Policy: N6 Non-Medical Prescribing Policy · N6 - Non-Medical Prescribing Policy ... Appendix G Guidance Notes For Completing ... of medicines by non-medical prescribers within the

West London Mental Health NHS Trust_________________________________________ Page 1 of 49

Policy N6 First Date of Issue: Feb 2013 This is current version N6/02 Feb 2015

Version: N6/02

Ratified by: Trust Management Team

Date ratified: 11th February 2015

Title of Author: Senior Nurse Manager

Title of Responsible Director: Director Of Nursing & Patient Experience

Governance Committee: Clinical Effectiveness & Compliance

Date issued: 12th February 2015

Review date: January 2017

Target audience: All staff Trust wide

Disclosure Status Can be disclosed to patients and the public

EIA / Sustainability

G:\Trust Policies and Procedures\TMT\February 2013\NMP\N6 NMP EIA form 310113 approved mmv.doc

Implementation Plan

G:\Trust Policies and Procedures\TMT\February 2013\NMP\Implementation Plan NMP November 2012.xls

Monitoring Plan

G:\Trust Policies and Procedures\TMT\February 2013\NMP\Monitoring Plan NMP November 2012.xls

Other Related Procedure or Documents: M2 Medicines policy, C31 - Controlled Drugs, Trust Guidance: A14g - Approved off-label medicines, A13g - Approved unlicensed medicines, Bg5 - BNF Borderline substances, P23g – Pharmaceutical Industry Sales Reps wanting to work with WLMHT

Policy: N6

Non-Medical Prescribing Policy



Equality & Diversity statement

The trust strives to ensure its policies are accessible, appropriate and inclusive for all. Therefore all relevant policies will be required to undergo an Equality Impact Assessment

and will only be approved once this process has been completed.

Sustainable Development Statement

The Trust aims to ensure its policies consider and minimise the sustainable development impacts of its activities. All relevant policies are therefore required to undergo a Sustainable Development Impact Assessment to ensure that the financial, environmental and social implications have been considered. Policies will only be approved once this process has been completed.



N6 - Non-Medical Prescribing Policy Version Control Sheet

Version Date Title of Author Status Comment

N6/01 Oct 2012 Senior Nurse Manager

New Policy issued titled Non-Medical Prescribing Policy

Newly written policy Under Consultation, ending 4 January 2013. Presented to February 2013 TMT - Approved. Minor amendments made to section 16, Policy re-issued 14th May 2014

N6/02 Oct 2014 Section 12 and Appendix D inserted. Trustwide consultation ending 20th Oct 2014 Submitted to CEC & Feb 2015 TMT for approval.



N6 - Non-Medical Prescribing Policy Ensuring the safe and appropriate use of non-medical prescribing by personnel working for West London Mental Health NHS Trust.

Contents Page

1 Introduction 6

2 Background 6

3 Scope 6

4 Definitions 7

5 Duties 8

6 Patient Consent 10

7 Prescribing For Children & Young People 10

8 Prescribing Off LABEL Medicines 10

9 Prescribing Unlicensed Medicines 11

10 Approved Formularies for Non Medical Prescribers 11

11 Supplementary Non-Medical Prescribing 11

12 Agreement of Formularies and Standard Operating Procedures

13

13 CSU Responsibilities 13

14 Independent Non-Medical Prescribing 14

15 Transition From Supplementary To Independent Prescribing

15

16 Education, Training And Preparation 15

17 Patient Group Directions 17

18 Post Qualification 18

19 Risk Management 19

20 Record Keeping 20

21 Legal And Clinical Liability 20

22 Monitoring 21

23 Glossary of Terms/Acronyms 21

24 References 22

Appendices

Appendix A Clinical Management Plan Template (e-version on RIO) 23

Appendix B Approved Formulary For Approved Areas Of Practice 24

Appendix C Template for Standard Operating Procedures (SOPs) 28

Appendix D Request To Add Medicine to NMP Formulary 32

Appendix E Competency Assessment for Supplementary to Independent Prescribing

33



Appendix F Application for funding for Non-medical Prescribing Training

35

Appendix G Guidance Notes For Completing Application Form 38

Appendix H Check List/ Evidence Sheet 39

Appendix I Summary Of Route To Non-Medical Prescribing 41

Appendix J Supplementary And Independent Prescribing Notification Of Practice

42

Appendix K Competency Assessment for Practitioners on completion of the NMP Course

44

Appendix L Non-Medical Prescribing Sample Signature Record 46

Appendix M Practice Reference for Independent Prescribers Joining the Trust

47



1. INTRODUCTION

1.1 This policy has been formulated to support staff in their understanding of non-medical prescribing and to ensure the administrative and procedural steps necessary to undertake non-medical prescribing are outlined.

1.2 The aim of the policy is to provide staff with advice and guidance as to how non-medical prescribing should be implemented, it provides guidance for independent and supplementary prescribers and their independent prescribing partners (Doctor). It is essential that all staff are conversant with this policy prior to undertaking and following non-medical prescribing training programmes.

2. BACKGROUND

2.1 The NHS plan: A Plan for Investment, a Plan for Reform emphasised the need to organise and deliver services around the needs of the service user (DoH 2000). To achieve this aim it was envisaged that traditional boundaries between clinical roles be broken down to allow clinical professionals to work with greater flexibility for the benefit of service users. One area where traditional barriers have been removed is in the area of prescribing.

2.2 The Cumberledge report of 1986 (DHSS 1986) first recommended prescribing by community nurses as a way of improving service user care and access to health care resources. Since 1994 suitably trained nurses have been able to prescribe from a limited list of items (Nurses Prescribers Formulary). The right to prescribe was extended following the Health and social Care Act 2001.

2.3 In May 2001 ministers announced that steps would be taken to allow supplementary prescribing by nurses and other health care professionals. It was envisaged that this form of prescribing would likely to be particularly suitable for health professionals working with service users experiencing more complex chronic conditions such as asthma, diabetes or mental ill health.

2.4 Following Parliamentary approval changes to enable nurse independent prescribing (and pharmacist independent prescribing) for all licensed medicines within a prescriber’s competence came into effect on 1st May 2006. Amendments to the Misuse of Drugs Regulations 2001 came into force in April 2012 relating to nurse and pharmacist independent prescribing of controlled drugs.

3. SCOPE OF POLICY

3.1 This document sets out the WLMH NHS Trust policy for non-medical prescribing.

3.2 For the purposes of this policy the term non-medical prescribers applies to registered nurses, pharmacists and allied health professionals (physiotherapists). Hereafter the term nurse’ will be used to refer to registered mental health nurses and the term allied health professional refers to pharmacists and physiotherapists.

3.3 This policy provides the framework for the prescribing of medicines by appropriately trained and registered non-medical prescribers employed by WLMH NHS Trust. This must be used in collaboration with the Medicines Policy (M2), and any other relevant policy, procedure or guidelines relating to prescribing of medicines and with other Medicines Management standards such as the Nursing & Midwifery Council Medicines management and prescribing standards.



3.4 Non medical prescribers must prescribe within the context of:

The code standards of conduct, performance and ethics for nurses and midwives (NMC 2008)

Standards for Medicine Management. NMC (2008)

DoH improving Patients Access to Medicines (2006)

Standards of conduct, ethics and performance (July 2012) General Pharmaceutical Council (GPC)

4. DEFINITIONS

TYPES OF NON - MEDICAL PRESCRIBERS

4.1 Independent Prescribers

4.1.1 These are professionals [e.g. a doctor, dentist, nurse or pharmacist] who are responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing medication (Department of Health [DoH] 2006).

