About Non-Medical Prescribing

Legislation permitting the prescription of medicines by health professionals other than doctors and dentists has been in place since the mid-1990s. This enables patients to have timely access to medicines prescribed by the most appropriate practitioner often without them being required to attend further appointments or see additional health professionals. Non-medical prescribing has enabled the emergence of new clinical services and development of existing ones.

NHS North West of England has been at the forefront of developments in Non-Medical Prescribing during this long journey, investing in NMP through various projects including ‘Prescribing for Success’. The North West has one of the highest numbers of NMPs within Great Britain.

NMP Definitions

1. Independent Prescribing

Independent prescribers are responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing.

  • Nurse and pharmacist independent prescribers are able to prescribe any medicine for any medical condition within their competence, including most controlled drugs in Schedules 2, 3, 4 and 5.
  • Optometrist independent prescribers can prescribe any licensed medicine for ocular conditions affecting the eye and surrounding tissue, but cannot prescribe any controlled drugs.
  • Physiotherapists, podiatrists, and therapeutic radiographers can prescribe any licensed medicine provided it falls within their individual area of competence and respective scope of practice as independent prescribers, and from a limited list of controlled drugs.

2. Supplementary prescribing

Supplementary prescribers may prescribe any medicine (including controlled drugs), within the framework of a patient-specific clinical management plan, which has been agreed with an independent medical prescriber and the patient.

Nurses, pharmacists, physiotherapists, podiatrists, therapeutic radiographers, and optometrists train as a supplementary prescriber alongside their independent prescribing preparation.
Dieticians and diagnostic radiographers may train and register as a supplementary prescriber only.

3. Prescribing by Community Practitioners from the Nurse Prescribers’ Formulary for Community Practitioners

Community Practitioners, including District Nurses and Health Visitors, are able to prescribe independently from a limited formulary comprising dressings and appliances, and a limited range of medicines suitable for use in community settings.

Historical Context of NMP

Following the introduction of the necessary legislation in 1992 and 1994, nurse prescribing for District Nurses (DNs) and Health Visitors (HVs) was first piloted in eight GP fund- holding practices in 1994. It was expanded to a whole district community NHS Trust in 1996 and to a further community Trust in each of the seven remaining regions in 1997. Following this successful pilot, Ministers agreed that prescribing for DNs and HVs could be expanded throughout the UK.

A 3 month consultation began in October 2000 with nursing, medical and pharmacy professional organisations. Following this, in May 2001 Ministers announced that nurse prescribing would be extended to more nurses and a wider range of medicines, known as extended independent nurse prescribing, or V200.

To further benefit the NHS and patients, the introduction of supplementary prescribing by nurses and pharmacists, following diagnosis by a doctor was also to be considered. In late 2002, the recommendations from a series of informal consultation meetings on supplementary prescribing with representatives of the medical, pharmacy and nursing professions and a formal joint consultation by the Department of Health and Medicines Control Agency were accepted, to allow supplementary prescribing by suitably trained nurses and pharmacists. This was extended to include supplementary prescribing of Controlled Drugs in March 2005.

Following consultation, also in 2005, specified Allied Health Professionals i.e. physiotherapists, podiatrists and radiographers, were granted prescribing rights to become supplementary prescribers.

Following a further consultation, from May 1st 2006 nurses previously prescribing from the Extended Independent Nurses Formulary were then able to prescribe from the full BNF (with the exception of some Controlled Drugs) and their title was changed to Nurse Independent Prescriber (NIP).

From autumn 2006 pharmacists were able to also prescribe independently from the full BNF (although they were not able to prescribe any Controlled Drugs) and their title was changed to Pharmacist Independent Prescribers (PIP). Pharmacists who had been previously qualified as Supplementary prescribers had to undertake ‘top-up’ days or ‘conversion’ in conjunction with either the HEI where they originally obtained their qualification or an alternative education provider.

From June 2008, optometrists became able to independently prescribe any licensed medicine for ocular conditions (but not controlled drugs).

Since December 2009 nurse and pharmacist independent prescribers have been able to prescribe unlicensed medicines and direct others to mix medicines. In 2012 the legislative changes took place which allowed the prescribing of Schedule 2-5 Controlled Drugs by nurse and pharmacist independent prescribers (except diamorphine, cocaine and dipipanone for the treatment of addiction), and to mix and direct others to mix Schedule 2-5 Controlled Drugs.

In 2013 Podiatrist and Physiotherapist prescribing was widened to include independent prescribing status. Those with the supplementary prescribing qualification are required to undertake conversion courses to become independent prescribers.

In 2016 therapeutic radiographers were able to become independent prescribers and those already qualified are required to undertake conversion courses to become independent prescribers. Also in 2016 dieticians became eligible to train as supplementary prescribers and orthoptists gained exemptions to administer certain medicines.

Professional Standards Related to Prescribing

Nursing and Midwifery Council: Standards of proficiency for nurse and midwife prescribers
General Pharmaceutical Council: Standards of conduct, ethics and performance for pharmacists
Health and Care Professions Council: Standards for prescribing
College of Optometrists: Guidance for optometrist prescribers

Stakeholders

Developing the skills and knowledge of health care professionals is a crucial element of workforce sustainability and transformation, plans for the NHS. One of these skills is prescribing.
Equipping suitable health care professionals with a prescribing qualification enables them to deliver more flexible services and to complete episodes of care, which all fits with the QIPP agenda.

Nursing & Midwifery Council
General Pharmaceutical Council
Health and Care Professions Council
Society & College of Radiographers
Chartered Society of Physiotherapy
College of Podiatry
College of Optometrists
Association of UK Dietitians
Association for Prescribers

*Information (links) last updated: 26/08/21