse prescriber, the Nursing and Midwifery Council (2007) state that nurses and midwives should:

Have practiced for a sufficient period to be deemed competent in the area they intend to practice. This would normally be a minimum of 2 years.

Provide evidence via the Accreditation of Prior and Experiential Learning (APEL) process of their ability to study at minimum academic level three (degree level).

Be assessed as being competent to take a history, undertake a clinical assessment and make a diagnosis. For example, they must be able to carry out a comprehensive assessment of the patient’s physiological and/or psychological condition, and understand the underlying pathology and the appropriate medicines regime.

To undertake the preparation programme to prescribe as a nurse independent/supplementary prescriber the DH (2006)1 and the Nursing and Midwifery Council (2006)3 state that nurses and midwives should:

Have the ability to study at Level 3 (degree level).

Normally have at least three years’ post-registration clinical nursing experience, of which at least one year immediately preceding their application to the training programme should be in the clinical area in which they intend to prescribe.

Be assessed as being competent to take a history, undertake a clinical assessment and make a diagnosis. For example, they must be able to carry out a comprehensive assessment of the patient’s physiological and/or psychological condition, and understand the underlying pathology and the appropriate medicines regime.

3 Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife Prescribers. London: NMC

http://www.nmc-uk.org/Documents/Standards/nmcStandardsofProficiencyForNurseAndMidwifePrescribers.pdf

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8.2 Pharmacists

To undertake the preparation programme to prescribe as a pharmacist independent/supplementary prescriber the DH (2006)1 and the Royal Pharmaceutical Society of Great Britain (2006)4 state that pharmacists should:

Have the ability to study at Level 3 (degree level).

Have at least two years’ experience practicing as a pharmacist in a clinical environment, in a hospital or a community setting, following their pre-registration year after their graduation.

Be competent to prescribe in the area in which they will prescribe following training.

Demonstrate how they will develop their own networks for support, reflection and learning, including prescribers from other professions.

8.3 Allied Health Professionals

To undertake the preparation programme to become a supplementary prescriber the DH (2005)2 and the Health Professions Council (2005)5 state that allied health professionals should: Have the ability to study at Level 3 (degree level).

Normally have at least 3 years relevant post-qualification experience.

For Nurses, Midwives, Pharmacists and Allied Health Professionals seeking to prescribe as supplementary prescribers their competencies will be agreed by their medical mentor.

8.4 All Applicants For all applicants LCP needs to:

Approve the designated mentor, (for community practitioner nurse prescribers), and ensure the mentor has agreed to provide supervision for the duration of the programme. It is the responsibility of the applicant to identify this mentor who must be a practising community practitioner nurse prescriber.

Approve the designated medical practitioner, (for independent/supplementary prescribers), hereafter referred to as the medical mentor, and ensure the mentor is willing and able to

4 General Pharmaceutical council (2011) Pharmacist independent prescribing programme - learning outcomes and

indicative content London: GPhC. http://www.pharmacyregulation.org/pdfs/education/pharmacistindependentprescribinglearningoutcomesandindicativesyllabus.pdf

5 Health Professions Council (2005) Standards for Education and Training. London: HPC http://www.hpc-

uk.org/assets/documents/10000BCF46345Educ-Train-SOPA5_v2.pdf

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contribute to and supervise 12 days of learning in practice. It is the responsibility of the applicant to identify this mentor. See below for further requirements and guidance.

Verify that the member of staff’s post is one in which they will have the need and opportunity to act as a prescriber immediately upon qualifying, with an appropriate prescribing budget in place.

Ascertain whether the individual will need to prescribe for children and young people on qualification. If the individual is to prescribe for children and young people LCP must ensure only non medical prescribers with relevant knowledge, competence, skills and experience in treating children and young people should prescribe for children and young people. This is in compliance with NMC Circular 22/2007. http://www.nmc-uk.org/Documents/Circulars/2007circulars/NMC%20circular%2022_2007.pdf

Agree with the individual independent/supplementary non-medical prescriber the therapeutic area in which they will prescribe.

Support staff undertaking their course whilst training.

Support continuing professional development (CPD) opportunities related to their prescribing role on completion of the course. For more details contact training department or the Non Medical Prescribing Lead.

Provide written confirmation to the Higher Education Institution providing the training that the applicant has had a recent Criminal Records Bureau Check within the previous 2 years.

8.5 Mentors The mentor has a crucial and highly responsible role in teaching and assessing the non-medical prescriber and assuring competence in prescribing as identified by the Higher Education Institution providing the training. For community practitioner nurse prescribers the mentor:

Must be an experienced practicing community practitioner nurse prescriber. For independent/supplementary prescribers the medical mentor:

Has normally had at least 3 years medical, treatment and prescribing responsibility for a group of patients/clients in the relevant field of practice.

Is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post-graduate Training in General Practice Certificate or is a specialist registrar, clinical assistant or a consultant within NHS Kirklees.

For those non medical prescribers intending to prescribe for children and young people, should be experienced and competent in prescribing for children and young people to confirm the demonstration of competence for those wishing to prescribe for this age group on qualification.

Has some experience or training in teaching and/or supervising in practice

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Support for the Medical Mentor

The National Prescribing Centre (2005)6 has produced a guide to help doctors prepare for and carry out the role of the medical mentor. This guide can be found at: http://www.npc.nhs.uk/resources/designated_medical_practitioners_guide.pdf The University chosen for non-medical prescribing training may also provide medical mentor

training as well as support by the course leader.

8.6 Support from an Experienced Non Medical Prescriber

The Nursing and Midwifery Council states that practice assessment in Independent/Supplementary prescribing programmes is the legal responsibility of a designated medical practitioner who supports, teaches and supervises the student with, where possible, an experienced non medical prescriber who should ensure that the learning is applied to specific areas of practice. LCP supports this statement and will where possible seek to allocate an experienced non medical prescriber to assist non medical prescribing students apply their learning to their specific area of practice.

8.7 The Course

Course details can be obtained from the Higher Education Institution to which the applicant wishes to apply. See appendix L for course details within the Yorkshire and the Humber Strategic Health Authority.

Applicants should seek approval from LCP Non Medical Prescribing Lead before applying to undertake a prescribing course. Applicants should complete the ‘Approval to Undertake Non Medical Prescribing Course’ form (appendix K) and return, together with the university application form, to the Non Medical Prescribing Lead.

Once agreement to train as a non medical prescriber has been reached, the applicant must apply for study leave as per LCP organisational policy.

Without management agreement, study leave approval, an agreed mentor and approval from LCP Non Medical Prescribing Lead, application to the non medical prescribing courses must not be made.

9. QUALIFICATION AS A NON-MEDICAL PRESCRIBER

The following subsections describe the actions to be taken when an individual non-medical prescriber successfully completes their prescribing training by:

The individual non-medical prescriber

Their line manager

The Non-Medical Prescribing Lead or Community Services Pharmacy Manager

Human Resources by completion of a ‘Changes to Staff Contract Form’ with their line manager.

6 National Prescribing Centre (2005) Training Non-Medical Prescribers in Practice: A guide to help doctors prepare for

and carry out the role of designated medical practitioner. Liverpool: National Prescribing Centre

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9.1 Actions by the Individual Non-Medical Prescriber

Once the individual non-medical prescriber has successfully completed their prescribing training, they will be notified by the relevant Higher Education Institution. The Higher Education Institution also notifies:

The Nursing and Midwifery Council in the case of Nurses and Midwives

The Royal Pharmaceutical Society of Great Britain in the case of Pharmacists

The Health Professions Council in the case of Physiotherapists, Podiatrists, Radiographers, and Optometrists

The relevant regulatory body will then make the appropriate non-medical prescribing annotation on the register for the individual non-medical prescriber. Any costs associated with recording their qualification with the appropriate regulatory body will be met by the individual non-medical prescriber. The individual non-medical prescriber cannot legally prescribe until this annotation has been made.

Once the individual non-medical prescriber has received notification from the relevant regulatory body that an annotation has been made on the register they must provide a copy to:

Their line manager

LCP Non-Medical Prescribing Lead Before prescribing can take place the non-medical prescriber must:

Ensure their job description reflects their non-medical prescribing role. The job description MUST state that non medical prescribing is a requirement for the post. Ensure Human Resources have received a completion of a ‘Changes to Staff Contract Form’ from your line manager)

Be registered with the NHS Business Services Authority as follows:

Community Practitioner Nurse Prescribers (CPNP) must complete the CPNP intention to prescribe form (appendix E), and return to the Non Medical Prescribing Lead.

Independent/Supplementary Prescribers must complete the Independent Prescribing proforma, (appendix F), and return to the Non Medical Prescribing Lead.

9.2 Actions by the Line Manager

The line manager will ensure that they:

View a copy of the individual non-medical prescriber’s course results letter and notification of annotation to the register from the relevant regulatory body.

Ensure that the individual non-medical prescriber’s job description refers to their non-medical prescribing role. The Job description MUST state that Non medical prescribing is a requirement for the post. (Complete a ‘Changes to Staff Contract Form’ and submit to Human Resources).

Sign the completed independent prescribing proforma, (for independent/supplementary prescribers), or the CPNP intention to prescribe form, (for community practitioner nurse prescribers), to confirm that prescribing is a requirement of that non-medical prescriber’s role.

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9.3 Actions by the Non-Medical Prescribing Lead

LCP Non Medical Prescribing Lead will be responsible for:

Registering the non medical prescriber with the NHS Business Services Authority.

Entering the individual non-medical prescriber’s non-medical prescribing status on the non-medical prescribing data base.

Sending the independent prescribing proforma or CPNP intention to prescribe form to the newly qualified non medical prescriber.

Verifying that the prescribing qualification is annotated on the relevant regulatory body’s register as follows:

The Nursing and Midwifery Council at:

http://www.nmc-uk.org/Search-the-register/

The General Pharmaceutical council:

http://pharmacyregulation.org/

The Health Professions Council at:

http://www.hpcheck.org

9.4 Actions by Human Resources

Human Resources will be responsible for receiving and retaining on file the individual non-medical prescriber’s:

Changes to Staff Contract Form

Revised job description

Proof of CRB check if appropriate.