4.1.2 Nurse independent prescribers are able to prescribe any licensed medicine for any medical condition, including some controlled drugs. Nurse independent prescribers must only ever prescribe within their own level of experience and competence, acting in accordance with Clause 6 of the Nursing & Midwifery Council’s ‘code of professional conduct: standards for conduct, performance and ethics’.

4.1.3 Pharmacy independent prescribers can prescribe any licensed medicine for any medical condition, including controlled drugs with the exception of diamorphine, cocaine and dipipanone for the treatment of addiction. Pharmacist independent prescribers must only prescribe within their own level of competence and in accordance with ‘Standards of conduct, ethics and performance’ General Pharmaceutical Council.

4.2 Supplementary Prescribers

4.2.1 Supplementary prescribing is a voluntary partnership between an independent prescriber [who must be a Doctor] and a supplementary prescriber, to implement an agreed patient specific Clinical Management Plan with the patient’s agreement (Appendix A).

4.2.2 The Clinical Management Plan will be drawn up with the patient’s / carer/ parent’s agreement, following diagnosis of the patient by the independent prescriber and following discussion and agreement between the independent and supplementary prescriber.

4.2.3 Supplementary prescribers are able to prescribe all medicines specified on the Clinical Management Plan, including controlled drugs or unlicensed medication if specified in the Clinical Management Plan.

4.2.4 There are no legal restrictions on the clinical conditions that may be treated under supplementary prescribing, although the DOH would normally expect supplementary prescribing to be used for the management of chronic medical conditions and health conditions.



4.3 Designated Medical Practitioner

4.3.1 A designated medical practitioner is a doctor who agrees to supervise non-medical prescribers throughout their training and during clinical practice as a supplementary prescriber.

4.4 Medicine Management Group

4.4.1 This is a trust wide group chaired by the Chief Pharmacist and is responsible for developing strategies, policies and practice guidance to promote evidence based medicines management across WLMHT.

4.5 Non-Medical Prescribing Sub Group

4.5.1 This group will meet bi-monthly chaired by the Trusts’ Non-Medical Prescribing Lead and is responsible for developing Non Medical Prescribing policy (N6), reviews new applications / candidates for training and addresses issues in practice relating to Non-Medical Prescribing. Non-Medical Prescribing standard operating procedures and formularies will be approved by the Non-Medical Prescribing sub-group. The group reports to the Medicines Management Group.

4.6 Non-Medical Prescribing Clinical Forum

4.6.1 This is a quarterly meeting organised for Non-Medical Prescribers to attend to discuss continuing professional development/training needs, case studies and to receive peer supervision.

4.7 Off Label Prescribing

4.7.1 ‘Off-label’ prescribing refers to the use of a licensed medicine outside of the specifications of the products marketing authorisation.

4.8 Unlicensed Prescribing

4.8.1 Unlicensed prescribing refers to the use of a medicinal product without a United Kingdom Marketing Authority.

5. DUTIES

5.1 Chief Executive

5.1.1 The Chief Executive has the overall statutory responsibility for the safe prescribing of medicines by non-medical prescribers within the Trust with ultimate responsibility for implementation and monitoring of policies in use in the Trust. This responsibility may be delegated to an appropriate colleague.

5.2 The Director of Nursing

5.2.1 The Director of Nursing is the Executive Director responsible for Nursing Practice and has Trust Board responsibility for all aspects of Non-Medical Prescribing.

5.2.2 They are also responsible for ensuring all Nursing and Allied Health Professional staff are trained to carry out the tasks required of them in the prescribing and management of medicines.

5.3 The Medical Director

5.3.1 The Medical Director is the Executive Director responsible for Pharmacy and Medicines Management and has Trust Board responsibility for all aspects of



medicines Management. They are also responsible for ensuring all medical staff are trained to carry out tasks required of them in prescribing and management of medicines. The Medical Director is supported by the Trust’s Medicines Management Committee.

5.4 Chief Pharmacist

5.4.1 The Chief Pharmacist is Chair of the Medicines Management Group and has responsibility for co-ordinating the activities of the Medicines Management Group to ensure that good practice relating to medicines, as described in this policy, becomes embedded in to everyday working practice across the Trust. The Chair will raise any medicines management issues at the Clinical Effectiveness and Compliance Group. The Chief Pharmacist is also responsible for ensuring all pharmacy staff are trained to carry out the tasks required of them in the management of medicines.

5.5 Non-medical Prescribing Lead

5.5.1 The Non-Medical Prescribing Lead is the Chair of the Non-Medical Prescribing Sub Group of the Medicines Management Group and has responsibility for overseeing the practice of non-medical prescribers to ensure that good practice relating to their prescribing, as described in this policy, becomes embedded in to everyday working practice across the Trust. The Chair will raise any non-medical prescribing issues at the Medicines Management Group.

5.5.2 The non-medical prescribing lead is also responsible for ensuring all non-medical prescribers are trained to carry out the tasks required of them in the prescribing of medicines.

5.6 Medical Staff

5.6.1 Medical staff are responsible for prescribing medicines for patients. It is their responsibility to comply with legislation, the Trust Medicines Policy (M2) and associate policies and procedures. Medical staff should also take into consideration the Trust's Drugs and Therapeutics Committee recommendations with respect to medicine selection, prescribing protocols and guidelines. Medical staff also have the responsibility of supporting nurses and Allied Health Professional’s in their prescribing practice.

5.7 Pharmacy Staff

5.7.1 Responsible for providing information and advice to Trust personnel on all aspects of medicines management within the Trust, assisting where appropriate in formulating local procedures at ward/departmental / level, ensuring that the laws relating to the safe and secure handling and storage of medicines are complied with.

5.8 Non-Medical Prescribers

5.8.1 Non-medical Prescribing staff are responsible for prescribing medicines for patients within the limit of their clinical competency. It is their responsibility to comply with legislation, the Trust Medicines Policy (M2) and associate policies and procedures. Non-Medical Prescribing staff should also take into consideration the Non-Medical Prescribing Sub Group recommendations with respect to medicine selection, prescribing protocols and guidelines.



5.9 Committees

5.9.1 The Medicines Management Group is responsible for the development, updating and monitoring of this policy. The Non-Medical Prescribing Sub Group is responsible for developing guidance on prescribing for Trust Non-Medical Prescribing clinicians. Are responsible for undertaking appropriate medicines management training and following guidance set out in this policy and any other medicines related policies.

6. PATIENT CONSENT

6.1 When non-medical prescribing is chosen as a means to manage the patients’ condition then the principles of non-medical prescribing must be explained in advance to the patient/guardian/carer and their agreement sought. Without such agreement non medical prescribing must not proceed.

6.2 In the case of a patient who cannot consent the situation is currently untested in law.

6.3 Every effort should be made to obtain informed consent from the patient prior to commencement of non medical prescribing. Where this is not possible, or where a patient’s capacity to consent fluctuates, independent and supplementary prescribers should clearly document the benefits of supplementary prescribing for that patient and proceed in the patients best interests [DOH 2004].

7. PRESCRIBING FOR CHILDREN AND YOUNG PEOPLE

7.1.1 Only non-medical prescribers with relevant knowledge, competence and experience in nursing children and young people should prescribe for them.

