Concern Over Rights Of Nurses To Prescribe Drugs

Medical practitioners have expressed ‘serious concerns’ over the rights of nurses to prescribe complex medicines after new figures showed a big increase in the practice.

The number of prescriptions issued by independent nurse prescribers has risen by 49% since new rules allowing nurses to prescribe complex medicines to patients were introduced last year, according a report in Pulse, the newspaper for GPs.

The figures have prompted a row among medical practitioners over whether nurses and pharmacists should have the right to prescribe a wide range of drugs in a bid to speed up patient treatment.

Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, told Pulse he had “serious concerns” about the rule change.

He said: “Nurses’ knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent to make a differential diagnosis. Only a country with not enough doctors would go down this cheapy line.”

But Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), defended the role of nurses. He said: “Nurse prescribing has been a historic move for the nursing profession and it is one of the most successful parts of the current NHS reforms. Far from being the problem Professor McGavock suggests, nurse prescribing has proved itself to be an important part of the solution in improving access to medicines and cutting waiting times for patients.”

Under the changes, nurses were encouraged to complete a post-graduate prescribing training course and given the right to prescribe for long-term conditions such as asthma and diabetes – typically the domain of GPs.

The training for independent nurse prescribers involves a 26-day theory course, 12 days of mentored practice and five assignments. Another group of nurses, called “community practitioner nurse prescribers”, who undergo less detailed training, are allowed to prescribe from a more restricted list of drugs.

Pulse obtained the figures under the Freedom of Information Act from the NHS Business Services Authority and compared figures between May 2006 and May 2007. The newspaper found that prescriptions for the antibiotic ciprofloxacin were up 218%, the anti-depressant paroxetine was up by 262% and the diabetes drug rosiglitazone was up by 245%.

Jo Haynes, editor of Pulse, also voiced concerns. “The whole nurse prescribing scheme has been rushed through with only the bare minimum of piloting and evaluation, and it won’t be until academics start analysing the rates of adverse events and prescribing errors that we will know whether it has been a good or bad thing,” she said.

But Dr Carter said: “Research shows that the majority of nurses who prescribe have at least 10 years’ nursing experience before starting their prescribing training and must have either degree or masters-level education.

“Far from having a ‘pathetically poor’ knowledge of diagnosis, before they can even access a course, nurses have to be able to demonstrate that they have sufficient assessment and diagnostic skills in the specialist area they will prescribe in.

“Ultimately, every single nurse prescriber has to be ‘signed off’ by a doctor before they can begin prescribing. With well over 10,000 nurse prescribers currently practising, it appears there are at least 10,000 doctors who would disagree with Professor McGavock’s concerns.”

A Department of Health spokesman said the actual number of prescriptions issued was quite small. “GPs still account for 99% of the overall number of items prescribed but, by expanding traditional professional roles, the NHS can give patients easier access to medicines,” he said.

“Patient safety is our priority. That’s why nurse prescribers are senior, experienced nurses who have undergone rigorous training before being able to prescribe – they have to successfully complete the relevant courses, be accredited by their respective regulatory bodies and had their qualifications noted on the professional register.

“Once trained, they are required to keep their skills up to date. This ensures that patient safety is protected and that patients can be confident that they are receiving the highest standards of care.”