18 | Nursing in Practice | Autumn 2022

PRESCRIBING

Anna Young shares her work in supporting non-medical prescribers across Sheffield and South Yorkshire , and offers advice for others wanting to change workplace culture

Primary care has the highest proportion of independent or non-medical prescribers ( NMPs ) in the UK ¹ and yet there is often a lack of organisational understanding about how to develop this role , and how practitioners can remain up to date and safe within our day-to-day clinical practice .

Historically , organisations have placed the onus to do this on the individual clinician . However , using the Venus model of CPD ² and a systematic review of best practice for my masters degree in advancing practice , I challenged this obligation and have been putting the recommendations into place in Sheffield and across South Yorkshire .

There are many articles on prescribing to read and courses to attend , but how do we know if they fit with the local formulary and referral pathways ?

Sitting on the Sheffield Formulary support group , I see how much time and effort is put into developing these prescribing guidelines , including balancing the financial constraints of healthcare , evidence-based practice and working alongside the wider local health providers to ensure a commonality in prescribing practice .

Within this context , I have developed a monthly lunchtime clinical teaching programme looking at topics such as diabetes , reflux , allergic rhinitis , HRT and the menopause , contraception and anxiety and depression in young people . At these events we consider good prescribing practice , using the local formulary and shared decision making . We look at the risks versus the benefits of medication , including when not to prescribe , and deprescribing . These sessions have been evaluated well in terms of increasing prescribers ’ confidence , competence and safety .

CPD cannot stand alone , however , and there needs to be a wider framework to support NMPs in primary care , including good governance . With this in mind , I worked with colleagues across the ( then ) four clinical commissioning groups to draw up such a framework .

It sets out the responsibilities of individual prescribers , their employers and the wider organisation – now the integrated care system ( ICS ) – in ensuring prescribing practice is kept up to date and safe . This has been an exciting , collaborative , cross-professional piece of work that will provide the foundation for excellent practice and patient safety going forwards .

Working in primary care is not a ‘ boundaried ’ role . As professionals we need support to develop our prescribing practice to meet the patient needs .

Our professional roles are dynamic , and we need provision to grow our prescribing practice alongside our clinical competencies . The framework we have written sits alongside the new Royal Pharmaceutical Society guidance Expanding Prescribing Scope of Practice ³ encouraging the use of mentors and teaching events .

This work is being driven through the local workforce and training hub and is multiprofessional . As roles increasingly overlap in primary care , we need the same provision and support for all who are prescribers , as well as for those who influence prescribing but lack a prescribing qualification , such as GPNs and physician associates .

What I ’ ve learned It is not easy to change a workplace culture . Coming in as an ‘ outsider ’ ( a clinician without a strategic role or title ) has meant I have needed a lot of persistence

Our professional roles are dynamic , and we need provision to grow our prescribing practice alongside our clinical competencies

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