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Non-Medical Prescribing Guidance for Use in General Practices

Non-Medical Prescribing Guidance for use in General Practices– v1.0NHS East and North Hertfordshire Clinical Commissioning Group of 21

DOCUMENT CONTROL SHEET

Document Owner: Director of Nursing & Quality Document Author(s): Louise Kelleher Care Home PharmacistVersion: 1.0Directorate: Nursing & QualityApproved By: CCG Quality CommitteeDate of Approval: 16th January 2020Date of Review: 16th January 2022Effective Date: 17th January 2020

Change History:

Version Date Reviewer(s) Revision Description

v1.0 04/07/19 Louise Kelleher Draft

Implementation Plan:

Development and Consultation

Developed in conjunction with Stacey Golding, Lead Pharmaceutical Adviser East and North Herts CCG and Michelle Shanahan, Primary Care Nurse Tutor – Stort Valley and VillagesCCG Primary Care Commissioning Committee

Dissemination To GP practices through locality prescribing meetings and the CCG GP bulletinTo non-medical prescribers in ENH CCG including those starting the approved training course

Training External training provided by Higher Education Institutions approved by Health Education England

Monitoring GP practices/PCNs to monitor through clinical supervision and staff appraisal

Review July 2021 or earlier if required following any changes in legislation


Document Status:This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet http://www.enhertsccg.nhs.uk/policies

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Table of Contents

Section No. Section Name Page No.

1.0 Introduction 5

2.0 Scope and Purpose 5

3.0 Definitions 5

4.0 Governance and Accountability 6

5.0 Roles & Responsibilities 9

6.0 Prescribing Practice 9

7.0 Security and Safe Handling of Prescription Forms 10

8.0 Setting Up Independent Non-Medical Prescribers On Clinical

Systems

12

Appendix 1 Application for Admission to the Non-medical Prescriber List 15

Appendix 2 Intention to Prescribe Scope of Practice Statement 17

Appendix 3 Prescribing Rights Summary 18

Appendix 4 Prescription Pad Ordering Process 19

Appendix 5 Lost and Stolen Prescriptions 20


1.0 Introduction

Legislation permitting the prescribing of medicines by health professionals other than doctors and dentists has been in place since 1998 to enable patients to have access to medicines when they need them and from the most appropriate practitioner, without them being required to attend further appointments or see additional health professionals. Non-medical prescribing has enabled the emergence of new clinical services and development of existing ones. Non-medical prescribing is not additional to GP prescribing, rather it is substitute prescribing. It is the same drug or appliance for the same patient in the same circumstances, but prescribed rather than recommended by the practitioner making the clinical assessment. It requires the prescriber to be legally accountable for the prescribing commissions or omissions and stops the practice of rubber stamping by GPs which was so prevalent in the past.

2.0 Scope and Purpose

The purpose of this guidance is to provide a framework for general practices to adapt and adopt for use as a policy for their employed non-medical prescribers

3.0 Definitions

Independent Prescribing is prescribing by a suitably qualified practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about clinical management, including prescribing. All practitioners must undertake an approved course and be annotated on the relevant professional register as an independent prescriber.

A Nurse Independent Prescriber may legally prescribe any drug from the British National Formulary (BNF) including controlled drugs in Schedule 2 to 5 (except diamorphine, dipipanone or cocaine for treating drug addiction) for any medical condition within their competence. Nurse independent prescribers may also prescribe off label and unlicensed medicines.

A Community Practitioner Nurse Prescriber (CPNP) is a district nurse, health visitor or any nurse who has undertaken a V100 or V150 prescribing programme as part of a Specialist Practitioner qualification. They can only prescribe from a limited list called the Nurse Prescribers Formulary (NPF) which is included in the BNF.

A Pharmacist Independent Prescriber may prescribe any drug from the BNF including controlled drugs Schedule 2 to 5 (except diamorphine, dipipanone or cocaine for treating drug addiction) for any medical condition within their competence. Pharmacist independent prescribers may also prescribe off label and unlicensed medicines.

A Chiropodist/Podiatrist Independent Prescriber may prescribe any drug from the BNF for any medical condition within their competence. They can prescribe from a limited list of controlled drugs for oral administration, currently diazepam, dihydrocodeine, lorazepam and temazepam. Off label medicines are prescribable but not unlicensed medicines.

An Optometrist Independent Prescriber may prescribe for ocular conditions affecting the eye and surrounding tissue only. They cannot prescribe parenteral medicines, controlled drugs or unlicensed medicines. They can prescribe off label medicines.


A Paramedic Independent Prescriber may prescribe any drug from the BNF for any medical condition within their competence. They cannot prescribe controlled drugs or unlicensed medicines, but may prescribe off label medicines.

A Physiotherapist Independent Prescriber may prescribe any drug from the BNF for any medical condition within their competence, and currently the following controlled drugs: diazepam, dihydrocodeine, lorazepam, oxycodone and temazepam for oral administration only; morphine for oral administration or injection; fentanyl for transdermal administration. They can prescribe off label medicines but not unlicensed medicines.

