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2016 P.58
STATES OF JERSEY
r DRAFT HEALTH INSURANCE
(AMENDMENT No. 15) (JERSEY)
LAW 201-
Lodged au Greffe on 31st May 2016
by the Minister for Social Security
STATES GREFFE
Page - 3 P.58/2016
DRAFT HEALTH INSURANCE (AMENDMENT
No. 15) (JERSEY) LAW 201-
European Convention on Human Rights
In accordance with the provisions of Article 16 of the Human Rights (Jersey) Law
2000, the Minister for Social Security has made the following statement
In the view of the Minister for Social Security, the provisions of the Draft Health
Insurance (Amendment No. 15) (Jersey) Law 201- are compatible with the
Convention Rights.
Signed: Deputy S.J. Pinel of St. Clement
Minister for Social Security
Dated: 26th May 2016
Page - 4 P.58/2016
REPORT
Introduction
This report presents amendments to the Health Insurance (Jersey) Law 1967 which
seek to establish a mechanism by which specialist nurses and other health care
professionals can issue community prescriptions for prescription-only medicines.
These amendments will also equalise current provisions by expanding the existing
proper and necessary test to community prescribing. The constitution of the Health
Services Disciplinary Tribunal and Pharmaceutical Benefit Advisory Committee are
moved into Ministerial Orders, and further minor amendments have been made to
clarify and align provisions within the Law.
Prescribing practitioners
Medicines issued on a community prescription can be obtained in community
pharmacies, and the cost of the medicine and dispensing fees are paid for by the
Health Insurance Fund. This is established in the Health Insurance (Jersey) Law 1967
which describes these community prescriptions as pharmaceutical benefit. The Law
currently states that only 2 classes of practitioner may issue pharmaceutical benefit:
these being G.P.s and dentists.
P.82/2012: Health and Social Services: A New Way Forward noted that the demand
for health services is set to increase in Jersey as the population ages. At the same time,
our current workforce is under-utilised, with many working below the competencies
associated with their role. P.82/2012 identified the need for a new health and social
care system, and recommended development towards multi-disciplinary teams formed
around the patient care pathway. The vision suggested these teams would include
specialist nurses who are authorised to prescribe medicines within their scope of
practice, that they might support patient care at home and in the community, reducing
our reliance on institutionalised care models. (These specialist nurses are known as
non-medical prescribers.)
P.82/2012 also noted that
Roles [in Jersey] have not developed in line with international best practice,
as there are only a limited number of expanded role practitioners.
Nonmedical prescribing is only now being developed, and the skill mix needs
to change within teams in order to secure service sustainability and offer
more attractive career options.1
Health and Social Services has successfully implemented non-medical prescribing,
following amendments to the Medicines (Jersey) Law 1995 which enabled the
Minister for Health and Social Services to specify a wider range of practitioners who
may prescribe prescription-only medicines. Three additional pieces of secondary
legislation were subsequently enacted, providing legislation around the individual
registration and regulation of non-medical prescribers
Health Care (Registration) (No. 4) (Jersey) Regulations 2012;
Medicines (Prescription Only) (Amendment No. 8) (Jersey) Order 2013; and
Misuse of Drugs (Miscellaneous Amendments) (No. 4) (Jersey) Order 2013.
Thirty-two nurses have completed a bespoke accredited education programme, and
additional non-medical prescribers have been successfully recruited from the UK.