9.5 Employment of a Non-Medical Prescriber

When employing a non-medical prescriber that has been trained previously via a different organisation, the individual non-medical prescriber, their line manager, LCP Non Medical Prescribing Lead and Human Resources need to act in accordance with sections 9.1 to 9.4 of this policy. The individual MUST demonstrate they have completed the appropriate training and have their competencies assessed before applying to be registered as a non medical prescriber within LCP.

10. PRACTICING AS A NON-MEDICAL PRESCRIBER

Section 10 is divided into 2 main subsections each subsection dealing with different aspects of practice as a non-medical prescriber. The subsections are:

Support for non-medical prescribing (10.1)

Accountability and responsibility as a non-medical prescriber (10.2)

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10.1 SUPPORT FOR NON-MEDICAL PRESCRIBING

Provision of Support

The following table details the support for non-medical prescribing and the responsibilities of key personnel in the provision of this support:

Support Responsibility

Provision of a current BNF/NPF

The Non-medical prescribing lead /Medicines Management Team when editions are delivered - normally in March and September of each year. Nurse prescribers will be provided with an NPF when published -normally biannually in September.

Information relating to pharmacovigilance and other non-medical prescribing related updates

The Non-medical prescribing lead when notified.

Medicines information The Non-medical prescribing lead /Medicines Management Team.

Prescription pads Sourced by WYCSA and delivered to either Locality Bases or GP Practice. Non-medical prescribers collect from Locality Base.

Arrangement for cross boundary prescribing. Line manager to complete cross boundary agreement (appendix N) and forward to the organisations Non Medical Prescribing Lead.

Buddying for Non-Medical Prescribers

The DH (2006) recommends buddying for non-medical prescribers. LCP accepts this recommendation. Support from other professional colleagues is invaluable to non-medical prescribers, especially to those who are newly qualified. A buddy or mentor could be a doctor or another non-medical prescriber. LCP will encourage the engagement of newly qualified non-medical prescribers with buddying and furthermore will encourage doctors, non-medical prescribers and line managers to provide this role.

Supplementary Prescribing for Nurses, Midwives and Pharmacists

The DH (2006) notes that supplementary prescribing is a useful mechanism to enable new non-medical prescribers to develop their expertise and confidence in prescribing. LCP accepts this recommendation. Non-medical prescribers will be encouraged to prescribe following qualification as a supplementary prescriber to gain expertise and confidence and will also encourage doctors and managers to assist with this process.

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Clinical Supervision

The DH (2006) recommends that nurse and pharmacist independent prescribers should use clinical supervision arrangements or equivalent as an opportunity for reflection on prescribing, as well as other aspects of practice. LCP accepts this recommendation for all of its non-medical prescribers. The model of clinical supervision should be agreed at local level, taking into account;

clinical supervision is regular, protected time for facilitated, in-depth reflection on clinical practice. It aims to enable the supervisee to achieve, sustain and creatively develop a high quality of practice through means of focus, support and development. (Bond,1998).

Non-Medical Prescribers Network

It may be helpful for Non-Medical Prescribers and those undergoing training to form network links. Any issues can be discussed and concerns taken forward to the Medicines Management Committee which is accountable to the Board.

10.1.1 Prescribing Across Organisational Boundaries

The practice of some Non Medical Prescribers necessitates prescribing across the boundaries of local NHS organisations e.g. a Local Community Partnerships employed independent non medical prescriber may have to treat a patient within the hospital setting. Or it may occur through an honorarium contract between two organisations e.g. Tissue Viability nurses employed by a Secondary Care Trust who during the course of their duties are required to prescribe for patients in primary care using the local Primary Care Trusts’ prescription pads.

A cross boundary agreement template has been drawn up to ensure that the proper elements and commitment are in place to provide optimal services and addresses risk management issues from an accountability, responsibility, quality and resource perspective for the prescribing practice of these non-medical prescribers.

The non-medical prescriber must comply with any terms and conditions relating to ordering and/or receipt of prescription pads/treatment charts as outlined in the service receivers’ non medical prescribing policy/framework.

Any resources required specifically for the prescribing setting should be provided by the receiver organisation, for whom the individual is undertaking prescribing duties

If you will be required to prescribe outside this organisation’s boundaries you must discuss with the Non-medical Prescribing Lead at the relevant organisation

Calderdale and Huddersfield Foundation Trust Mike Culshaw Mid Yorks Hospitals Trust Philip Shaw South West Yorkshire Partnership NHS Foundation Trust Lynn Haygarth

In addition you must inform both LCP and the service receiver organisations’ Non-medical prescribing lead(s), and complete the proforma in appendix N.

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10.2 ACCOUNTABILITY AND RESPONSIBILITY AS A NON-MEDICAL PRESCRIBER

Professional Accountability and Responsibility

All non-medical prescribers must work within their own level of professional knowledge and competence, and must seek advice and make appropriate referrals to other professionals with different expertise. Non-medical prescribers are accountable for their own actions and must be aware of the limits of their knowledge and competence.

Nurses and Midwives must act according to:

Nursing and Midwifery Council (2008) Code of Professional Conduct: Standards of Conduct, Performance and Ethics. Available at: http://www.nmc-uk.org/Nurses-and-midwives/The-code/

Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife Prescribers. Available at: http://www.nmc-uk.org/documents/Standards/nmcStandardsofProficiencyForNurseAndMidwifePrescribers.pdf

Pharmacists must act according to:

General Pharmaceutical council (Sept 2010) Standards of conduct, ethics and performance. Available at: http://www.pharmacyregulation.org/pdfs/other/gphcstandardsofconductethicsandperflo.pdf

Allied Health Professionals must act according to:

Health Profession Council’s (2008) Standards of Conduct, Performance and Ethics. Available at: http://www.hpc-uk.org/assets/documents/10002367FINALcopyofSCPEJuly2008.pdf

Furthermore Allied Health Professionals must abide by their respective Standards of Proficiency as thus:

Physiotherapists

http://www.hpc-uk.org/assets/documents/10000DBCStandards_of_Proficiency_Physiotherapists.pdf

Podiatrists

http://www.hpc-uk.org/assets/documents/10000DBBStandards_of_Proficiency_Chiropodists.pdf

Radiographers

http://www.hpc-uk.org/assets/documents/10000DBDStandards_of_Proficiency_Radiographers.pdf

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All non-medical prescribers must abide by non-medical prescribing related policies and procedures as described in LCP Medicines Management Policy, A Guide to the Safe and Secure Handling of Medicines7

Finally should independent/supplementary prescribers seek to prescribe additional items not approved in their independent prescribing proforma, they should complete an additions form, (appendix G), which should be submitted to the Non Medical Prescribing Lead

10.2.1 Vicarious Liability/ Indemnity Insurance

Where an employed nurse, midwife, pharmacist or allied healthcare professional is appropriately qualified and prescribes within their agreed area of practice, as part of their professional duties with the consent of the employer, LCP is vicariously liable for their acts and omissions.

For Non Medical Prescribers who are directly employed by GPs or other commissioned services, the responsibility for vicarious liability/indemnity insurance lies with the individual prescriber and their employer.

It is the personal responsibility of ALL Non Medical Prescribers to ensure arrangements for vicarious liability/indemnity insurance provides a suitable level of protection for their intended prescribing practice.

10.2.2 Continuing Professional Development (CPD)

LCP accepts the recommendation from the DH (2006) that non-medical prescribers must keep up to date with evidence and best practice in the management of the conditions for which they prescribe and in the use of the relevant medicines.

Furthermore the respective regulatory bodies all stipulate CPD requirements and non-medical prescribers must fulfill these obligations in terms of both their prescribing role and their wider practice. Therefore LCP requires each non-medical prescriber to use CPD as a means of enhancing their professional knowledge and competence related to their non-medical prescribing role.

To assist non-medical prescribers review their competency, the National Prescribing Centre have produced a series of competency frameworks which can be found at the following link:

http://www.npc.nhs.uk/publications_resources.php?textfield=competency+frameworks&datepicker=Search+by+Date&select=%3Aall&imageField.x=10&imageField.y=16

LCP encourages non-medical prescribers to use these frameworks to review their competence in non-medical prescribing.

CPD takes a variety of forms8. Examples of how individual non-medical prescribers may undertake CPD include:

7 The Medicines Management Policy can be found at: http://www.kirklees.nhs.uk/your-health/medicines-

management/locala-policiesguidelines/

8 Bramley, I (2006) Continuing Professional Development: what is it and how do I get it?

Nurse Prescribing, Volume 4, Number 3, Pages 117 -121

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Attendance at external formal events such as conferences or events delivered by Universities

Attendance at LCP study events

Attendance at non-medical prescribing network meetings

Buddying

Time spent with medical colleagues on relevant prescribing activities.

Reviewing their competence using the National Prescribing Centre competency frameworks

Undertaking audit

CPD remains the responsibility of the non-medical prescriber. It is the responsibility of the non-medical prescriber to keep up to date in their field of practice and any changes in national and local policy. Individual non-medical prescribers will negotiate their CPD requirements using LCP performance and KSF development review process.

The line manager should ensure that CPD is encouraged to maintain competence in their clinical area.

10.2.3 Performance and KSF Development Review

The Performance and KSF Development review will facilitate non-medical prescribing in two key ways:

The identification of individual non-medical prescribers suitable to train as non-medical prescribers.

The ongoing review of performance related to non-medical prescribers once trained. Non-medical prescribers should include prescribing as part of their review annually in order to continue in this role. Once such a review has been undertaken, non-medical prescribers should notify LCP Non-Medical Prescribing Lead and the date should be recorded on the non-medical prescribing database.

Annual Declaration of Competence Each year, as part of their annual review, all Non-Medical Prescribers will be asked to declare ongoing competence. Details will be recorded within the individual’s IPR.

10.2.4 Audit

Audit is an essential element of the clinical governance of non-medical prescribing. Within the organisation audit will operate at two levels:

Organisational level - LCP will audit non-medical prescribing as a means of determining the standard of current non-medical prescribing practice and future service requirements.