8. PRESCRIBING OFF LABEL MEDICATION

8.1 Nurse and pharmacist independent prescribers can prescribe medicines outside their licensed indications where this is accepted clinical practice, but cannot prescribe unlicensed medications. ‘They must however, accept professional, clinical and legal responsibility for that prescribing and should only prescribe ‘off label’ where it is acceptable clinical practice’ (DOH 2006). The prescriber should explain the situation to the patient / carer, where possible, but where a patient / carer is unable to agree to such treatment, the prescriber should act in accordance with best practice in the given situation and within the Medicines Policy (M2).

8.2 Supplementary non-medical prescribers can prescribe medicines ‘off-label’ under a Clinical management plan. The ’off-label’ indication must be clearly stated.

8.3 Any ‘off-label’ use of medication should be in line with the Medicines Policy (M2).

8.4 Non-medical prescribers can only prescribe medication ‘off-label’ if the indication has been approved by the WLMHT Drugs Therapeutic Committee and has been placed on the approved off-label list.



9. PRESCRIBING UNLICENSED MEDICINES

9.1 Nurse and pharmacist independent prescribers are not permitted to prescribe unlicensed medicines.

9.2 Supplementary non-medical prescribers can prescribe unlicensed medicines under a Clinical Management Plan. It must be clearly stated that the medication is unlicensed.

9.3 Any unlicensed use of medication should be in line with the Medicines Policy (M2).

10. APPROVED FORMULARIES FOR NON MEDICAL PRESCRIBERS

10.1 Non-medical prescribers have to work within their own scope of practice. To provide the Trust with assurance non-medical prescribers working within an approved area of practice will be required to adhere to a formulary for prescribing medication and ordering tests specific to that practice area (Appendix B).

11. SUPPLEMENTARY NON MEDICAL PRESCRIBING

11.1 Key Principles

11.2 There are a number of key principles that should underpin non-medical prescribing. These principles emphasise the importance of communication between the prescribing partners and the need for clear agreements regarding the management of the patient and responsibilities for patients’ clinical records. It is also essential that the patient is treated as a partner in their care and is involved at all stages in decision making, including whether part of their care is delivered by supplementary prescribing.

11.3 The criteria that are currently set in regulations for lawful supplementary prescribing are:

The independent prescriber must be a doctor

The supplementary prescriber must be a Registered Nurse, Registered Pharmacist or Allied Health Professional.

The supplementary prescriber must have successfully completed a recognised training course for non-medical prescribing

For supplementary prescriber there must be a written clinical management plan relating to a named patient and to that patient’s specific diagnosis and condition. Agreement to the plan must be recorded by both the designated medical practitioner and the supplementary prescriber before supplementary prescribing begins. The clinical management plan must include clear aims of treatment and circumstances for referral.

The clinical management plan represents a partnership between the supplementary prescriber, the designated medical practitioner and the patient / parent. Where appropriate the patient / carer should therefore agree and sign the clinical management plan

The designated medical practitioner and supplementary prescriber must ensure good record keeping practices are adhered to in line with the Health Records policy (H8)



Each area of practice which has been approved in the Trust will require a standard operating procedure for supplementary prescribing, a standard operating procedure for independent prescribing and a formulary. A template for standard operating procedures can be found in Appendix C.

11.4 Prescribing Relationship

The relationship between designated medical practitioner and supplementary prescriber is a voluntary one; both parties agree to share responsibility for the practice and will be accountable for their own prescribing decisions.

If the designated medical practitioner changes and responsibility for the patient moves to another doctor, the supplementary prescribing management will be discontinued unless a new partnership is agreed and recorded by a new designated medical practitioner. New designated medical practitioners will be discouraged from abandoning previously successful supplementary practice.

The work plan of the designated medical practitioner should incorporate the role of working with supplementary prescriber’s.

11.5 Responsibilities of the Designated Medical Practitioner

The designated medical practitioner must conduct an initial clinical assessment of the patient and provide an ICD 10 diagnosis

In partnership with the patient and the supplementary prescriber a clinical management plan will be agreed, consented to and drawn up

The designated medical practitioner must clearly outline the limits of the delegated responsibility and state the parameters of the medicine(s) and the doses which can be prescribed

The designated medical practitioner will provide advice and support to the supplementary prescriber as required

The patient must be reviewed on a regular basis and the frequency of this is recorded on the clinical management plan

The designated medical practitioner will resume full responsibility for the patient’s prescribing at the request of the supplementary prescriber

The designated medical practitioner will provide regular prescribing supervision (minimum of every 6 weeks) to the supplementary prescriber

The designated medical practitioner will contribute to the supplementary prescriber’s annual review (PDR) regarding competency in prescribing by providing a report to the individual’s line manager.

11.6 Responsibilities of the Supplementary Prescriber

The Supplementary Prescriber will work within the supplementary Non-Medical Prescribing standard operating procedure and formulary for their area of practice

The Supplementary Prescriber will monitor and assess the patients progress in line with the Clinical Management Plan

The Supplementary Prescriber will work in collaboration with the Designated Medical Practitioner to agree and draw up the Clinical Management Plan



The Supplementary Prescriber will prescribe in accordance with the Clinical Management Plan

The Supplementary Prescriber will change the prescribed medicine(s) as stated within the limits of the Clinical Management Plan, if the monitoring of the patients’ progress indicates this is clinically appropriate

The Supplementary Prescriber will accept professional accountability and clinical responsibility for their prescribing practice.

The Supplementary Prescriber will undertake regular audit of their prescribing practice

The Supplementary Prescriber will adhere to the Trust Non-Medical Prescribing, Medicines and Incident policies and all other policies, procedures and guidance related to medicines management.

The Supplementary Prescriber will record prescribing and monitoring activity in the shared common patient record contemporaneously.

12. AGREEMENT OF FORMULARIES AND STANDARD OPERATING PROCEDURES

The initial Non Medical Prescriber (NMP) formulary and standard operating procedure (SOP) for a service should be agreed with the NMP, the Designated Medical Practitioner and the clinical lead for that service. These should then be reviewed at NMP sub-group for agreement then to the MMG for approval.

At this point the formulary and SOP will be uploaded to the exchange.

Amendments to SOPs

Amended SOPs should be agreed with the service area prior to being submitted to the NMP sub-group for agreement then to the MMG for approval.

Request to add medicines to NMP formularies.

The request form (Appendix D) should be completed and submitted to the NMP sub-group for agreement then to the MMG for approval.

13. CSU RESPONSIBILITIES

Identifying clinical areas and patient care which may benefit from the introduction of non medical prescribing practice

Identifying and supporting the training of named non-medical practitioners employed by the CSU, including ensuring those nominated meet the requirements for entry onto a course



Assessing and managing the service and financial impact of the introduction of non medical prescribers in relation to managed services.

Ensuring the registration and notification processes for new non medical prescribers are followed

Introducing clinical governance procedures to ensure non medical prescribing practices are monitored within local structures

Ensuring the monitoring of ongoing professional registration and competence of non medical prescribers employed in the CSU

Ensuring the effective clinical supervision and case management structures are in place to support Non-medical prescribing practice. Nurse Clinical Supervision must be provided in line with the Clinical Supervision for Nurses Policy (C16)

To ensure that all nursing & midwifery council’s have access to appropriate continuing professional development annually

14. INDEPENDENT NON MEDICAL PRESCRIBING

14.1 Key Principles

The criteria for independent non medical prescribing are:

There must be a clear service need for independent prescribing that has been discussed and agreed within the CSU and individual services

The designated medical practitioner must verify the competencies of the Supplementary Prescriber/newly qualified non-medical prescriber and provide evidence that Supplementary Prescriber /newly qualified Non-Medical Prescriber is fully competent to undertake Independent prescribing.

