• 1986, the Cumberledge Report recommended that community nurses should be able to prescribe some medicines, appliances and dressings.
• 1989, the Crown Report ‘Recommended that suitably qualified nurses working in the community should be able – in clearly defined circumstances – to prescribe from a limited list of items and to adjust timing, dosage of medicines within a set protocol’.
• 1992, Medicinal Product: Prescribing for Nurses Act, allowing nurses to prescribe for the first time ever. This was then followed by a Pharmaceutical Services Regulation (1994) to allow pharmacists in the community to dispense medicines prescribed by nurses.
• 1998, the Crown Report 2 (part 1) – gives rise to PGDs, prescribnig algorithms specified healthcare professionals can follow.
• 2001, the government gave support to the extension with a limited formulary including POM/P/GSL for conditions within 4 treatment areas including minor ailments, minor injuries, health promotion, palliative care
• 2004, all nurses who complete the NMC qualification can prescribe independently as well as in a supplementary capacity.
• 2006, nurse prescribers and pharmacists gain access to the entire British National Formulary and this was designed to increase the number of nurse independent prescribers to further improve quality care and reduce access issues.
• Early 2016, Louise C. Cope, Aseel S. Abuzour, et al, publish a document comparing NMP’s to a traditional doctor prescribing. It was found to be on par.
• Late 2016, a meta-analysis, Cochrane review, was conducted finding that: “With appropriate training and support, nurses and pharmacists are able to prescribe medicines as part of managing a range of conditions to achieve comparable health management outcomes to doctors.”
• Today (late 2018) the GPhC estimate that there are 6,019 prescribers this is up from 1,545 in 2010.

What does this latest GPhC release mean?

The GPhC have completed their review and have come up with three new changes which will come into force “early 2018”:

• Revision of learning outcomes: this seems to be a bureaucratic change in what is required. Essentially, the general course curriculum was found to be sound but some minor drafting revisions are required mainly concerning technology and promotion of equality and diversity (maybe this is from demographic analysis of IPs already gone through).
• Entry requirements: there was a proposal for the 2 years experience to be removed (as there was talk about a quantitive measure is not indicative of quality) however, this was found by the council not be the best course of action to reduce this so the 2-year requirement stays.
• Designated prescribing practitioners – this is arguably the most important change to the pharmacy profession in a decade. In the New Year, Pharmacists who are prescribers will be able to train other pharmacists to become prescribers.

For current Independent Prescribers this may be seen as diluting their unique selling point. For the profession, it gives us all more ability meaning we are more useful.

Pharmacist prescribing is a good idea, where the skills and abilities of pharmacists are used to enhance medicines use in the community. It’s not about pharmacists “taking over”, it’s about collaborative models of care for the betterment of health outcomes and care for patients. There are numerous opportunities for this to occur in a system already under pressure from the burden of chronic disease and an ageing population.

Taking a wider perspective, there are talks internationally that progress in the UK may translate to pharmacist prescribers in Australia as early as 2020.

Kudos to the NHS and the UK healthcare professionals for pioneering this!