Non-medical prescriber level - non-medical prescribers will audit their own prescribing practice as a means of demonstrating its quality. However non-medical prescribers can fulfil such audit requirements by participating in audit being undertaken within their prescribing team.

10.2.5 Change of Role Within the Organisation

Non-medical prescribers may change their role within an organisation as a result of:

Career development

Service redesign

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Succession planning The non-medical prescriber should notify the Non Medical Prescribing Lead or Community Services Pharmacy Manager of any role change so that LCP database of prescribers can be amended to reflect the non-medical prescriber’s new prescribing area.

If a non-medical prescriber moves to another area of practice they must consider the requirements of their new role and only ever prescribe within their own level of knowledge and competence.

Existing prescribing competence. If a non-medical prescriber moves to a new area, they can prescribe within their expertise gained in their previous prescribing area, for example if from a dermatology background the non-medical prescriber can prescribe within this area for patients with these conditions if this is appropriate within the new team.

Continuing professional development (CPD) needs. The non-medical prescriber and their new manager must work in partnership to identify individual non-medical prescribing CPD needs within their new area of practice. Individual CPD needs will determine the length of time it takes for a non-medical prescriber who has moved practice areas, to feel confident and competent to prescribe in their new area of practice. This must be incorporated into the Performance and KSF Development Review process. The non-medical prescriber is responsible for attaining the knowledge and competence that will give them the skills to apply the principle of prescribing in a new area. It would be good practice to undertake reflective supervision with the prescribing team in practice, which should include the lead clinician (mentor).

Independent prescribing. Before independent prescribing can take place a new independent prescribing proforma (see appendix F) must be completed and submitted to the Non Medical Prescribing Lead. The non-medical prescribing data base will then be amended by LCP Non Medical Prescribing Lead or Community Services Pharmacy Manager to reveal the individual non-medical prescriber’s new prescribing area.

Supplementary prescribing. Before supplementary prescribing can take place the non-medical prescriber and the independent prescriber involved must be satisfied that the individual non-medical prescriber has achieved the necessary knowledge and competence in their new area of prescribing practice. A clinical management plan must then be completed as required by the DH (2005) (see appendix H). For those only prescribing on a supplementary basis, the non-medical prescribing data base will be amended by LCP Non Medical Prescribing Lead or Community Services Pharmacy Manager to reveal the individual non-medical prescriber’s new prescribing area.

10.2.6 Return to Practice as a Non-Medical Prescriber

A non-medical prescriber may complete return to practice requirements laid down by their regulatory body and wish to resume non-medical prescribing. The individual non-medical prescriber and their line manager will need to:

Assess prescribing competence - this will be undertaken using LCP performance and KSF development review process. The individual non-medical prescriber’s personal portfolio will also be of use in determining existing competence and

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continuing professional development needs. Individuals will be encouraged to review their prescribing competency using the National Prescribing Centre competency frameworks detailed in section 10.2.2 of this policy. The non-medical prescriber and new manager must work in partnership to identify individual non-medical prescribing CPD needs within their new area of practice.

Continuing professional development (CPD) needs - individual CPD needs will determine the length of time it takes for a non-medical prescriber who has returned to practice to feel confident and competent to prescribe in their area of practice. This must be incorporated into the Performance and KSF Development Review process. The non-medical prescriber is responsible for attaining the knowledge and competence that will give them the skills to re-apply the principle of prescribing. It would be good practice to undertake reflective supervision with the prescribing team in practice, which should include the lead clinician (mentor).

Independent prescribing - before independent prescribing can take place an independent prescribing proforma, (appendix F), must be completed and submitted to the Non Medical Prescribing Lead. The non-medical prescribing data base will then be amended by LCP Non Medical Prescribing Lead or Community Services Pharmacy Manager to show the individual non-medical prescriber’s prescribing area following return to practice.

Supplementary prescribing - before supplementary prescribing can take place the non-medical prescriber and the independent prescriber involved must be satisfied that the individual non-medical prescriber has achieved the necessary knowledge and competence in their new area of prescribing practice. A clinical management plan must then be completed as required by the DH (2005) (see appendix H). For those only prescribing on a supplementary basis, the non-medical prescribing data base will be amended by LCP Non Medical Prescribing Lead or Community Services Pharmacy Manager to reveal the individual non-medical prescriber’s prescribing area following return to practice.

10.2.7 Leaving a Non-Medical Prescribing Role Within LCP

The following actions must be undertaken when a non-medical prescriber leaves the organisation.

The Non-Medical Prescriber should:

Return all unused FP10 prescription forms for recording and shredding, to the Service Manager’s PA or service secretary from whom they would normally order pads.

GP practice staff must return all unused FP10 prescription forms to the Practice Manager who will then return them to WYCSA.

All staff should notify the Non Medical Prescribing Lead or Community Services Pharmacy Manager to be de-registered with the NHS Business Services Authority.

The Line Manager must:

Notify, or ensure that the Non Medical Prescribing Lead or Community Services Pharmacy Manager has been notified, so that the non-medical prescriber can be de-registered with the NHS Business Services Authority.

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Notify Human Resources.

Ensure all unused FP10 prescription forms are returned to the Service Managers PA or service secretary for recording and secure shredding.

For GP practice staff unused FP10 prescription forms must be returned to WYCSA.

LCP Non-Medical Prescribing Lead or Community Services Pharmacy Manager must:

Remove the individual non-medical prescriber from the non-medical prescribing database.

Notify the NHS Business Services Authority and WYCSA Support Services to request the non medical prescriber is removed from their databases.

11. PRESCRIBING PRACTICE

11.1 Principles of Prescribing

The following principles should be applied to all prescribing:

Ensure that the treatment prescribed is both safe and cost effective and meets the clinical needs of the patient.

Prescribing should follow the organisation’s formularies and guidelines where possible.

Patients requiring treatments should have their needs continually assessed and prescriptions issued should reflect assessed need.

If requested to prescribe large quantities for patients travelling abroad, prescribers should be aware that a patient ceases to be registered with a GP after 3 months absence from the country.

More information on prescribing principles is available in LCP Medicines Management Policy.

11.2 What Can be Prescribed by Non-Medical Prescribers?

Community Nurse Practitioners who have completed the necessary training can prescribe only items listed in the Nurse Prescribers’ Formulary for Community Practitioners (NPF). This can be found in the appendix of the British National Formulary (BNF) and in part XVIIB(i) of the Drug Tariff.

Nurse Independent Prescribers who have completed the necessary training programme can prescribe any licensed or unlicensed medicine for any medical condition, including any controlled drug listed in schedules 2-5 for any medical condition within their competence, except diamorphine, cocaine and dipipanone for the treatment of addiction (nurse independent prescribers are able to prescribe other controlled drugs for the treatment of addiction) (Dept of Health, 2012) The disease management areas that prescriptions are to be issued for must have been agreed and approved prior to any prescribing taking place. See section 9.1.

Pharmacist Independent Prescribers can also prescribe any licensed or unlicensed medicine for any medical condition including any controlled drug listed in schedules 2-5 for

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any medical condition within their competence, except diamorphine, cocaine and dipipanone for the treatment of addiction (pharmacist independent prescribers are able to prescribe other controlled drugs for the treatment of addiction). (Dept of Health, 2012) See section 9.1.

Supplementary prescribing was introduced in April 2003 for nurses and pharmacists. It was extended to physiotherapists, chiropodists/podiatrists, radiographers and optometrists in May 2005.

Supplementary prescribing is a voluntary prescribing partnership between the independent prescriber (doctor or dentist) and supplementary prescriber, to implement an agreed patient-specific clinical management plan (CMP), with the patient’s agreement.

Following agreement of the CMP, the supplementary prescriber may prescribe any medicine for the patient that is referred to in the plan, until the next review by the independent prescriber. There is no formulary for supplementary prescribing, and no restrictions on the medical conditions that can be managed under these arrangements. Supplementary Prescribers can prescribe Controlled Drugs and unlicensed medicines in partnership with a doctor, where the doctor agrees within a patient’s CMP

Non medical prescribers may prescribe only:

For patients they have personally assessed.

Using their own prescription pad or personalised computerised prescriptions.

With an agreed Clinical Management Plan (CMP) for Supplementary Prescribers

Only as described in the formulary for community nurse practitioner prescribers.

Within their own agreed level of professional competence and expertise

No more than six repeat prescriptions, and only for patients they have reviewed within the last six months

Non medical prescribers may not prescribe:

Outside their own agreed areas of competence and expertise.

For themselves, family, friends or colleagues.

On another prescribers prescription pad

On behalf of another person

To replace an item that has been administered to a patient using GP or clinic stock items.

For patients in GP practices not covered within LCP or which a prescribing budget has not been agreed.

For patients they believe may have received a recent prescription for the same product but have been unable to assess the relevant documentation.

11.3 Prescribing Unlicensed Medicines From 21st December 2009 legislation changed to allow nurse and pharmacist independent prescribers to prescribe unlicensed medicines for their patients, on the same basis as doctors and dentists (and supplementary prescribers if part of a Clinical Management Plan9).

9 The status of unlicensed medicines must be recorded on the Clinical Management Plan.

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Medicines prescribed should be licensed, and licensed for the indication for which they are to be prescribed. Prescribing an unlicensed medicine increases the clinical and legal liabilities on the prescriber. Before prescribing an unlicensed medicine the prescriber must ascertain that a reasonable body of medical opinion would support the use of the product in that way (or expert guidelines support its use), and that there is no suitable licensed alternative. In all cases of “unlicensed” prescribing within LCP, the prescriber is fully accountable and liable for their actions and must be satisfied that:

An alternative licensed treatment would not meet the patient’s needs.

The prescribed drug and indication is within their area of competence.

There is satisfactory evidence or experience of safety in prescribing the medication in the circumstances faced.

The patient or carer understands that they are being prescribed an unlicensed medication, understands the implications of this, and gives consent

Legal responsibility for any prescription lies with the person who signs the prescription. It is the responsibility of prescribers to be aware of the license status of products they prescribe. Patients MUST be informed of the license status and their consent gained. This discussion must be documented in the patient’s record. Important Note: In the case of both unlicensed and “off label” prescribing it is the personal responsibility of each prescriber to ensure they have a suitable level of indemnity protection for their prescribing practice.