Audit of prescribing practice is undertaken by the Independent prescriber

Non-medical prescribing sub group authorises practice as an Independent prescriber

Job Description to be amended to reflect Independent prescribing role

The Independent prescriber will work within the independent Non-medical prescribing standard operating procedure and formulary for their area of practice

The Independent prescriber must be able to competently conduct a clinical assessment of the patient, order any necessary investigations or tests, make a clinical formulation and prescribe appropriate medicines within their scope of practice

The Independent Prescriber will prescribe from the British National Formulary in accordance with the specified medical condition

The Independent Prescriber will record prescribing and monitoring activity in the patients’ record contemporaneously

The Independent Prescriber will monitor and assess the patients’ progress as appropriate to the patient’s condition and the medicines prescribed



The Independent Prescriber will provide clinical feedback to the multidisciplinary team caring for the patient

The Independent Prescriber will work within their clinical competence and professional code of conduct at all times and seek advice as appropriate

The Independent Prescriber will accept professional accountability and clinical responsibility for their prescribing practice

The Independent Prescriber will adhere to Trust Non-medical prescribing, Medicines and Incident policies and all other policies, procedures and guidance related to medicines management.

15. TRANSITION FROM SUPPLEMENTARY TO INDEPENDENT PRESCRIBING

15.1 Depending on the situation staff may be required to practice as a supplementary prescriber for an agreed period of at least three (3) months before they can be considered by the Trust to practice as an Independent Prescriber. This would include staff who have not practiced following their qualification or staff who wish to have additional support in moving into practice.

15.2 It is essential that Supplementary Prescribers are deemed to be fully competent to enable them to make the transition to independent prescribing. The following criteria must be fulfilled and submitted as evidence to the Non-medical prescribing Sub Group for authorisation-

Minimum 3 months continuous practice as Supplementary Prescriber

Evidence of prescribing practice demonstrating safe prescribing – clinical audit and incident review

Written evidence from Independent Prescriber about the competency and ability of the Supplementary Prescriber to progress to Independent Prescriber using the standardised competency assessment (Appendix D).

16. EDUCATION, TRAINING AND PREPARATION

16.1 To be considered for entry onto the non medical prescribing training the prospective student must have the agreement of their Line Manager and be able to demonstrate that their post is one in which they will have the need and opportunity to fulfil the role of a non-medical prescriber. Staff must also fulfil the standards of proficiency set out by the Nursing & Midwifery Council (NMC, 2006). All candidates must complete and application for funding for Non-Medical Prescriber Training (Appendix E) using the guidance (appendix F) and also complete the check list evidence sheet (Appendix G).

16.2 All nursing staff in the Trust will undertake the non-medical independent/supplementary prescribers training (NMC V300).

Nursing & Midwifery Standards of proficiency for nurse and midwife prescribers

Under the new legislation prescribers must have sufficient knowledge and

competence to:



Assess a patient/client’s clinical condition

Undertake a thorough history, including medical history and medication history, and diagnose where necessary, including over-the-counter medicines and complementary therapies

Decide on management of presenting condition and whether or not to prescribe

Identify appropriate products if medication is required

Advise the patient/client/client on effects and risks

Prescribe if the patient/client agrees

Monitor response to medication and lifestyle advice

16.3 Trusts’ Criteria

Nursing staff, pharmacists and Allied Health Professionals will need to be at Band 6 and above and have 3 years clinical experience. Must have experience in the speciality they wish to practice for minimum 12 months

Justification that there will be maximum benefit to patients and the Trust in terms of quicker and more efficient access to medicines for patients

Must have the academic ability to study at level 6 (degree)

Must either demonstrate their practical knowledge of clinical pharmacology or undertake educational courses to achieve sufficient knowledge and skills. Knowledge and skills will be assessed at interview.

All prospective students must obtain a designated medical practitioner (supervisor) willing to provide 12 days learning in practice during training and provide supervised prescribing practice post qualification

Must successfully complete the application process for training

16.4 The Application Process

Applicants to discuss their wish to undertake the training with their line manager and the benefits of Non-Medical Prescribers identified and agreed

All applicants must complete an application form for the relevant University and this must be signed by their line manager and Head of Service and confirm their support of attendance on the course and how this will be implemented in practice on completion (Appendices A-D).

Line manager to confirm that the Job Description will be updated on completion to reflect this new role

Each application must be sent to the Training department and the Non-medical prescribing sub group will discuss the appropriateness and the Trusts’ Head of Education will agree the funding arrangements before it is submitted to the relevant University.

Any concerns arising during a staff member undertaking the course must be referred to the Trusts’ Non-medical prescribing Lead



16.5 Supervision in Practice for Non Medical Prescribing Students

16.5.1 A Designated Medical Practitioner must supervise each non-medical prescribing student: the Designated Medical Practitioner must be a doctor who has

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

is a consultant, registrar or clinical assistant within the Trust

has some experience of supervision and training

16.5.2 At the beginning of the period of supervision the supervisor will receive details of the training programme and content and the learning outcomes to be achieved from the relevant university. The supervised learning in practice will comprise of a total of 12 days. The designated medical practitioner should be willing and able to devote a sufficient part of his or her time during this period of supervision to provide the appropriate guidance to the Non-medical prescribing student.

16.5.3 The designated medical prescriber should be a doctor with whom the designated medical prescriber regularly works with.

16.5.4 The designated medical prescriber will need to complete and ‘sign off’ the assessment of practice form which should be returned to the University where the designated medical prescribing student is registered. This will confirm that the student has completed the period of learning in practice and has met the required standards. A summary of the route to non-medical prescribing is available in Appendix H.

17. PATIENT GROUP DIRECTIONS (PGDs)

17.1 A PGD is defined in Health Service Circular 2000/026 as ‘written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment’. Using a PGD is not a form of prescribing. The majority of clinical care should still be provided on an individual, patient specific basis. PGDs should be reserved for those limited situations where there is an advantage for patient care without compromising patient safety, and there are clear governance arrangements and accountability.

17.2 Medicines may be either supplied or administered under a PGD. If medication is supplied (i.e. given to the patient to take at a later time) all legal requirements regarding labelling, leaflets and prescription charges apply. If medication is administered directly to the patient these requirements do not apply.

17.3 The legislation enables Patient group direction’s to be used for the supply or administration of medicines by named and authorised individuals in the following registered professional groups:

Chiropodists/Podiatrists

Dental hygienists

Dental therapists

Dieticians

Midwives

Nurses



Occupational Therapists

Optometrists

Orthoptists

Orthotists/Prosthetists

Paramedics

Pharmacists

Physiotherapists

Radiographers

Speech and Language Therapists

17.4 The following groups of medication are not permitted on a PGD:

Unlicensed medicines

Dressings appliances and devices

Radiopharmaceuticals

Abortifacients

17.5 Only certain Controlled Drugs are legally eligible for inclusion in a PGD.

17.6 Consideration for the need of a PGD must follow the recommendations in the NICE good practice guidance.

17.7 Once a need had been identified a proposal to develop a PGD must be submitted to the Medicines Management Group for approval. This proposal must include all information as outlined in the NICE good practice guidance.

17.8 PGDs should be drawn up by a multidisciplinary group and must be signed by a senior doctor and pharmacist, both of whom should have been involved in the group. In addition the Strategic Health Authority, NHS Trust or CCG must authorise the PGD.