Currently, there are small specialist teams of nurse prescribers who provide symptom
management to stabilise vulnerable patients within their own homes and prevent
hospital admission. These nurses work in the Rapid Response team. Additionally,
https://www.jerseylaw.je/laws/revised/Pages/26.500.aspxhttp://www.statesassembly.gov.je/AssemblyPropositions/2012/P.082-2012.pdfhttps://www.jerseylaw.je/laws/revised/Pages/20.625.aspxhttps://www.jerseylaw.je/laws/enacted/Pages/RO-118-2012.aspxhttps://www.jerseylaw.je/laws/enacted/Pages/RO-082-2013.aspxhttps://www.jerseylaw.je/laws/enacted/Pages/RO-166-2013.aspx
Page - 5 P.58/2016
there are qualified prescribing practitioner nurses working within the specialist
palliative care team who will be able to offer advanced symptom control, and thus
provide choice for terminally-ill patients who wish to die in their own homes. Further
prescribing practitioners (such as practice nurses, district nurses and community-based
pharmacists) could similarly provide improved medicines management across the
Island to patients in a primary care context. The development of such roles enables
service redevelopment to be optimised, and improvements to patient care. In addition,
specific medical roles within the Hospital may also be identified as prescribing
practitioners under the Health Insurance Law to allow new care pathways to be
developed, straddling secondary and primary settings. For example, the introduction
of a specialist palliative care consultant could offer care for patients irrespective of
their care setting, in the General Hospital, in the Hospice, and in their own homes.
Approval to prescribe in the community from the Health Insurance Fund
Non-medical prescribers in other jurisdictions have proven to be highly successful in
providing safe and cost-effective care. Their impact locally can be enhanced by
approving them to issue pharmaceutical benefit within the Health Insurance Law. This
will enable patients (or their carers) to collect medicines from community pharmacies
rather than the General Hospital pharmacy.
To this end, these amendments to the Health Insurance Law expand the class of
practitioner who may issue pharmaceutical benefit to include prescribing
practitioners identified under Article 57(1) of the Medicines (Jersey) Law 1995. The
primary Law is amended to enable an approval process to be established by
Ministerial Orders, whereby individual prescribing practitioners can be approved
according to the service they are providing and the environment (primary care and
community) in which they are working.
The Health Insurance Law already provides an approval process for General
Practitioners (established within the G.P. performers list). The Law has offered some
provision to approve dentists to issue pharmaceutical benefit, but this has not been
enacted. To equalise the treatment of all prescribers under the Health Insurance Law,
these amendments also seek to establish an approval process for dentists. As with non-
medical prescribers, approval will be a simple administrative process established
under Ministerial Orders.
The implementation of an approval process will enable the Minister to maintain a
nominal roll of community prescribers as has been envisaged by Article 26 of the
Law, and will improve the operational procedures for monitoring community
prescriptions.
It can be stressed that in no part does the Health Insurance Law determine which
health professionals may or may not prescribe within the qualification of their
profession. The ability of practitioners to prescribe prescription-only medicines is
established under the Medicines (Jersey) Law 1995, which registers health care
professionals.
Proper and necessary
Medical Benefit is paid from the Health Insurance Law in respect of G.P.
consultations, and the Law requires that the benefit may only be claimed in respect of
G.P. medical services which are proper and necessary. This amendment seeks to
echo this test and apply it to all prescribing funded by the Health insurance Fund, thus
equalising the provisions of the Law to each benefit created under the Law.
Page - 6 P.58/2016
Health Services Disciplinary Tribunal
The Health Insurance Law establishes a Health Services Disciplinary Tribunal which
may rule on the activity of G.P.s and dentists with respect to medical benefit and
pharmaceutical benefit. The Tribunal thus enables the Minister to challenge
practitioner activity and take recommendations on the use of the Fund, when it is
deemed there is cause to do so. This amendment increases the scope of the Tribunal to
include any approved practitioner who may issue Health Insurance Law benefits, thus
capturing the newly-created non-medical prescribers.
The Law currently restricts the issues which the Tribunal may consider to activities
which may be prejudicial to the efficient administration of the Health Insurance Law
or cause an unreasonable cost to the Health Insurance Fund. This is maintained, but
will capture the ability to consider whether prescribing has been proper and
necessary as discussed above. Currently, the Tribunal may only recommend that a
practitioner repay money to the Fund or that their approval is removed. This