11.4 Prescribing Licensed Medicines for use outside their Product License -“Off- Label” Prescribing Independent Prescribers may prescribe medicines outside their licensed indications (off-label) where it is accepted clinical practice. In doing so, they are fully accountable and liable for their actions, and should comprehensively document their reasons for prescribing. Supplementary prescribers may prescribe medicines outside their license if they are included in relevant Clinical Management Plans. Supplementary prescribers are also fully accountable and liable for such prescribing and should comprehensively record their reasons for prescribing. Community Practitioner Nurse Prescribers (CPNPs) may not prescribe medicines off-label, except for nystatin oral suspension for neonates under 1 month of age, where the diagnosis of oral thrush is absolutely clear. In these circumstances, it should be prescribed at the dose recommended in the BNF for Children. This exception is without precedent and there are no other exceptions for off-label prescribing by CPNPs.

In all cases of “off-label” prescribing within LCP, the prescriber is fully accountable and liable for their actions and must be satisfied that:

An alternative licensed treatment would not meet the patient’s needs.

The prescribed drug and indication is within their area of competence.

There is satisfactory evidence or experience of safety in prescribing the medication in the circumstances faced.

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The patient or carer understands that they are being prescribed an unlicensed medication, understands the implications of this, and gives consent.

Important Note: In the case of both unlicensed and “off label” prescribing it is the personal responsibility of each prescriber to ensure they have a suitable level of indemnity protection for their prescribing practice.

11.5 Mixing Medicines in Clinical Practice

Mixing of Medicines

From 21st December 2009 legislation changed to allow pharmacist independent prescribers and nurse independent prescribers to mix medicines to produce an unlicensed medicine, where the “mixing of medicines” means the combining of two or more medicinal products together for the purposes of administering them to meet the needs of a particular patient. In a registered pharmacy, hospital, care home service or health centre, legislation already enables medicines to be mixed, by or under the supervision of a pharmacist.

A supplementary prescriber can mix medicines to produce an unlicensed medicine but only where the mixing of medicines forms part of the clinical management plan for an individual patient.

The mixing of medicinal products to produce an unlicensed medicine can also be undertaken by another person acting on the written directions of a pharmacist independent prescriber, a nurse independent prescriber or by a supplementary prescriber where the mixing of the medicines forms part of the clinical management plan for an individual patient.

The mixing of drugs should be avoided unless essential to meet the needs of the patient, and that those involved in both the prescribing and actual mixing should be competent to do so and take full professional and clinical responsibility for their actions. In addition such actions must be within the governance structures and guidance of the employing authority and of the relevant statutory bodies.

The Medicines (Exemptions and Miscellaneous Amendments) Order 2009 SI 3062: www.opsi.gov.uk/si/si2009/uksi_20093062_en_1

Mixing of Controlled Drugs

Nurse and pharmacist independent prescribers, as well as supplementary prescribers acting in accordance with the terms of a clinical management plan for an individual patient, are authorised to mix any drugs listed in schedules 2-5 prior to administration. Persons acting in accordance with the written directions of a nurse or pharmacist independent prescriber or, a supplementary prescriber when acting in accordance with the terms of a clinical management plan, are authorised to mix drugs listed in schedules 2-5.

Nurse and pharmacist independent prescribing changes announced

11.6 Controlled Drugs

All non-medical prescribers must abide by LCP policy for Controlled Drugs. This can be found on the NHS Kirklees website under the Locala section.

With effect from 23 April 2012, there have been amendments to the Misuse of Drugs Regulations which mean that nurse and pharmacist independent prescribers can now

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prescribe controlled drugs. This and other changes are summarised in the link below. A brief summary also follows.

Nurse and pharmacist independent prescribing changes announced

Nurse independent prescribing of Controlled Drugs

Current restrictions are removed to enable nurse independent prescribers to prescribe any

controlled drug listed in schedules 2-5 for any medical condition within their competence,

except diamorphine, cocaine and dipipanone for the treatment of addiction (nurse

independent prescribers are able to prescribe other controlled drugs for the treatment of

addiction). Nurse independent prescribers are able to requisition controlled drugs and are

authorised to possess, supply, offer to supply and administer the drugs they are able to

prescribe. Persons acting in accordance with the directions of a nurse independent

prescriber are authorised to administer any schedule 2-5 drugs that the nurse can prescribe.

Pharmacist independent prescribing of Controlled Drugs

Pharmacist independent prescribers are able to prescribe any controlled drug listed in

schedules 2-5 for any medical condition within their competence, except diamorphine,

cocaine and dipipanone for the treatment of addiction (pharmacist independent prescribers

are able to prescribe other controlled drugs for the treatment of addiction). Pharmacist

independent prescribers are able to requisition controlled drugs and are authorised to supply

or administer the drugs they are able to prescribe. The existing authorities for pharmacists to

possess, supply and offer to supply schedule 2-5 controlled drugs remain. Persons acting in

accordance with the directions of a pharmacist independent prescriber are authorised to

administer any schedule 2-5 drugs that the pharmacist can prescribe.

Patient Group Directions and Controlled Drugs

Patient Group Directions (PGD) are not a form of prescribing, but these amendments to the

Misuse of Drugs Regulations also make changes to the authorities that nurses and

pharmacists possess when acting in accordance with a PGD. Nurses and pharmacists

working under a PGD are now authorised to supply, or offer to supply, diamorphine and

morphine where administration of such drugs is required for the immediate and necessary

treatment of sick or injured persons (excluding the treatment of addiction). This removes the

restrictions whereby a nurse could only supply diamorphine under a PGD for the treatment

of cardiac pain in patients admitted to a coronary care unit or an accident and emergency

department of a hospital. The existing authorities for registered health professionals working

in accordance with a PGD to supply and/or administer all drugs in schedules 4 and 5 of the

2001 regulations remain.

Note: The changes relating to prescribing and mixing of controlled drugs by nurse and

pharmacist independent prescribers also apply to midwives who are registered as nurse

independent prescribers. The amendments relating to PGDs also apply to midwives who are

registered nurses.

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The Home Office circular, which provides full details of the changes being made, is available

at: http://www.homeoffice.gov.uk/about-us/corporate-publications-strategy/home-office-

circulars/circulars-2012/009-2012/

11.7 Issuing Prescriptions

An independent prescriber can only issue a prescription for a patient whom they have personally assessed for care and should only write prescriptions on a prescription pad bearing their own unique prescriber number or on an in-patient drug chart. A supplementary prescriber can only issue a prescription for a patient who has an agreed clinical management plan and should only write prescriptions on a prescription pad bearing their own unique prescriber number. Staff qualified to prescribe should not issue prescriptions on behalf of colleagues. Accountability for the prescription rests with the non-medical prescriber who has issued the prescription. Non-medical prescribers within LCP can only prescribe for patients of a GP contracted with LCP and for whom the GP has responsibility under the NHS. This includes patients temporarily registered with a GP. The exceptions are non medical prescribers working in Walk-In-Centres or practices who routinely see non-registered patients, such as the Equitable Access Centre for Dewsbury, or where a cross boundary prescribing agreement is in place - see section 10.1.1.

11.8 Prescription Writing

For further guidance refer to Prescription writing: British National Formulary. For information about prescription form types refer to appendix E of LCP Medicines Management Policy.

Writing must be clear and legible using indelible ink

A line should be inserted between each item being prescribed

Space should be blocked out using a ‘Z’ line

Prescriptions may be computer generated if this facility is available

The prescription must be completed with the following details:

(1) Patient Details:

Full Name (forename and surname)

Full Address (including postcode)

Age & Date of Birth should preferably be stated. This is a legal requirement when prescribing Prescription Only Medicines to children less than 12 years of age.

(2) Details of the items to be supplied:

Name, form and strength

Dose and frequency

Directions

Quantity

Signature & date

Code for the practice where the patient is registered

Non medical prescribers correct contact telephone number

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The names of medicines should be written clearly using approved generic titles, wherever possible.

Prescribers working for more than one organisation or practice will need separate prescription pads corresponding to the organisation or practice for which they are to prescribe.

Prescribers employed by LCP and working across different practices can use one prescription pad, but must add the relevant practice number for each patient for whom they prescribe.

It is the responsibility of the non medical prescriber and employer to ensure the security of the prescription pads at all times.

11.9 Reporting Arrangements and Record Keeping

All Non-Medical Prescribers are required to keep records, which are unambiguous and legible. Prescription details must be entered immediately into the prescriber’s patient records / parent-held child health records / professional record / medication sheet, as appropriate. The record of all non-medical prescriptions should clearly indicate: • Date • Name of prescriber • Name and form of item prescribed • Dosage schedule • Route of administration • Quantity (where possible) and frequency of application (for topical)

Advice given

GP records should be amended as soon as possible. Notification of any prescription must be forwarded to the relevant GP within 48 hours. In some situations it may be necessary to advise the GP immediately of the prescription. In these circumstances the action should also be documented in the records.

The GP may be informed:

In person

By telephone

By secure fax

By Nurse Prescribing Communication Sheet

By other local protocols agreed with the GPs

If a prescription is given to a patient from another community nurses’ caseload, the caseload holder must be informed within 24 hours where possible, but within 48hours of writing the prescription. The caseload holder may be informed by any of the routes above, or by e-mail.

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11.10 Handling Adverse Drug Reactions (ADRs) and Medication Incidents

The Non-Medical Prescriber must report any medication incidents in accordance with LCP incident reporting policy. If a patient suffers a suspected adverse drug reaction to a prescribed, over the counter or herbal medicine, the adverse drug reaction should be reported via the Yellow Card Scheme. Yellow cards are available electronically, together with instructions on how to complete the form, which are detailed on the MHRA website; http://yellowcard.mhra.gov.uk/

Whilst electronic submission of forms is encouraged, yellow cards are also available at the back of the BNF. Suspected adverse reactions to medicines prescribed by another prescriber should be reported and ideally discussed with the prescriber.

All ADRs should be recorded in the patient’s notes and GP record.