17.9 Patient Group Directions must use the Trust template available from the pharmacy department.

17.10 Examples of PGDs are available at : http://www.medicinesresources.nhs.uk/en/Communities/NHS/PGDs/

17.11 The medicines management group will act as the governance group for PGDs and will ensure that the NICE good practice guidance is followed.

17.12 Once PGDs have been approved by the MMG they will be authorised by the Medical Director on behalf of the Trust and published on the intranet.

17.13 Each individual staff member must receive training on each PGD and be signed off as competent prior to supplying or administering medication under the PGD(s). Training records will be kept centrally.

17.14 Where a PGD has been revised with minor changes, these changes can be communicated to staff working under the PGD via a clinical team meeting. Where a large number of changes have been made and based on the complexity of the changes, training sessions may be required

17.15 PGDs will be regularly reviewed, the frequency of which will be determined on a case-by-case basis, but must occur at least every 2 years.

http://www.medicinesresources.nhs.uk/en/Communities/NHS/PGDs/



18. POST QUALIFICATION

18.1 On successful completion of the Non-medical prescribing course the Non-medical prescriber must inform the Trusts’ Non-medical prescribing Lead and register with their professional body. They must also complete the Non Medical Prescribing Notification of Practice form (Appendix I) and the Competency Assessment for Practitioners on completion of the NMP Course (Appendix J) and send to the Trusts’ Non-medical prescribing Lead. The Non-medical prescriber will then be invited to attend the Non-medical prescribing Clinical Forum. On completion the Job description and person specification must be updated to reflect the Non-medical prescribing responsibilities. The Chief Pharmacist will keep a list of signatures of all active non medical prescribers. The Trust Non-medical prescribing Lead will keep copies of the Non medical Prescribing Sample Signature Record sheets (Appendix K).

19. RISK MANAGEMENT

19.1 It is important that both practitioner and patients are protected and supported.

All newly qualified Non-medical prescribers will follow the competency framework pathway to move from Supplementary Prescribers to Independent Prescribers in practice

All newly appointed practitioners who are already qualified as a Non-medical prescriber and have continuous prescribing practice will need to provide the Non-medical prescribing sub-group with a written reference from their previous line manager regarding their Non-medical prescribing practice using the template in Appendix L.

All Non-medical prescribers will have their prescribing practice monitored by their Line Manager and where possible by their designated medical practitioner via their annual PDR

All Supplementary Prescribers will have prescribing supervision every 4-6 weeks which will be additional to their clinical supervision if the designated medical practitioner is not their line manager

All Non-medical prescribers will attend a minimum of 3 Non-medical prescribing Clinical Support groups per year for support in practice, mentoring and continuing professional development. Failure to attend may lead to termination of practice

All Non-medical prescribers will attend a Non-medical prescribing update course annually which will be funded and sourced centrally

All Non-medical prescribers should undertake continuing professional development to update them within their practice area and should retain evidence of this.

A prescribing audit will be carried out by the Non-medical prescribers in each area of practice. The results of the audit will be sent to the Trusts’ Non-medical prescribing lead and discussed locally in the appropriate clinical governance forum.



Non-medical prescribers must adhere to the Trusts’ Medicines Policy (M2), Non-medical prescribing Policy (N6) and Incident Policy (I8) and all other policies, procedures and guidance related to medicines management as well as guidance in the British National Formulary and follow their agreed standard operating procedure and formulary

All non-medical prescribing errors must be reported using the Trust incident reporting system

If a patient suffers harm due to an adverse incident or if harm could have been caused to the patient [near miss], the incident or near miss must be reported by the non-medical prescriber using the Trusts’ Reporting system. If the patient experiences an adverse reaction to a medication it may also require reporting on the MHRA yellow card scheme (https://yellowcard.mhra.gov.uk/).

The CSU will make arrangements to monitor and audit non medical prescribing within its services. It is recommended that audit information is collected annually to include:

o frequency of prescribing,

o standard of documentation and record keeping,

o items prescribed and cost

o adherence to shared care arrangements

20. RECORD KEEPING

Non-medical prescribers must adhere to the procedure for record keeping as laid out in the Medicines Policy (M2), Health Records Policy (H8) and Consent to Examination or Treatment Policy (C7).

Nurse prescribers must adhere to the Guidelines for Records and Record Keeping [NMC 2004a].

All medicines prescribed on an FP10 or outpatient prescription by a non-medical prescriber should be stamped, with the individuals name and professional registration number to indicate that it is the prescription of a non-medical prescriber. Ward based staff will use the inpatient prescription chart so will not require a stamp.

A record of the non-medical prescribers’ prescription must be entered into the patients’ health care notes contemporaneously.

In the instance of supplementary prescribing both the independent and supplementary prescriber must agree and record the Clinical Management Plan with the consent of the patient/guardian before supplementary prescribing can begin.

21. LEGAL AND CLINICAL LIABILITY

21.1 Prescribers are individually accountable to their own professional regulatory bodies and must at all times act in accordance with the relevant professional codes.

21.2 Prescribers are accountable for their own practice and are responsible for ensuring they maintain the necessary knowledge, skills and clinical competence to practice.



21.3 West London MH NHS Trust as an employer will accept vicarious liability for the actions of non-medical prescribers providing:

They have successfully completed an approved training course

The required professional registration process is complete and current

The Trusts’ notification process has been followed

The prescriber has Trust authorisation to prescribe within a specific clinical domain and this is reflected in the current job description

The prescriber has followed this and the Medicines Management policies, procedures and guidance

The prescriber can demonstrate they have met continuing professional development requirements.

The prescriber has prescribed within the agreed formulary for their area

22. MONITORING

The monitoring if the Non-medical prescribing policy (N6) will be monitored by the Trusts Non-medical Prescribing Group.

Outcomes from monitoring of the Non-medical prescribing policy (N6) will be reported to the Medicines Management Group who report to the Clinical Effectiveness & Compliance Committee.

The Clinical Effectiveness and Compliance committee will report Medicines Management Outcomes to the Trust Board.

Compliance with the Non-medical prescribing policy (N6) will be monitored through a number of methods including audit as outlined in the monitoring template.

Where poor compliance is highlighted the lead for that service will be required to develop an action plan to address these areas which will need to be reported to the Non-medical prescribing group.

Arrangements must be put in place in each service for an appropriate clinical or managerial staff to audit one in ten of all prescriptions written by non medical prescribers.

Prescribing skills and competences will be discussed at individual’s annual PDR meeting with their line manager.

The non medical prescriber will be expected to undertake an annual audit of their prescribing practice in collaboration with the clinical audit department.

23. GLOSSARY OF TERMS/ACRONYMS

Commonly Used abbreviations

AHP Allied Health Professional



CMP Clinical Management Plan

CSU Clinical Service Unit

DHSS Department of Health and Social Services

DoH Department of Health

GPC General Pharmaceutical Council

MHRA Medicines and healthcare products regulatory agency

NHS National Health Service

NMC Nursing and Midwifery Council

NMP Non-Medical Prescribing

PCT Primary Care Trust

PDR Performance Development Review

WLMHT West London Mental Health Trust

24. REFERENCES

Department of Health [1999] Crown Report - Review of Prescribing, Supply and Administration of medicines.

Department of Health [2000] The NHS Plan. London.

Department of Health [updated May 2005] Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England: a guide to implementation.

Department of Health [2004] Supplementary prescribing. Frequently asked questions. Last updated 29/09/04.

Department of Health [2006] Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing with the NHS in England.

Health professions Council [2004] Standards of Conduct, Performance and Ethics.

