Non-medical prescribing in end of life care – overcoming the barriers

Categories: Care.

The past 15 years has seen extensive changes in non-medical prescribing – the prescribing of medicines by healthcare professionals who are not doctors. The most recent legislation in 2012 allowed non-medical prescribers (NMPs) to prescribe controlled drugs, such as morphine.

This legislative change gave non-medical prescribers in palliative care access to the majority of medications required to support them to manage their patients’ symptoms, such as morphine preparations and fentanyl patches.

So it is unsurprising that palliative care has seen growth in the number of non-medical prescribers; a national survey undertaken of Executive Clinical Leaders in Palliative Care (1) found that, out of 52 responses, 58% of community clinical nurse specialist were qualified NMPs who were actively prescribing.

However, those responding to the survey also highlighted multiple reasons as to why teams did not prescribe, including the training required, engagement and support of primary care, expectations of the role, not wanting to de-skill doctors and difficulties in accessing prescription pads.

Another regional survey (2) found additional barriers: the transition from qualifying to actually prescribing was frequently delayed, with 57% of respondents having to wait between two and four months to prescribe. These delays are caused by the need to register the qualification with the Nursing and Midwifery Council and register for prescription pads before you can begin prescribing. Lack of confidence and time were also cited as significant issues.

With patients expressing a wish to die at home there are significant advantages for NMPs who are specialists in palliative care being able to assess and prescribe, to meet the patients’ needs in a timely way. (3) NMPs working in inpatient units and day hospices also have a pivotal role in ensuring high quality medicines management.

What do hospices need to do to support non-medical practitioners to become practicing non-medical prescribers?

St Gemma’s Hospice and Sue Ryder Wheatfields Hospice, in partnership with Hospice UK, are hosting a workshop on 14 October 2015 in Leeds to discuss the barriers to non-medical prescribing. A range of speakers including governance leads, university lecturers and front-line practitioners will be presenting, taking questions and leading on workshops to help you develop non-medical prescribing in your own hospice.

The event is aimed at clinical leaders and chief executives who would like to introduce non-medical prescribing, non-medical prescribers who wish to expand and develop their practice and anyone else who wants to learn more about the benefits of non-medical prescribing in end of life care.

For more information on this workshop, or to book your place, visit Hospice UK’s website.


  1. Horne G. Results from a survey of Executive Clinical Leaders in Palliative Care (ECLiHP) members. 2014 (unpublished).
  2. Ziegler L, Bennett M, Blenkinsop A, Coppock S. Non-medical prescribing in palliative care: A regional survey. Palliative Medicine. 2015; 29(2):177-181.
  3. Wood C, Slater J. A time and a place: what people want at the end of life. Sue Ryder; 2013.

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