12. GENERAL GUIDANCE

12.1 Recording and Security of Prescription Forms

Prescription pads are controlled stationary and MUST be obtained, stored securely, and issued only to the individual prescriber named on it. Guidelines for Good Practice in the Safe and Secure Handling of Prescription Forms for Non Medical Prescribers are detailed in appendix M.

A permanent record of prescription pad serial numbers must be made when prescription pads are received and issued.

It is also good practice to record the first and last serial number of an in-use pad at the end of the working day. Such steps will identify any prescriptions that are lost or stolen overnight.

Blank prescription forms must never be pre-signed.

Prescribers must only use their own prescription pads.

It is the responsibility of each prescriber to ensure the security of his/her prescription pads at all times. When on duty, the prescriptions must remain in the possession of the prescriber at all times

When travelling between patients the prescription pad must not be visible and must be locked in the car boot (within the nursing bag for nurses).

The nursing bag and prescription pad must always be removed from the car, when the car is unattended (apart from exceptional circumstances where the risks of taking out the bag are deemed to be greater).

On leaving the organisation or changing roles where prescribing is not required, ALL remaining prescription pads MUST be returned to the Service Managers PA/service secretary for recording and secure destruction. They should be annotated as returned on the individual non medical prescribers’ prescription record log and signed out of the log when shredded.

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Practice employed staff must return unused prescription forms to the Practice Manager or GP Prescribing Lead.

12.2 Ordering and Supply of Prescriptions

The non medical prescriber will receive notification from the Non Medical Prescribing Lead or Community Services Pharmacy Manager when the registration process is complete and prescribing can commence.

The non medical prescriber can commence to prescribe electronically with immediate effect. The non medical prescriber’s details must be added to the clinical system prior to issuing electronic prescriptions to patients. This is to ensure any prescribing undertaken is attributable to the individual prescriber and that the regulations for writing prescriptions are complied with.

Hand Held Prescription Pads

Non medical prescribers should routinely generate electronic prescriptions. However in the event of there being a need to prescribe using hand held pads;

For GP practice staff requests for hand held prescription pads should be sent to WYCSA by the non medical prescriber on a PN FP10 order form. (This is available from WYCSA on request). The order form can either be faxed or posted to WYCSA at Broad Lea House as instructed on the form.

The prescription pads will be returned to the individual non medical prescriber at the GP practice via the GP post bag system.

Staff requests for hand held prescription pads should be sent to the relevant Service Manager’s PA/service secretary by the non medical prescriber on an FP10/C form (appendix I). The form can be sent by post, email or fax, but MUST go via the Service Manager’s PA/service secretary.

Staff will be notified when the prescription pads arrive and asked to collect in person from the relevant locality base.

For pharmacist and allied health care professional prescribers. Currently this cohort of prescribers use electronically generated prescriptions. However in the event of hand held pads being required, consent should be gained from the line manager and a request submitted using the order form FP10/C, (see appendix I), to the relevant Service Managers PA or service secretary. See section 12.4.

The pads will be available to collect from the relevant Locality base when notified.

Ordering, receipt, distribution and destruction of hand held prescription pads for employed Non-Medical Nurse Prescribers is the responsibility of the relevant Service Managers Personal Assistants (PA).

12.3 Requirements for Handling Prescription Pads at Locality Bases

Each Locality Base MUST have limited access secure lockable storage for prescription pads. The keys to this location must be kept by the Service Managers PA, or designated deputy and the keys securely stored at the end of each working day.

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Each non-medical prescriber must have an individual file within the secure location containing a prescription record sheet, (appendix J). This will allow the following information to be recorded for audit and security:

Non Medical Prescribers prescribing code number

Base

Contact telephone number

Sample signature of non medical prescriber

Date and number of prescription pads ordered

Name of person ordering

Date prescription pads received

Quantity of pads received

To/from serial numbers of prescriptions received

Date prescriptions taken for use

To/from serial numbers of prescriptions taken for use

Signature and name of person removing from file

Signature of non medical prescriber collecting prescriptions.

The to/from serial numbers of all prescriptions returned for destruction must also be entered on the sheet as ‘returned for destruction’ and signed by the Service Managers PA when securely shredded.

12.4 Ordering Prescription Pads

Requests for a supply of prescription pads should be submitted directly to the appropriate Service Managers PA. This is done by completing a prescription order form (appendix I). Orders can be sent by post, email or fax, but MUST go via the Service Manager’s PA.

The nominated PA will record the order details on the prescription record sheet (see appendix J) this will be placed in the named individual’s folder and the order forwarded to WYCSA. This may be done electronically, fax or by post.

No more than 2 pads should be ordered for each non medical prescriber. Requests for quantities which exceed this amount should be addressed to the Non Medical Prescribing Lead by the PA before the order is placed.

WYCSA will order the prescription pads from the supplier using the details supplied on the submitted prescription order form.

When the ordered prescription pads are received by WYCSA they will:

Check the order against the delivery note and record the prescription pad details and serial numbers.

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Log out the prescription pads to the non medical prescriber at the relevant Locality Base. The prescription pads will be placed in a sealed envelope along with a copy of the delivery note, and addressed for the attention of the named Service Managers PA. The envelopes must be stored securely until collected by the authorised transport driver.

Ensure the authorised transport driver checks and agrees the number of envelopes against the acknowledgement slip. An acceptance signature will be provided by the driver prior to leaving WYCSA with the envelopes.

When delivering to Locality Bases the authorised transport driver will:

Hand the appropriate envelope to the named individual (or delegated deputy). If neither is available, the receptionist on duty can accept the envelope and hand to the Service Managers PA/service secretary (or deputy) in person. A signature must be provided to the transport driver against the acknowledgement slip as proof of delivery.

Return the signed log sheet to WYCSA to complete the audit trail.

The Service Managers PA/service secretary will:

Accept the relevant envelope and sign against the appropriate entry on the drivers acknowledgement slip. If the PA is unavailable to personally accept delivery of the envelope, a designated named deputy should be available to accept delivery on behalf of the PA.

The prescription pads should be checked against the copy delivery note and the ‘to /from’ serial numbers annotated onto the individual non medical prescribers prescription record form. The delivery note should be retained for 2 years.

The prescription pads MUST be securely stored in the designated file until the non medical prescriber collects the pads in person.

The non medical prescriber MUST bring evidence of identity with them and sign for the prescription pads when collecting.

It is not possible to collect another prescriber’s prescriptions on their behalf.

12.5 Loss or Suspected Theft of Prescriptions

Community Nurse Prescribers

In the event of loss or suspected theft, the nurse must report this immediately to:

Relevant Service Manager – who will inform:

WYCSA Support Services (Broad Lea House) – 01484 464415

The police on 0845 606 0606 or Huddersfield 01484 436659

The nurse should inform the GP (where appropriate) as soon as he/she is aware of missing prescriptions.

The prescriber must complete the organisation’s incident reporting form.

Information required will be the prescribers NMC number and the serial numbers for the prescriptions which have been lost/stolen (from/to). The serial numbers will have been recorded in either the back of the diary or on the WYCSA prescription record form.

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Other Non-Medical Prescribers

In the event of loss or suspected theft, the non medical prescriber must report this immediately to their line manager who will inform WYCSA Support Services, details as above, and complete the relevant documentation.

WYCSA will require the prescriber’s details and the serial numbers for the prescriptions which have been lost / stolen (from/to).

Following loss / theft of prescription forms the prescriber will be requested by WYCSA Support Services to prescribe and sign all scripts in red for a period of 1 month. This information will also be provided to pharmacists within 24 hours, where possible. The NHS Business Services Authority (NHS BSA) is also notified.

13. Equality Impact Assessment

This policy has been assessed for the potential adverse impact as set out in Appendix C. On initial screening the policy has not identified any adverse impact.

14. Training Needs Analysis

In order to ensure that policies, guidelines and protocols are introduced and work effectively, there is a need to provide adequate training and instruction. As a result the author of this document has carried out a training needs analysis which has identified the staff who require training, the methodology of training delivery and the frequency that the training will be provided. The policy author must ensure that the details of this training are passed to the Training and Education Team and where necessary, this will then be included in LCP Training Prospectus.

15. Monitoring Compliance with this Policy

To be monitored by the Medicines Management Team.

16. References

Department of Health (2006) Improving Patients Access To Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England. London: DH

Department of Health (2005) Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England: a guide for implementation. London: DH

Department of Health (2012) Nurse and pharmacist independent prescribing changes announced. London DH.

Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife Prescribers. Available at: http://www.nmc-uk.org/documents/Standards/nmcStandardsofProficiencyForNurseAndMidwifePrescribers.pdf

General Pharmaceutical council (2011) Pharmacist independent prescribing programme - learning outcomes and indicative content London: GPhC. http://www.pharmacyregulation.org/pdfs/education/pharmacistindependentprescribinglearningoutcomesandindicativesyllabus.pdf

Health Professions Council (2005) Standards for Education and Training. London: HPC http://www.hpc-uk.org/assets/documents/10000BCF46345Educ-Train-SOPA5_v2.pdf

National Prescribing Centre (2005) Training Non-Medical Prescribers in Practice: A guide to help doctors prepare for and carry out the role of designated medical practitioner. Liverpool: National Prescribing Centre

Bramley, I (2006) Continuing Professional Development: what is it and how do I get it? Nurse Prescribing, Volume 4, Number 3, Pages 117 -121

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The Medicines (Exemptions and Miscellaneous Amendments) Order 2009 SI 3062: www.opsi.gov.uk/si/si2009/uksi_20093062_en_1

The British National Formulary

Appendix A

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Definitions

Community Practitioner Nurse Prescribers Health visitors, district nurses and specialist practitioner/specialist community public health nurses holding the NMC V100 qualification and registered nurses holding the V150 qualification may prescribe independently from a limited formulary; the Community Nurse Prescribers Formulary (NPF). This consists of dressings, appliances and some medicines, including a small number of prescription only medicines. Training for prescribing from this formulary is now incorporated into the Specialist Practice training for all specialist practitioners with a proviso that there is a clinical need. Independent Prescribing

Independent prescribing is prescribing by a practitioner responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions, and for decisions about the clinical management required, including prescribing. These practitioners are not restricted by a separate formulary but can prescribe any licensed or unlicensed medication for any condition, including most controlled drugs. The limit for any prescribing is the scope of the prescriber’s professional practice as defined by their professional registering body; the registered prescriber may only prescribe within their own level of experience, knowledge and competence; within the scope of their professional role. Supplementary Prescribing Supplementary prescribing is a voluntary partnership between an independent prescriber, (who must be a doctor or a dentist), and a supplementary prescriber, who has completed necessary training, to implement an agreed patient specific clinical management plan (CMP), with the patient’s agreement. It is a legal requirement for a CMP to be in place before supplementary prescribing can begin. The Department of Health has published guidance in creating a CMP: http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Supplementaryprescribing/DH_4123030 Supplementary prescribers can prescribe any medicine, including controlled drugs, as long as this is in line with the CMP agreed with the patient and the doctor. The supplementary prescriber will provide ongoing clinical management of patient care through review and revision of medication management within an agreed clinical plan. A supplementary prescriber is not an independent prescriber and cannot initiate a treatment plan.