Nursing and Midwifery Council [2008] The Code: Standards of conduct, performance & ethics for nurses & midwives.

Nursing and Midwifery Council [2008] Standards for medicine management.

Nursing and Midwifery Council [2004a] Guidelines for Records and Record Keeping.

Nursing and Midwifery Council [2006] A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England.

Nursing and Midwifery Council [2006] Standards of proficiency for nurse and midwife prescribers.

Standards of conduct, ethics and performance (July 2012) General Pharmaceutical Council (GPC)



Further Information can be obtained from:

Department of Health www.doh.gov.uk

National Prescribing Centre website www.npc.co.uk

General Pharmaceutical Council website http://www.pharmacyregulation.org/

Centre for Pharmacy Postgraduate Education (CPPE) PGD Training https://www.cppe.ac.uk/programmes/l/ptgpdir-e-01/

http://www.doh.gov.uk/

http://www.npc.co.uk/

http://www.pharmacyregulation.org/

https://www.cppe.ac.uk/programmes/l/ptgpdir-e-01/



APPENDIX A CLINICAL MANAGEMENT PLAN TEMPLATE

MEWOOR IDENTIFYING NEW PRESCRIBERS Name of Patient: Patient medication sensitivities/allergies:

Patient identification e.g. ID number, date of birth:

Independent Prescriber(s): Supplementary Prescriber(s):

Condition(s) to be treated Aim of treatment

Medicines that may be prescribed by SP:

Preparation Indication Dose schedule Specific indications for referral back to IP

Guidelines or protocols supporting Clinical Management Plan

Frequency of review and monitoring by:

Supplementary prescriber Supplementary and independent prescriber

Process for reporting ADRs

Shared record to be used by IP and SP:

Agreed by independent prescriber(s)

Date Agreed by supplementary prescriber(s)

Date Date agreed with patient/guardian



Medications that have been approved for prescribing will depend on whether the practitioner is acting as an independent or supplementary prescriber.

Medication Independent Supplementary (CMP required)

Clozapine

Hyoscine Hydrobromide (off-label - approved)

Pirenzepine (unlicensed) x

Tests that can be ordered by non-medical practitioners working in clozapine clinics.

Test Frequency

ECG Baseline when maintenance dose reached then every 6 months

Full Blood Count (FBC) Baseline Weekly for 18 weeks then fortnightly for the first year thereafter every 4 weeks or as required by ZTAS.

Glucose Monitoring (BMs) (fasting if possible)

Baseline at 1 month then every 3 – 6 months

Lipids (fasting if possible) eg cholesterol LDLs, HDLs, triglycerides

Baseline every 3 months for 1 year then 12 monthly

Liver Function Test (LFTs) Baseline every 12 months

Urea and Electrolytes (U+Es) every 12 months

Plasma Assays

Medication Time to Steady State

Form When to take level

Therapeutic Range

Clozapine 2-3 days Tablets 12 hours post dose

0.35mg/l – 0.6mg/l

References

1. Clozapine Zaponex Summary of Product Characteristics (SPC) Leyden Delta BV 11th March 2010 http://www.ztas.co.uk/pdf/Zaponex_Summary_of_Product_Characteristics_2010.pdf

2. WLMHT Blood and ECG Monitoring for patients prescribed psychotropic medication.

Approved formulary for non-medical prescribers working in Clozapine Clinics

APPENDIX B





Lithium Carbonate Tablets

Lithium Citrate Liquid

Tests that can be ordered by non-medical prescribers working in Lithium clinics

Test Frequency

ECG Baseline

Full Blood Count (FBC) Baseline Weekly for 18 weeks then fortnightly for the first year thereafter every 4 weeks or as required by ZTAS.

Urea and Electrolytes (U+Es) Baseline every 6 months

Thyroid Function Tests Baseline every 6 months

Plasma Assays

Medication Time to Steady State

Form When to take level

Therapeutic Range

Lithium 4-5 days MR tablets 12 hours post dose

0.6 -1.0mmol/l

Liquid or ordinary release tablets

Pre-dose (bd dosing)

Approved formulary for non-medical prescribers working in Lithium Clinics




Medication Controlled Drug?

Independent* Supplementary (CMP required)

Methylphenidate Yes

Dexamfetamine Yes

Atomoxetine No

*Changes to the Misuse of Drugs Regulations 2001 (Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 (Statutory Instrument 2012/973)) came into force on 23rd April 2012 allowing nurse and pharmacist 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. Tests that can be ordered by non-medical practitioners working in ADHD clinics.

Test Frequency

ECG

Baseline (if indicated)

Approved formulary for non-medical prescribers working in ADHD Clinics





Donepezil

Galantamine

Rivastigmine

Memantine

Tests that can be ordered by non-medical prescribers working in Memory clinics.

Test Frequency

ECG At the beginning before initiation. However, report needs to be interpreted by a doctor.

Blood tests including FBC, U&E, LFT, Sugar ( F) , TFT, Serum B12 & Folate, CRP, Lipid profile

At the beginning before initiation. However, report needs to be interpreted by a doctor.

MSU for C/S At the beginning or if any deterioration is suspected. The report may need to be discussed with a doctor.

Approved formulary for non-medical prescribers working in Memory Clinics



1.0 INTRODUCTION

The Department of Health have extended prescribing responsibilities to a range of professions including nurses and pharmacists to make it easier and quicker for patients to get the medicines they need without compromising patient safety. Non-medical prescribing (NMP) contributes to a more flexible team making better use of the skills of health professionals and increases patient choice in accessing medicines.

2.0 PURPOSE

The aim of this procedure is to ensure consistent processes are in place across the [Service area] for supplementary non-medical prescribing of [Treatment].

3.0 SCOPE

This procedure should be followed by all non-medical prescribers working in the [Service area] as supplementary prescribers. This procedure must be used in line with the Medicines Policy (M2) and the Non-Medical Prescribing Policy (N6).

4.0 PROCEDURE FOR INITIATING SUPPLEMENTARY NON MEDICAL PRESCRIBING

Standard Operating Procedure for Supplementary Non Medical Prescribing of [Treatment(s)] for service users in the [Practice Area]

[ ] Service

APPENDIX C



4.1 [To be completed by service, must include consent, how medicines will be prescribed e.g. FP10, inpatient chart and required documentation]

5.0 PROCEDURE FOR ONGOING TREATMENT FOR SERVICE USERS

5.1 [To be completed by service]

6.0 PROCEDURE FOR STOPPING TREATMENT

[Treatment] will be stopped, in discussion with the Independent prescriber, either if the service user has unacceptable side effects, poor concordance or if the medicine is no longer shown to be effective.

7.0 REFERENCES

British national Formulary http://www.bnf.org/bnf/index.htm [Additional references to be completed by service, e.g. NICE guidance]

8.0 TRAINING

8.1 A minimum of monthly senior medical supervision from the Independent Prescriber

8.2 A minimum of 3 attendances a year at the Trust Non-medical Practitioner

clinical support group 8.3 Annual attendance at a Non-medical Practitioner update course which will

be funded and sourced centrally 8.4 Continuing professional development within the practice area (evidence of

this must be retained)

9.0 MONITORING Yearly audit of each prescribers practice using a standardised tool to be overseen by the trust Non-medical Practitioner lead prior to each prescribers yearly review.

