The rather dry title belies what is, in fact, a truly emancipatory and exciting development which enables nurses and allied health professionals (AHP) to utilise their expertise and create more clinical capacity to directly improve patients’ care experience.
Non-medical prescribing is prescribing by specifically trained nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers, working within their clinical competence as either independent or supplementary prescribers. [National Prescribing Centre, 2010]
In 2000 the NHS plan stated how “the new approach will shatter the old demarcations which have held back staff and slowed down care…employers will be required to empower appropriately qualified nurses, midwives and therapists to undertake a wider range of clinical tasks including the right to make and receive referrals, admit and discharge patients, order investigations and diagnostic tests, run clinics and prescribe drugs.”
Fifteen years later we are seeing – in very tangible ways – what can happen when ‘old demarcations’ are removed and organisational leaders invest in real professional practice development.
At the masterclass we heard from experts and leaders in the field, including Cath Miller, director of nursing at St Gemma’s, and Jane Turner, deputy chief nurse for Sue Ryder – both of whom have championed and invested in the NMP role and made the case for organisational executive leadership to ensure successful role implementation.
Indeed, genuine engagement by management to ensure that NMPs feel supported and secure in the role was highlighted as one of the most important factors to enabling new practitioners to succeed, along with continued monitoring, support and education.
NMP bring benefits for patients and services
Andrew McEwan, a senior lecturer Leeds Beckett University and a leader of the NMP course for over 12 years, described how adopting the practice brings benefits on many levels:
- Patients have improved access to timely assessment and treatment.
- Practitioners experience an increase in role satisfaction, as they are empowered to meet the needs of their patients and lead new services.
- Services can increase capacity and capability to provide responsive care which could help meet the demand for medical intervention – for example, out of hours.
Another compelling reason for services to build NMP capacity is financial. After staff pay, the biggest expenditure for the NHS is the drug budget – a staggering £15 billion. So getting the most from medicines, for both patients and providers, is increasingly becoming a priority.
While there is a need for further research in this area, there is growing evidence that NMPs lead to improved cost effectiveness for services, due to improved medication choices (Stenner & Courtenay, 2008).
What does NMP mean in practice?
The St Gemma’s Hospice team and local GP Dr Emma Anderson described what NMP can mean in practice and how their team work is built on trust, respect and excellent mutual support.
They described some of the key benefits they have seen, which include:
- a reduction in inappropriate prescribing decisions and prescribing errors
- increased frequency of communication/patient reviews
- timelier access to medications, relieving pressure on regular out of hours services
- improved opiate prescribing by GPs
- increased safety of administration of drugs eg CSCI volumes/diluents
- increased role satisfaction and efficiency for NMP.
The development of NMP practitioners has also led to service development opportunities. For example, a CNS-led four-bed palliative care service in a local care home, nurse-led inpatient units beds and a seven-day CNS service – all directly improving the end of life care experience for people in the community.
There has also been an increase in trust in NMPs from other healthcare professionals, for example, one GP expressed that patients “would not have received such appropriate and quick management from an out of hours GP.”
There is also the opportunity for informal education and up-skilling for other healthcare professionals on drugs and appropriate prescribing as NMPs create opportunity to share their knowledge with doctors through their prescribing decisions. (Stenner & Courtenay, 2008).
As one local pharmacist commented “I find the independent prescribers a valuable member of a community team, especially when it comes to dealing with end of life patients. They are very knowledgeable with palliative care medication and doses and again can prescribe much quicker and more effectively than a GP.”
I was left with a real sense of how the NMP role augments the true role of a CNS and their AHP colleagues, and how these practitioners really understood the worth of this skill set for their patients, families and colleagues.
The role of a NMP is a real asset in the drive to provide timely expert palliative care in the person’s own home but if we are to increase our reach, the role requires far wider organisational investment and support than it currently receives.
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