WYCSA

West Yorkshire Central Services Agency

Appendix B

31

Key Stakeholders Consulted/involved in the development of the document

Stakeholders name and designation Key Participant

Yes/No

Feedback requested Yes/No

Feedback accepted Yes/No

Lucianne Ricketts – Non Medical Prescribing Lead - Locala

Yes Yes Yes

Medicines Management Committee - Locala Yes Yes Yes

Catherine Smyth – Professional Development Lead (Nursing)

Yes Yes Yes

Gwen Ruddlesdin – Head of Integrated Governance and Quality

Yes Yes Yes

Karen McLean - WYCSA No Yes Yes

.

Appendix C

32

Equality Impact Assessment Tool

To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.

Insert Name of Policy / Procedure

Yes/No Comments

1. Does the policy/guidance affect one group less or more favourably than another on the basis of:

Race No

Ethnic origins (including gypsies and travellers)

No

Nationality No

Gender No

Culture No

Religion or belief No

Sexual orientation including lesbian, gay and bisexual people

No

Age No

Disability - learning disabilities, physical disability, sensory impairment and mental health problems

No

2. Is there any evidence that some groups are affected differently?

No

3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

NA

4. Is the impact of the policy/guidance likely to be negative?

No

5. If so can the impact be avoided? NA 6. What alternatives are there to achieving the

policy/guidance without the impact? NA

7. Can we reduce the impact by taking different action?

NA

Appendix D

33

Sign Off Sheet regarding Dissemination of Procedural Documents

To be completed and attached to any document which guides practice when submitted to the appropriate committee for consideration and approval.

Title of Document: Non Medical Prescribing Policy

Responsible Director:

Director of Clinical and Operational Services

Date Ratified: 7th September 2011

Where approved: Locala Policy Group

Placed on Website: November 2011

Review Date: November 2013

Appendix E

34

CPNP INTENTION TO PRESCRIBE FORM

FULL NAME (print): …………………………………………………………………………..

JOB TITLE: …………………………………………………………………………………….

PROFESSION: ………………………………………………………………………………..

APPROVED TO PRACTICE AS (Independent/Supplementary/Community Practitioner Nurse Prescriber): ……………………………………………………………………………..

PROFESSIONAL REGISTRATION NUMBER: ……………………………………………

DATE OF BIRTH: ………………………………………………………………………………

TITLE (Mr/Miss/Ms/Mrs): ………………………………………………………………………

SERVICE BASE/GP PRACTICE: ……………………………………………………………..

CONTACT DETAILS (Mobile/base number): ………………………………………………

USUAL SIGNATURE:

LINE MANAGER/TEAM LEADER: …………………………………………………………………………………………………….

HEAD OF SERVICE/MANAGER (Service Manager/Service Lead/Practice Manager): …………………………………………………………………………………………………….

TO BE COMPLETED BY APPROPRIATE SERVICE LEAD

I confirm that (insert name):……………………………… is employed in their role as (insert):…………………….. and that they are required to prescribe in this role.

APPROVED BY HEAD OF SERVICE/MANAGER (Service Manager/Service Lead/Practice Manager): …………………………………………(Signature)…………………(Date).................

Base/Contact No

Return to:

Non Medical Prescribing Lead, Medicines Management Team, LCP, Beckside Court, Bradford Road, Batley, WF17 5PW

Date: …………….

Appendix F

35

INDEPENDENT PRESCRIBING PROFORMA

INTENTION TO PRACTICE AS AN INDEPENDENT NURSE OR PHARMACIST PRESCRIBER

Please complete this form electronically, then print, sign and arrange for manager and lead clinician (mentor) to sign.

Name: Title (Ms/Miss/Mrs/Mr): Base:

Role: Contact No:

Professional Reg Number: Date of Birth:

Disease Area Evidence of Competence

to prescribe for this disease area

CPD undertaken supporting prescribing within this area

State items to be prescribed and guidelines worked to, or attach protocols.

E.g. Asthma E.g. Asthma Diploma or 10 years experience (whatever is applicable)

E.g. Formal updates, courses attended (whatever is applicable) Please give as much information as possible including dates attended etc.

You may list individual items or make reference to guidelines or sections of BNF. Prescribing intentions must be clear and the evidence base identified.

Continued overleaf

Appendix F

36

Have you received a prescribing related appraisal in last 12 months?

If so, when and with whom.

If not, identify when and with whom this will take place.

Do you receive clinical supervision for your prescribing role?

If so please give brief description

If not identify how you will receive clinical supervision for your prescribing role.

What plans do you have to audit your prescribing?

Please provide a brief description

Have you identified any CPD needs related to prescribing?

If so how do you plan to address these needs?

Independent Prescribers Signature: …………………………………………………. Date: …………………………………

My intended scope of prescribing practice has been discussed and agreed with my manager and lead clinician (mentor).

Managers Name: …………………………………………………. Base/Contact No………………………………………

Managers Signature: ……………………………………………. Date: ……………………………

Lead Clinicians Name (Mentor): …………………………………………… Base/Contact No............................................

Lead Clinicians Signature (Mentor): ………………………………….. Date: ……………………………..

Please send the completed and signed form to:

Non Medical Prescribing Lead, Medicines Management Team, LCP, Beckside Court, Bradford Road, Batley, WF17 5PW

A copy should be retained by the Non Medical Prescriber and Manager.

Appendix G

37

INDEPENDENT PRESCRIBING PROFORMA ADDITIONS FORM

ADDITIONS TO PRACTICE AS AN INDEPENDENT NURSE OR PHARMACIST PRESCRIBER

Please complete this form electronically, then print, sign and arrange for manager and lead clinician (mentor) to sign.

Name: Title (Ms/Miss/Mrs/Mr): Base:

Role: Contact No:

Professional Reg Number: Date of Birth:

Disease Area Evidence of Competence

to prescribe for this disease area

CPD undertaken supporting prescribing within this area

State items to be prescribed and guidelines worked to, or attach protocols.

E.g. Asthma E.g. Asthma Diploma or 10 years experience (whatever is applicable)

E.g. Formal updates, courses attended (whatever is applicable) Please give as much information as possible including dates attended etc.

You may list individual items or make reference to guidelines or sections of BNF. Prescribing intentions must be clear and the evidence base identified.

Continued overleaf

Appendix G

38

Independent Prescribers Signature: …………………………………………………. Date: …………………………………

My intended scope of prescribing practice has been discussed and agreed with my manager and lead clinician (mentor).

Managers Name: …………………………………………………. Base/Contact No………………………………………

Managers Signature: ……………………………………………. Date: ……………………………

Lead Clinicians Name (Mentor): ……………………………………………. Base/Contact No…………………………………

Lead Clinicians Signature (Mentor): ………………………………….. Date: ……………………………..

Please send the completed and signed form to:

Non Medical Prescribing Lead, Medicines Management Team, LCP, Beckside Court, Bradford Road, Batley, WF17 5PW

A copy should be retained by the Non Medical Prescriber and Manager.

Appendix H

39

SUPPLEMENTARY PRESCRIBING CLINICAL MANAGEMENT PLAN (CMP)

Patient Label / Details

Existing Patient Medication Not Covered Under CMP

Allergies / Sensitivities

Independent Prescriber(s)

Supplementary Prescriber(s)

Condition(s) to be Treated

quires

Aim of Treatment

Treatment Plan

Indication Preparation &

Dosage

Dosage

Dose Schedule Referral back to the

Independent

Prescriber

Appendix H

40

Review & Monitoring:

Supplementary Prescriber

Independent Prescriber

Process for reporting Adverse Drug Reactions

Yellow Card Scheme

IR1 if applicable

Documentation & Record Keeping

Guidelines supporting Supplementary Prescriber’s Treatment Plan

Names of Independent

Prescriber(s) Managing

this Patient’s CMP

Date

Name(s)of Supplementary

Prescriber(s) Prescribing

from this CMP

Date Date Agreed with

Patient / Carer

Tel: 01484 464000 Broad Lea House

Ext: 4415 Bradley Business Park

Fax: 01484 464417 Dyson Wood Way

Huddersfield HD2 1GZ

41

Appendix I

Community Nurse Prescribers and Nurse/Pharmacist Independent Prescribers Hand

Held Prescription Pad

Order Form (Pads of 50)

PCT CODE 5N200

Locality Base Details:

Prescriber to complete details in boxes below and forward to Service Managers PA

Prescriber Name Prescriber

Registration No

No of Pads Required

Please State:

Community Nurse or Nurse/Pharmacist

Independent Prescriber

Service Manager: ……………………………………………………………………………

PA Name and Contact: ……………………………………………………………………...