Trust Non-medical Practitioner lead to collate audit findings and present to Medicines Management Group and Nurse Governance on a yearly basis.

http://www.bnf.org/bnf/index.htm



1.0 INTRODUCTION

The Department of Health have extended prescribing responsibilities to a range of professions including nurses and pharmacists to make it easier and quicker for patients to get the medicines they need without compromising patient safety. Non-medical prescribing (Non-medical Practitioner) contributes to a more flexible team making better use of the skills of health professionals and increases patient choice in accessing medicines.

2.0 PURPOSE

The aim of this procedure is to ensure consistent processes are in place across the [Service area] for independent non-medical prescribing of [Treatment].

3.0 SCOPE

This procedure should be followed by all non-medical prescribers working in the [Service area] as independent prescribers. This procedure must be used in line with the Medicines Policy (M2) and the Non-Medical Prescribing Policy (N6).

4.0 PROCEDURE FOR INITIATING INDEPENDENT NON MEDICAL PRESCRIBING

4.2 [To be completed by service, must include consent, how medicines will be prescribed e.g. FP10, inpatient chart and required documentation]

Standard Operating Procedure for Independent Non Medical Prescribing of [Treatment(s)] for service users in the [Practice Area]

[ ] Service



5.0 PROCEDURE FOR ONGOING TREATMENT FOR SERVICE USERS

5.2 [To be completed by service]

6.0 PROCEDURE FOR STOPPING TREATMENT

[Treatment] will be stopped, in discussion with the Independent prescriber, either if the service user has unacceptable side effects, poor concordance or if the medicine is no longer shown to be effective.

7.0 REFERENCES

British national Formulary http://www.bnf.org/bnf/index.htm [Additional references to be completed by service, e.g. NICE guidance]

8.0 TRAINING

8.5 A minimum of monthly senior medical supervision from an Independent Prescriber

8.6 A minimum of 3 attendances a year at the Trust Non-medical Practitioner

clinical support group 8.7 Annual attendance at a Non-medical Practitioner update course which will

be funded and sourced centrally 8.8 Continuing professional development within the practice area (evidence of

this must be retained)

9.0 MONITORING Yearly audit of each prescribers practice using a standardised tool to be overseen by the trust Non-medical Practitioner lead prior to each prescribers yearly review.

Trust Non-medical Practitioner lead to collate audit findings and present to Medicines Management Group and Nurse Governance on a yearly basis.

http://www.bnf.org/bnf/index.htm



APPENDIX D

NMP Formulary e.g. ADHD

Medication to be added

Indication

Monitoring requirements

Off-label? Y/N

Medication to be added

Indication

Monitoring requirements

Off-label?

Please add additional rows as required. Any other relevant information: This has been discussed at (service area meeting): On (date): And has been approved by (clinical lead): Name: Signature: Date: Once completed this form should be submitted to the NMP sub group for agreement prior to being approved at the MMG.

Request To Add Medicine to NMP Formulary



This assessment should be completed by the designated medical practitioner (Designated Medical Practitioner) who has supported the supplementary prescribing practitioner. The supplementary prescriber must have completed a minimum of 6 months supplementary prescribing.

Name of practitioner being assessed:

Area of practice for supplementary prescribing:

1. Date supplementary prescriber began prescribing under your supervision?

2. How many patients does the supplementary prescriber currently have on their case load that they are prescribing for?

3. Is the supplementary prescriber competent in assessing the patient’s condition within their area of practice?

4. Is the supplementary prescriber competent prescribing medication for the patient’s condition within their area of practice?

5. Is the supplementary prescriber competent in identifying changes in the patient within their area of practice?

e.g. mental health state treatment plan physical health adverse effects

Competency Assessment for Supplementary to Independent Prescribing

APPENDIX E



6. Has the supplementary prescriber prescribed medication outside of their agreed formulary? If Yes give details:

7. Has the supplementary prescriber made any errors in the last six

months? If Yes give details:

8. Do you have any concerns regarding this practitioners prescribing practice? If Yes give details:

9. Do you support this practitioner becoming an independent prescriber in their agreed area of practice? If No please specify reasons

Signed:

Print Name:

Date:

Once completed this form should be sent to the non-medical prescribing lead with the practitioner’s audit of their prescribing practice and at least one documented evidence of attendance at an educational event or a piece of reflective practice relevant to their area of practice . A decision will be made at the next non-medical prescribing meeting on the practitioner progressing to independent prescribing.



APPENDIX F

Application for funding for Non-medical Prescribing Training For nurses, Pharmacists and Eligible Allied Health Professionals

Funding is dependent upon a clearly articulated prescribing role, organisational support and the availability of a Designated Medical Practitioner. In order to obtain funding it is essential that all three sections of this form are completed and signed by the appropriate people. Funding is only available for the cost of the course and is not available for backfill or any other incidental costs. Once completed forms should be sent the Non-medical Prescribing Lead. SECTION A: To be completed by the Applicant:

Applicants Full Name:

Address for correspondence:

Postcode:

Daytime Telephone:

E-mail:

NMC* / GPC* / HPC* / GOC* Number:

Job Title:

Place of Work:

Prescribing Support and Networking It is essential that you establish links with your local Non-medical Prescribing Lead. Non-medical Prescribing Leads Name: Sandra Bailey

Please tick to confirm that you have discussed this and agreed this with the above person

□

Higher Education Institution

State which University you will apply Anticipated start date:



SECTION A continued

1. Describe how being able to prescribe will enhance you service to patients.

Please address the following issues

Has this area of practice been approved by the Trust? If Y will you be working in an established NMP service?(If Y continue to question 2 if N

complete questions below) If N complete questions below.

Please give an estimate of the number of patients that will be affected by your prescribing

Describe how prescribing will increase patients’ access and choice?

How will the quality of the service be improved?

How will the team/service in which you work will be affected by your prescribing? 2, Describe how you intend to maintain your prescribing competence, please include any CPD Networks you will be part of

Declaration by the applicant I confirm that I:

Can study at level three; Have had at least three years post registration experience (two years for Registered Pharmacists); Have worked for at least one year in the clinical specialty where I intend to prescribe; Have the clinical assessment and decision making skills that will enable me to work as a prescriber once I have completed the course

Signed: Date:



SECTION B: To be completed by the Manager ( Service/Senior Nurse Manager)

Managers’ Name:

Job Title:

Contact Telephone or e-mail address:

Declaration by the Manager I confirm that:

There is a clinical need in the applicant’s role for prescribing The applicant has the appropriate clinical assessment and decision making skills to be able to apply the principles of Prescribing to their area of practice. The applicant has had appropriate CRB clearance in order to function as a prescriber.

The new prescribing role will support the delivery and quality of service delivery and is part of a core programme of activity. The service will release the applicant for the study time required to complete the course and support the applicant in maintaining their competence as a prescriber through Continuing Professional Development.

Signed Date

SECTION C: to be completed by the Designated Medical Practitioner

Designated Medical Practitioner’s Name:

Job Title:

Contact Telephone or e-mail address:

Declaration by the Designated Medical Practitioner I confirm that:

I meet the requirements of the Department of Health to act as a Designated Medical Practitioner

I will provide structured quality practice-based learning as directed by the applicants course requirements I will provide feedback to the applicant and assess their competence to prescribe using the criteria of the course I will provide 12 days of supervised practice (or the equivalent number of hours)

(Further information can be obtained from the NPC Publication: Training non-medical prescribers in practice: a guide to help doctors prepare for and carry out the role of the designated medical practitioner available from www.npc.co.uk) and UWL DMP guidance booklet

Signed Date

http://www.npc.co.uk/



APPENDIX G – GUIDANCE NOTES FOR COMPLETING APPLICATION FORM

PLEASE ENSURE ALL SECTIONS OF THIS FORM ARE COMPLETED AND ALL THREE SECTIONS ARE SIGNED

How to complete this Application

Section A is to be completed by the proposed prescriber

Non-medical Prescribing Lead

You will need to discuss and agree your application with this person (even if you are not directly employed by them). This is to ensure a strategic approach is taken in the allocation of funding. Applications that have not been agreed with the appropriate Non-medical Prescribing Lead will be returned.

