INTRODUCTION authority who are VHA employees, can

INTRODUCTION

1.1      What is
non-medical prescribing?

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Non-medical prescribers (NMPs) are healthcare
professionals who, despite not being doctors or dentists, are legally permitted
to prescribe medicines, dressings and appliances subsequent to attaining an
advanced level qualification in prescribing. Non-medical prescribing within
healthcare settings enables healthcare professionals to enhance their roles,
using their skills and competencies effectively in order to improve patient
care in varied settings (Cope, et
al., 2016). The role of NMPs can range from nurses,
pharmacists, optometrists, chiropodists or podiatrists, radiographers and
physiotherapists (Department
of Health, 2017).

1.2 An international perspective

 Currently, only pharmacists and nurses have been granted prescribing
rights outside of the United Kingdom and not health care professionals who are
distinct from medicine, nursing and pharmacy (also known as Allied Health
Professionals). In the United States of America, independent pharmacists
currently have the ability to prescribe from a limited list of medications,
however, this is only apparent in the state of Florida (Cope, et al., 2016). Pharmacists can only prescribe
alongside doctors within Collaborative Drug Therapy Management Clinics (Drugs and Therapeutics Bulletin, 2006) in at least 16 states.
Other US states use dependent prescribing (supplementary prescribing) with the
use of a clinical management plan or independent prescribing using locally
agreed protocols, such as the Veterans’ Affairs Centres run by the Veterans
Health Administration (VHA) (Clause, et al., 2001, cited in Cope, et al., 2016).

Nurses in the USA must qualify as Advanced Practice
Registered Nurses at postgraduate level, specialise and then gain additional
prescriptive authority credentials proceeding certification by the relevant
board (Greenberg, et al., 2003 cited in
Cope, et al., 2016). The extent of prescriptive authority that nurses acquire
varies between states, as the profession is dependent on individual state
regulation. However, 21 states currently approve the full practice status for
nurse practitioners, allowing them to prescribe (Greenberg, et al., 2003). However, some
states still hold ‘restricted practice regulations for nurse practitioners’ (Cope, et al., 2016). In a similar way to
pharmacists, nurse practitioners with prescriptive authority who are VHA
employees, can be given rights to independently prescribe (Konnor, 2007).

Pharmacist prescribing is currently not
permitted anywhere else in Europe – the UK is an exception. However, countries
such as Ireland, Finland, Spain, the Netherlands and Sweden have introduced
nurse prescribing and the consequent legal restrictions on which nurses can
prescribe, what they are legally permitted to and for whom, and whether they can
independently (Kroezen, et al., 2011). Pharmacists in
Canada with prescribing rights can prescribe independently or in collaboration
with a medical practitioner (American Pharmacists Association, 2014). Similarly, New
Zealand has recently introduced legislation which allows qualified pharmacists
to prescribe (Parliamentary Counsel Office, 2013).

In Australia, the Health Workforce has
developed a national pathway for prescribing by other healthcare professionals
apart from doctors, dentists and nurses (Hale, et al., 2016). Nurse practitioners can currently
prescribe medications if they are endorsed by the Nursing and Midwifery Board
of Australia (NMBA), and medications are limited by the nurse practitioner’s
scope of practice, Medical Protection Society (MPS)/Pharmaceutical Benefits
Scheme (PBS) requirements and by hospital formularies or prescribing measures (South Australia Health, 2017). In 2015,
physiotherapists expressed an interest in non-medical prescribing and national
processes have commenced in order to evaluate the clinical need, quality and
safety issues surrounding physiotherapist non-medical prescribing (Australian Physiotherapy Association, 2015). Currently, the
Australian Health Workforce Council has published a guidance document regarding
developing a case in order for Health Ministers to ‘consider endorsing the prescribing
of scheduled medicines for health professions that currently do not have this
endorsement, such as physiotherapy’, which will allow the profession to
consider whether it wants to pursue prescribing rights (Physiotherapy Board of Australia, 2017).