Since May 2006, some nurses and pharmacists have been allowed to prescribe medicines that were previously only allowed to be prescribed by doctors. Non-medical prescribing has been introduced to improve patients’ access to treatment – that is, making it easier for you to get the medicines you need for your child. This page from Great Ormond Street Hospital (GOSH) explains about the process.
Only nurses and pharmacists that have been trained to prescribe will be allowed to do so, and they can only prescribe medicines that are within their area of expertise. The training required is in addition to their main qualification. To enable them to prescribe safely, they must also undergo assessments and examinations regarding, for example, the legal and ethical aspects of prescribing medicines.All non-medical prescribers at GOSH have to keep up to date by attending regular courses.
There are two types of non-medical prescribers: independent and supplementary. Independent non-medical prescribers can prescribe any medicines within their area of expertise.
There may be some circumstances where medicines are prescribed in partnership with a doctor. This is called supplementary prescribing. The doctor and non-medical prescriber will draw up a clinical management plan to be followed, after discussion and agreement with you. You will be given a copy of this plan to file in your family held record. Supplementary prescribers can then go on to prescribe or review the treatment and change medicine, dosage, timing or frequency of the medicine as appropriate.
Will there be any difference between a doctor prescribing the medicine or a non-medical prescriber?
No. You can expect the non-medical prescriber to go through the same procedure and ask the same questions as a doctor would.
What can I expect from a non-medical prescriber?
Non-medical prescribers will ensure that your child’s doctor is aware of any medicines they have prescribed for your child.
On some occasions, the non-medical prescriber will consult with you, along with a doctor, and make a joint decision about what to prescribe. In this case, your child will usually be followed up by the non-medical prescriber who will be able to change the medicine, dosage, timing or frequency of the medicine as appropriate. The non-medical prescriber may refer you back to the doctor if either they or you feel that it is appropriate.
In order to reduce the amount of time you have to wait for medicines including chemotherapy, medicines for certain procedures or medicines to take home, some prescriptions are written in advance of your visit. All treatment changes are recorded in your child’s medical notes so that all members of the prescribing team looking after your child know what decisions have been made and what to prescribe for your child.
How can I check if my pharmacist is a prescriber?
The General Pharmaceutical Council keeps a register of all pharmacists, including those who are qualified to prescribe. To search for a particular pharmacist, you will need to know their full name and/or their registration number. If you have this information, you can search the register yourself at www.pharmacyregulation.org/registers/pharmacist. Alternatively you can ask your pharmacist’s employer.
How can I check if my nurse is a prescriber?
You may check with your nurse’s employer. The Nursing and Midwifery Council (NMC) keeps a register of all nurses who are qualified to prescribe. To search for a particular nurse, you will need to know their full name or their membership (PIN) number. If you have this information, you can either telephone 020 7333 9333 or search the register yourself at www.nmc-uk.org
How can I be confident that a non-medical prescriber can safely prescribe for my child?
In line with Standards of Conduct, Ethics and Performance for pharmacy professionals (The Code of Professional Conduct), all pharmacists including those with prescribing qualifications have a duty to remain competent by keeping their knowledge and skills up to date.
Nurses with prescribing qualifications have to adhere to the Standards of Proficiency for Nurse and Midwife Prescribers. They too have a duty to remain competent by keeping their knowledge and skills up to date. Employers also have a responsibility to ensure that non-medical prescribers undertake the relevant training and development, so that their knowledge and skills remain up to date.
A non-medical prescriber should not prescribe for your child if they feel they are not competent to do so. This may be because your child’s condition is outside their area of expertise or because they do not feel that they have the necessary skills or experience to recommend a change in your child’s medicines. In such instances, they will refer you to a more experienced prescriber.
Where do I go if I have any concerns about a non-medical prescriber?
Initially, you should raise your concerns with the prescriber concerned. If you feel unable to do this, you should contact their manager or employer.
Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.
For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.
For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.