Higher Education Institution A decision will be made centrally as to the HEI where places will be contracted. You will be sent an application form to the University with confirmation of funding. Describe how Prescribing will enhance your service to patients Please be as specific as possible and address the issues listed on the form.

Section B: To be completed by the Employer

This should be completed by someone who has delegated responsibility to sign on behalf of the Trust. Your Non-medical prescribing lead can advise you who this should be.

Section C: To be completed by the Designated Medical Practitioner.

This must be completed by the Doctor who is going to be your supervisor.

The medical supervisor must be a registered Medical Practitioner (Doctor) who:

EITHER • Has at least three years recent relevant clinical experience for a group of

patients/ clients in the relevant field

OR

• Is a Specialist Registrar, Clinical Assistant or Consultant within the Trust • Has the support of the Trust to act as DMP • Has some experience of training in teaching and / or supervising in practice

FORMS THAT ARE RECEIVED WITHOUT ALL THREE SECTIONS SIGNED WILL BE RETURNED



APPENDIX H CHECK LIST/ EVIDENCE SHEET

ENDIX B CHECK LIST / EVIDENCE SHEET

This check list / evidence sheet must accompany all applications made for access

to courses. No application form may be submitted, or application made to a

university until this sheet has

been signed off by the Trust.

1. Personal Details

Name: Area of work: Job title:

Length of time in role:

Highest academic achievement and date:

2. Summary of Proposal if not an approved Trust established NMP Service

Full details should appear on the application form:

3. Give the names of individuals/groups with which this has been discussed and agreed.

4. Cost

i) What is the likely cost implication of Prescribing? (Give details)

ii) Which budget would you be accessing? (Give name /number)

iii) Who is the budget manager?



5. Who will be your Designated Medical Practitioner whilst on the course?

Signed Applicant

Applicant Date

Signed Senior Nurse / Service Manager

Line Manager Date

Signed

Non-Medical Prescribing Lead Date

Signed Chief Pharmacist

Prescribing Lead Date

Signed

Deputy Director of Nursing Date



APPENDIX I

SUMMARY OF ROUTE TO NON MEDICAL PRESCRIBING

1. Practitioner, manager, professional lead and lead clinician identify service need for non medical prescribing.

2. Medical practitioner meeting DOH criteria agrees to act as mentor/assessor. 3. Application Form [Appendix E] and Check list/evidence sheet [Appendix G]

completed and Higher Education Institution [HEI] notified centrally 4. Application agreed by non medical prescribing sub-group. 5. Trust application made for study leave to line manager. 6. Trust application form and HEI application form submitted to the

Professional Development Co-ordinator. 7. Trusts’ NMP Lead and practitioner’s professional body notified of successful

completion by HEI. 8. Non medical prescriber completes professional registration documents and

provides payment of professional registration fee. Professional register annotated accordingly.

9. Non medical Prescriber Notification of Practice Form [Appendix I] completed and sent to:

• Non-medical prescribing lead to enter name on Trust Prescribers’ Register

• Head of Education 10. Sample signature record (appendix J) completed and sent to chief

pharmacist. 11. Non medical prescriber’s personnel file and job description amended

to reflect change. 12. Supplementary prescribers develop CMP[s] with independent prescriber. 13. Non medical prescriber begins prescribing.



APPENDIX J

SUPPLEMNENTARY AND INDEPENDENT PRESCRIBING NOTIFICATION OF PRACTICE

DIX E NON MEDICAL PRESCRIBING NOTIFICATION OF TICE

Name of Professional

Job Title

Service

Clinical Specialty

Lead Medical Prescriber in area of practice

Area of Prescribing [Specify service or clinic]

Budget/Financial Code against which prescribing will be allocated [if applicable]

The above named professional has gained the following prescribing qualification [s]

Supplementary and Independent Prescribing Yes [ ] No [ ]

Academic Institution

Course dates

Professional Registration Number

Date or Entry Number

Signatures

Print Name……………………………….. Sign……………………………

Date

I confirm that the qualification stated above is now recorded against the individual’s entry in their professional register



Print Name ………………………………. Sign

…………………………. Line Manager Date

I confirm that the Service supports the above named individual in their role as non medial prescriber in the clinical area specified

Print name………………………………… Sign

………………………… Senior Manager Date



APPENDIX K

This section of the assessment should be completed by the practitioner.

Name of practitioner:

Area of practice for prescribing:

To support your transition to practice please indicate your preference below:

Option Tick

I wish to undertake a period of time as a supplementary prescriber prior to independently prescribing to support my transition to practice

I wish to move straight to independent prescribing

Once this section is completed this form should be given to your DMP. This section of the assessment should be completed by the designated medical practitioner (DMP) who has supported the practitioner during their non-medical prescribing course.

1. Is the practitioner competent in assessing the patient’s condition within their area of practice?

2. Is the practitioner competent in formulating a diagnosis in their area of practice?

Competency Assessment for Practitioners on completion of the NMP Course



3. Is the practitioner competent in prescribing medication for the patient’s condition within their area of practice?

4. Is the practitioner competent in identifying changes in the patient within their area of practice?

e.g. mental health state treatment plan physical health adverse effects

5. Has the practitioner recommended medication outside of their agreed formulary? If Yes give details:

6. In your opinion is the practitioner competent to prescribe safely within their area of practice? (If no give details of any concerns)

7. Do you support this practitioner becoming an independent prescriber in their agreed area of practice? If No please specify reasons

Signed:

Print Name:

Date:

Once completed this form should be sent to the non-medical prescribing lead with a copy of the final university course competency assessment. A decision will be made at the next non-medical prescribing meeting as to whether the practitioner can independently prescribe or whether a period of supplementary prescribing is required.



APPENDIX L

NON MEDICAL PRESCRIBING SAMPLE SIGNATURE RECORD

MEWOOR IDENTIFYING NEW PRESCRIBERS Non Medical Prescriber Sample Signature Record

Name [Block Capitals]

Sample Signature

Sample of signing using

initials

This completed form must be sent to the Chief Pharmacist



This reference should be completed by the line manager. The independent prescriber must have completed a minimum of 6 months continuous practice.

Name of practitioner:

Area of practice for independent prescribing:

1. Date prescriber began independent prescribing under your management?

2. How many patients does the independent prescriber currently have on their case load that they are prescribing for?

3. Has the independent prescriber prescribed medication outside of their area of practice? If Yes give details:

4. Has the independent prescriber made any errors in the last six months? If Yes give details:

5. Do you have any concerns regarding this practitioners prescribing practice? If Yes give details:

6. Are there any ongoing disciplinary actions or complaints regarding the practitioners prescribing practice? If Yes give details:

Practice Reference for Independent Prescribers Joining the Trust

APPENDIX M



Signed:

Print Name:

Job Designation:

Name of Organisation:

Contact Number:

The practitioner should send the completed from to their prospective line manager. The line manager will send a copy of the form to the NMP sub group Chair. A decision will be made at the next non-medical prescribing meeting on the practitioner’s suitability to independently prescribe within the service. The prescriber should not practice until authorisation has been given.