Orders can be sent by fax, post or e-mail:

Fax No: 01484 464417

Post to: Support Services, Broad Lea House, Bradley Business Park, Dyson Wood Way. Huddersfield. HD2 1GZ

E-mail: Orders.Huddersfield@wycsa.nhs.uk

FURTHER COPIES OF THIS ORDER FORM OR PRACTICE STOCK SHEETS CAN BE REQUESTED BELOW

FORM NUMBER

FORM NUMBER

PLEASE SUPPLY THE FOLLOWING

PLEASE SUPPLY THE FOLLOWING

QUANTITY REQ

QUANTITY

REQUIRED FP10/C

FP10/C

Request for Prescription Forms

Request for Prescriptions Form

CN/SCS

CN/SCS

Stock Control Sheet for Prescriptions

Stock Control Sheet for Prescriptions

Appendix J

42

PRESCRIPTION RECORD SHEET FOR NON MEDICAL PRESCRIBERS

ORDER AND RECEIPT OF PRESCRIPTION PADS

Name: Pin Number: Base: NMP Sample signature:

Date and Quantity of Pads Ordered

Date and Quantity of Pads Received

Serial Numbers From:

Serial Numbers to: Signature of PA

Continued Overleaf

Appendix J

43

COLLECTION OF PRESCRIPTION PADS

Date Quantity of Pads Collected

Serial Numbers

From:

Serial Numbers to: Signature of NMP and PA’s initials

DESTRUCTION OF PRESCRIPTION PADS

Date Quantity of pads returned

Serial Numbers

From:

Serial Numbers to: Reason for Return:

Signature of NMP Returning:

Signature of PA when Shredded

Appendix K

44

APPLICATION FOR APPROVAL TO UNDERTAKE NON-MEDICAL PRESCRIBING COURSE

FULL NAME (print): ………………………………………………….. JOB TITLE: ……………………………………………………………. BASE OF WORK: …………………………………………………….. LINE MANAGER: ……………………………………………………… What do you intend to prescribe? (Please give a brief description of disease areas you intend to prescribe for, or state ‘formulary’ if applying for the nurse V150 course ): ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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

Do you have a (please tick): Medical Mentor Non Medical Mentor Name of mentor: ……………………………………………………………………………………………. Designation and place of work: ……………………………………………………………………………. Mentor contact details: …………………………………………………………………………………………….

Will prescribing only take place within the boundaries of NHS Kirklees? Y/N …………………………. If No, please state where: ………………………………………………………………………………………. Signature: ……………………………………………………. Date: ……………………………………………. Please return completed form WITH university application to: Non Medical Prescribing Lead Medicines Management Team Beckside Court Bradford Road Batley WF17 5PW

Appendix L

45

NHS YORKSHIRE AND THE HUMBER

NON-MEDICAL PRESCRIBING LEADS

CONTACT DETAILS

For further information contact non-medical prescribing leads in each Trust.

Trust Non-Medical Prescribing Lead

E-mail

Airedale NHS Trust

Rachel Binks

Carl Booth

Rachel.Binks@anhst.nhs.uk

Carl.booth@anhst.nhs.uk

Bradford District Care Trust

Alistair Tinto Alistair.Tinto@bdct.nhs.uk

Bradford Teaching

Hospitals NHS

Foundation Trust

Kay Pagan

Kay.Pagan@bradfordhospitals.nhs.uk

Calderdale and Huddersfield NHS

Foundation Trust

Mike Culshaw

Karen Guy

Mike.culshaw@cht.nhs.uk

Karen.Guy@cht.nhs.uk

Leeds Teaching Hospitals NHS Trust

Chris Acomb

Jo Caldicott

Chris.Acomb@leedsth.nhs.uk

jo.caldicott@leedsth.nhs.uk

Mid-Yorkshire Hospitals NHS Trust

Philip Shaw Philip.Shaw@midyorks.nhs.uk

Leeds Partnerships Foundation NHS Trust

Elaine Weston

Damon Britton

Elaine.Weston@leedspft.nhs.uk

Damon.britton@leedspft.nhs.uk

South West Yorkshire Mental Health NHS

Trust

Lynn Haygarth

Ann Hargate

Lynn.haygarth@swyt.nhs.uk

Ann.hargate@swyt.nhs.uk

Appendix L

46

Bradford and Airedale Teaching PCT

Nessa Butler

Jeff Pearse

Phillipa Hubbard

nessa.butler@bradford.nhs.uk

Jeff.Pearse@bradford.nhs.uk

Phillipa.Hubbard@bradford.nhs.uk

Calderdale PCT Helen Foster Helen.Foster@calderdale-pct.nhs.uk

Kirklees PCT

Locala Community Partnerships CIC

Eric Power

Lucianne Ricketts

Eric Power@kirkleespct.nhs.uk

Lucianne.Ricketts@locala-cic.nhs.uk

Leeds PCT Karen Roger

Carolyn Nelson

karen.roger@nhs.net

Carolyn.Nelson@nhsleeds.nhs.uk

Spectrum Community Health CIC

Fozia Lohan fozia.lohan@spectrum-cic.nhs.uk

NHS Wakefield Margaret Mackie margaret.mackie@wdpct.nhs.uk

Appendix L

47

NHS YORKSHIRE AND THE HUMBER

NON-MEDICAL PRESCRIBING LEADS

CONTACT DETAILS

For further information contact non-medical prescribing leads in each Trust.

Trust Non-Medical Prescribing Lead

E-mail

Barnsley Hospital NHS Foundation Trust

Bernadette

Ah-Fat

Bahfat@nhs.net

Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Pauline Barber

Pauline.barber@dbh.nhs.uk

Doncaster & South Humber Healthcare NHS Trust

Mark Lawton

Mark.lawton@dsh.nhs.uk

Rotherham NHS Foundation Trust

Mandy Street

Mandy.Street@rothgen.nhs.uk

Sheffield Care Trust Peter Pratt Peter.Pratt@shsc.nhs.uk

Sheffield Children’s NHS Foundation Trust

John Reid

John.reid@sch.nhs.uk

Sheffield Teaching Hospitals NHS Foundation Trust

Kath Richardson

Karen. Reeder@sth.nhs.uk

Barnsley PCT Christine Lawson

Chris.Lawson@barnsleypct.nhs.uk

Appendix L

48

Sarah Hudson Sarah.Hudson@barnsleypct.nhs.uk

Doncaster PCT David Oxley

David.oxley@doncasterpct.nhs.uk

Rotherham PCT Susan Wright Sue.wright@rotherhampct.nhs.uk

Sheffield PCT David Rovardi

Lucy Pixton

David.Rovardi@sheffieldpct.nhs.uk

Lucy.Pixton@sheffieldpct.nhs.uk

Appendix L

49

NHS YORKSHIRE AND THE HUMBER

NON-MEDICAL PRESCRIBING LEADS

CONTACT DETAILS

For further information contact non-medical prescribing leads in each Trust.

Trust Non-Medical Prescribing Lead

E-mail

Harrogate District NHS Foundation Trust

Lesley Harris

Candy Norris

Lesley.Harris@hdft.nhs.uk

Candy.Norris@hdft.nhs.uk

Hull & East Yorkshire Hospitals NHS Trust

Stephen Knight

David Corrall

Steve.Knight@hey.nhs.uk

David.Corral@hey.nhs.uk

Humber Mental Health Teaching Trust

Helen Courtney

Jackie Stark

Helen.Courtney@humber.nhs.uk

Jackie.Stark@humber.nhs.uk

Northern Lincolnshire & Goole Hospitals NHS Trust

Dorothy Hulme Dorothy.Hulme@nlg.nhs.uk

Scarborough & North East Yorkshire Healthcare NHS Trust

Rowena Smith Rowena.Smith@acute.sney.nhs.uk

York Hospitals NHS Trust

Michelle Carrington

Michelle.Carrington@york.nhs.uk

East Riding of Yorkshire

PCT

Jackie Matthews

Andrew Powell

Jackie.Matthews@erypct.nhs.uk

Andrew.Powell@erypct.nhs.uk

Appendix L

50

Hull Teaching PCT Jacqui Laycock

Joanne Lane

Jacqui.Laycock@hullpct.nhs.uk

Joanne.Lane@hullpct.nhs.uk

North East Lincolnshire Care Trust Plus

Julie McGregor

Rachel Staniforth

Julie.Mcgregor@nelctp.nhs.uk

Rachel.Staniforth@nelctp.nhs.uk

North Lincolnshire PCT John Berry

Paul Ablett

John.Berry@nlpct.nhs.uk

Paul.Ablett@nlpct.nhs.uk

North Yorkshire & York PCT

Sue Swinson sue.swinson@nhs.net

Appendix L

51

YORKSHIRE AND THE HUMBER NON-MEDICAL PRESCRIBING PROVISION AND CONTACTS

University Contact/Course Leader Who do they train?

Taught (T)

Distance Learning (D)

Approximate Course

Start Dates *

How long is the course run over?

The University of Bradford

School of Healthcare Studies

Horton A Building

Jenny Adams

01274 236 472

j.adams@bradford.ac.uk

Justine Raynsford

Tel 01274 236300 j.raynsford@bradford.ac.uk

Nurse

V150

V300

AHPs

Pharmacists

T

T

February

October

4 or 9 months

Leeds Metropolitan University

Andrew McEwan

0113 2832600 ex 24413

a.mcewan@leedsmet.ac.uk

Nurse

V300

V150 (2010)

AHPs – not Pharmacists or Optometrists

T

January

September

6 months

The University of Leeds

Catherine Gill

0113 343 1297

(Nurses and Midwives)

C.gill@leeds.ac.uk

Dr Barry Strickland-Hodge

0113 343 1346 (Pharmacists)

b.strickland-hodge@leeds.ac.uk

Nurse

V300

Pharmacists

T

T/D

January

September

(Enquire separately for

D)

3 or 6 months

The University of Huddersfield

Val Ely

01484 473450

v.ely@hud.ac.uk

Nurse

V100

V150

T January

September

6 months

Appendix L

52

Vicky Kaye

01484 473471

v.kaye@hud.ac.uk

V300

AHPs not Pharmacists or Optometrists

The University of Hull

Sandra Burley

01482 464515

S.Burley@hull.ac.uk

Dr Andrea Hilton

01482 463347

A.Hilton@hull.ac.uk

Nurse

V150 (2010)

V300

AHPs

Pharmacist

T

T

T

January

September

6 months

Sheffield Hallam University

Jan Denton

0114 225 2549

J.V.Denton@shu.ac.uk

Nurse

V150

V300

AHPs

Pharmacists

T February

September

6 months

The University of Sheffield

Derek Darling

0114 2222041

D.Darling@sheffield.ac.uk

Nurse

V150 V300

T March

September

6 months

The University of York

Gerri Kaufman

01904 321629

Gerri.kaufman@york.ac.uk

Nurse

V150

V300

AHPs

Pharmacists

T October 6 months

Appendix M

53

GOOD PRACTICE GUIDELINES FOR THE SAFE AND SECURE HANDLING OF PRESCRIPTION FORMS FOR NON-MEDICAL PRESCRIBERS

1. Responsibility of the Individual Prescriber

Treat the prescription pad as you would a cheque book:

DO

• Keep the pad with you in your bag or on your person whilst out of the office.

• Consider only taking one or two prescriptions out with you.

• Secure the pad in a locked drawer in your place of practice when not in use.

• Record the number of the first and last prescription in each pad, and the date on which they were used. This can be done in your work diary.

• Notify your manager immediately if any forms or the pad go astray.

• Return all unused prescriptions to your manager if leaving LCP.

• Only use your own prescription pad, and check it’s yours before writing on it.

DON’T

• Pre-sign blank prescription forms.

• Leave the prescription pad in your car - 80% of GP pads that go missing get stolen from cars

• Leave the pad unattended on your desk.

• Have more than one prescription pad in use at any one time.

• Let any other practitioner use your prescription pad.

• Use any other pad except your own - if you run out of prescriptions you will not be able to prescribe until you get another pad!

2. Responsibility of LCP or Practice Base

• Provide secure, lockable storage for prescription pads.

• Ensure the provision of new prescription pads as required.

• Minimise the risk of fraud by recording the numbers of the first and last prescription in each pad at the central and local distribution centres.

• Inform the Community Services Pharmacy Manager of details of practitioners leaving LCP.

• Retrieve unused prescription pads from non-medical prescribers leaving LCP, or when prescription pads are no longer required (ie. moving to a non-prescribing role). ALL prescription pads MUST be returned to the Service Managers PA for secure destruction. They should be annotated as returned on the individual non medical prescriber’ prescription record log and signed out of the log when shredded.

Appendix N

54

SLA for Cross Boundary Non- Medical Prescribing between NHS organisations within South West Yorkshire area.

Introduction

The practice of some Non Medical Prescribers necessitates prescribing across the boundaries of local NHS organisations. Examples of this are where a non medical prescriber is employed by one organisation (e.g SWYMHT) but seconded to a different organisation (e.g.Lifeline) to provide services which would include prescribing. Or it may occur through an honorarium contract between two organisations e.g Tissue Viability nurses employed by a Secondary Care Trust who during the course of their duties are required to prescribe for patients in primary care using the local Primary Care Trusts’ prescription pads.

This agreement has been drawn up to ensure that the proper elements and commitment are in place to provide optimal services and addresses risk management issues from an accountability, responsibility, quality and resource perspective for the prescribing practice of these non-medical prescribers.

Policy/Framework

The non medical prescriber will work to the employer organisation’s non-medical prescribing policy/framework, (whilst paying due regard to the receiver organisation’s own non medical prescribing policy/framework).

Where the employer organisation does not have an approved policy/framework for non-medical prescribing the non-medical prescriber must work within the receiver organisation’s Non-Medical Prescribing Policy/Framework.

All prescribers are expected to work within the remit of the employer organisation’s Medicines code, (whilst paying due regard to the receiver organisation’s medicines code).

All relevant policies must be shared between organisations and Non-Medical prescribers to minimise risk.

Vicarious Liability

The employer organisation will accept vicarious liability prescribing by their employee i.e Vicarious liability sits with the service provider.

Individual liability is bound by the Non-Medical Prescribing policy of the employer organisation.

Formulary/Prescribing Guidance

The non-medical prescriber must follow BNF guidelines and work within approved national prescribing guidelines e.g NICE, etc relevant to their area of expertise/competence. It is expected that the non-medical prescriber will work to any formulary/prescribing guidance of the service receiver and in the case of supplementary prescribers, within the agreed Clinical Management Plans.

Current BNFs, Drug Tariffs, etc, are to be supplied to the non medical prescriber by the employer organisation.

All relevant prescribing guidelines and procedures must be shared between organisations to minimise risk.

Appendix N

55

Budget

It is the responsibility of the receiver organisation to

issue prescription pads

allocate the prescribing budget with relevant budget codes.

The prescription pads issued can only be used for the work carried out for that organisation. It is important/essential that all prescribing is charged to the appropriate budget. Non medical prescribers must ensure that the correct budget/prescriber code is entered on each prescription form.

Supply and Receipt of Prescription Pads

It is the responsibility of the receiver organisation to

register each non-medical prescriber

supply the appropriate prescribing stationery

provide any necessary information/training and education required to fulfil the role (e.g relevant prescriber codes).

The non-medical prescriber must comply with any terms and conditions relating to ordering and/or receipt of prescription pads as outlined in the service receivers non medical prescribing policy/framework.

Any resources required specifically for the prescribing setting should be provided by the receiver organisation, for whom the individual is undertaking prescribing duties.

Communication

It is the responsibility of the employer organisation to provide information about the non-medical prescribers scope of competence and area of practice to the non medical prescribing lead of the receiver organisation by completing Proforma A - attached.

The employer organisation must liaise with the proposed receiver organisation, prior to initiation of non medical prescribing training to ensure a prescribing budget will be available and that the proposed service is supported by the receiver organisation.

Where prescribing is taking place in primary care, it is the responsibility of the non medical prescriber to communicate effectively, any prescribing interventions, to the registered GP practice of the patient within 48 hours,

Continuing Professional Development / Monitoring

Continuing Professional Development (CPD) is the responsibility of the individual prescriber. Evidence of CPD must be made available to both the receiver and employer organisations.

The employer organisation must have facilities available for CPD events. The receiver organisation must allow reasonable study leave to attend CPD events.

CPD undertaken should be relevant to the individual’s scope/area of practice, agreed in the personal development plan and approved by the Line Manager.

Monitoring of prescribing is the responsibility of the employer organisation, however the receiver organisation is at liberty to share any prescribing monitoring carried out themselves with both the prescriber and non-medical prescribing lead of the employing organisation. Any issues/concerns raised are to be addressed by the employing organisation.

Appendix N

56

The receiver organisation should report to the Employer organisation any prescribing incident pertaining to the non medical prescriber, including any incident that did not cause harm to the patient.

Termination of Prescribing Arrangement

It is the responsibility of the employer organisation to inform the receiver organisation via the non medical prescribing lead, when a prescriber stops prescribing and therefore requires deregistration from the prescriber list.

The non-medical prescriber must comply with the terms and conditions pertaining to termination of prescribing as outlined in the non medical prescribing policy/framework of the receiver organisation.

Glossary of Terms

Non medical prescribing - is the term used to describe prescribing by health care professionals other than doctors and dentists. Non medical prescribers must comply with the current legislation for prescribing and be accountable for that practice.

Non Medical Prescribers include:

Community nurse practitioners

Supplementary prescribers

Nurse Independent Prescribers

Pharmacist Independent Prescribers

SLA - NHS bodies do not enter into legally enforceable contracts with each other where both are subject to powers of direction by the Secretary of State for Health. However, a Service Level Agreement (SLA) performs the same function as a contract between NHS bodies. The purpose of a SLA is to ensure that the proper elements and commitment are in place to provide optimal services and in the context of risk management raise issues from an accountability, responsibility, quality and resource perspective.

One party acts as the service provider and the other party acts as the service receiver (or a party that acts on behalf of a service receiver).

Employer Organisation OR service provider – the organisation employing the non medical prescriber.

Receiver organisation OR service receiver – the organisation that the non medical prescriber is prescribing within but is not employed by that organisation.

Vicarious Liability - An employer is vicariously liable for negligent acts or omissions by his employee in the course of employment whether or not such act or omission was specifically authorised by the employer. To avoid vicarious liability, an employer must demonstrate either that the employee was not negligent in that the employee was reasonably careful or that the employee was acting in his own right rather than on the employer's business.

Appendix N

57

Proforma A

Notification and Agreement for a Non-Medical Prescriber to Practise across Organisational Boundaries

(Completed proforma to be retained by non medical prescribing leads of both employer and receiver organisations)

Name of Non Medical Prescriber ………………………………………………….

Job Title ………………………………………………………………………………

Current Work Base ………………………………………………………………….

Profession and Registration number ………………………………………………

Prescribing Qualification (please tick as appropriate)

Community nurse Practitioner

Supplementary Prescriber

Independent Prescriber

Scope/areas of competence of non medical prescriber

………………………………………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………………………

Description of role to be undertaken by non medical prescriber in Receiver organisation:

…………………………………………….…………………………………………………..

…………………………………………………………………………………………………

…………………………………………………………………………………………………

Proposed Locality/Base of prescribing activity …………………………………………..

Name ………………………………………………………………………

Signature ………………………………………………………………………

Date ……………………………………………

Appendix N

58

Name of Employer organisation (i.e employer of non medical prescriber)

…………………………………………………………….……………………

Non-Medical Prescribing Lead of Employer organisation

Name ………………………………………… Base/Contact No………………………………

Signature …………………………………….. Date ………….….

Line manager of Non Medical Prescriber

Name……………………………………………… Base/Contact No……………………………………

Signature …………………………………….. Date ………….….

……………………………………………………………………………………………….

The above named non-medical prescriber can prescribe within the organisation named below in accordance with the terms of this cross boundary agreement.

………………………………………………………………………………………………..

Name of Receiver organisation (i.e. organisation receiving the services of the non medical prescriber)

……………………………………………………………………………………………….…

Non-Medical Prescribing Lead of Receiver organisation

Name ………………………………………………… Base/Contact No………………………………

Signature …………………………………….. Date ……………….

Commissioner/Manager of Service Area within Receiver organisation

Name…………………………………………………… Base/Contact No…………………………

Signature …………………………………….. Date ……………….