A Therapeutic Radiographer Independent Prescriber may prescribe any drug from the BNF for any medical condition within their competence. They cannot prescribe controlled drugs or unlicensed medicines, but may prescribe off label medicines.

Supplementary Prescribing is a voluntary partnership between a doctor or dentist and a supplementary prescriber to prescribe within an agreed patient-specific clinical management plan (CMP) with the patient’s agreement. Certain registered practitioners may become supplementary prescribers and once qualified may prescribe any medicine within their clinical competence, according to the CMP.

A Supplementary Prescriber is a registered professional who has successfully completed a recognised and approved education and training programme and is accredited by the appropriate professional body. They may be nurses, midwives, physiotherapists, diagnostic or therapeutic radiographers, podiatrists/chiropodists, pharmacists, paramedics, dieticians or optometrists. Supplementary prescribers may prescribe any drug from the BNF, controlled drugs in Schedule 2 to 5 (except diamorphine, dipipanone or cocaine for treating drug addiction), off label and unlicensed medicines as part of a clinical management plan and within their competence.

A Licensed Medicine has a marketing authorisation (formerly a product licence) granted by the Medicines and Healthcare Products Regulatory Agency (MHRA). The marketing authorisation specifies the indications for which the medicine can be used and these are included in the Summary of Product Characteristics for the product.

An Unlicensed Medicine has not had a marketing authorisation granted by the MHRA.

Off-label prescribing is where a licensed medicine is prescribed for an indication outside of the indications covered by the marketing authorisation. Off-label indications will not be included in the Summary of Product Characteristics for the product.

A Mentor is a registered medical practitioner who will provide support and supervision to the NMP.

4.0 Governance and Accountability

4.1 Clinical Governance

The employer should have clinical governance arrangements in place which includes a Disclosure and Barring Service (DBS) check and evidence of up to date registration with a professional body to enable the registrant to prescribe.


4.2 Professional Indemnity

All prescribers should ensure that they have sufficient professional indemnity insurance, for instance by means of membership of a professional organisation or trade union which provides this cover. The indemnity insurance must provide adequate cover for their prescribing practice, and be in place before they start prescribing.

4.3 Accountability

Non-medical prescribers are professionally accountable for their prescribing decisions, including actions and omissions, and cannot delegate this accountability to any other person. They should prescribe within the locally agreed formulary, guidance and policies, and only where they have relevant knowledge of the patients’ medical history.Non-medical prescribers must only ever prescribe within their level of experience andcompetence, and act in accordance with their Codes of Conduct, Ethics and Standards.

Nurses: https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/

Pharmacists: https://www.pharmacyregulation.org/standards-for-pharmacy-professionals

Chiropodists/Podiatrists, Dietitians, Paramedics, Physiotherapists and Radiographers:https://www.hcpc-uk.org/globalassets/standards/standards-for-prescribing/standards-for-prescribing2.pdf

Optometrists: https://www.college-optometrists.org/resourceLibrary/guidance-for-optometrist-prescribers.html

The Royal Pharmaceutical Society Prescribing Competency Framework is relevant to all prescribers: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-02-13-163215-030

A non-medical prescriber may move or expand into to another area of practice but they must consider the clinical knowledge needed for their new role, and how they are going to gain the knowledge and experience prior to prescribing.

Before prescribing for a patient the NMP must undertake a full assessment of the patient, including taking a thorough history and, where possible accessing a full clinical record. (It is recognised that a full clinical record is unavailable to some services such as ‘out of hours’ services).

4.4 Legal and Clinical Liability

Where a qualified healthcare professional prescribes as part of their professional duties with the consent of their employer, the employer is held vicariously liable and corporately responsible for their actions. The NMPs job description must include prescribing as part of the duties of that post. Patients must be aware that they are being treated by a NMP and of the scope and limits of their prescribing; and that there may be circumstances where the patient has to be referred on to another healthcare professional for other aspects of their care.


https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-02-13-163215-030



https://www.college-optometrists.org/resourceLibrary/guidance-for-optometrist-prescribers.html

https://www.college-optometrists.org/resourceLibrary/guidance-for-optometrist-prescribers.html

https://www.hcpc-uk.org/globalassets/standards/standards-for-prescribing/standards-for-prescribing2.pdf

https://www.hcpc-uk.org/globalassets/standards/standards-for-prescribing/standards-for-prescribing2.pdf

https://www.pharmacyregulation.org/standards-for-pharmacy-professionals

https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/%20

https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/%20

NMP must not prescribe for themselves, friends or family, other than in exceptional circumstances.

4.5 Documentation and Record Keeping

All NMPs are required to keep comprehensive contemporaneous records. Details of the assessment, prescription and rationale for prescribing must be recorded. For supplementary prescribers, the current clinical management plan (CMP) must be clearly visible within all records. The supplementary prescriber should not amend the CMP without discussion and agreement with the independent prescriber.

NMPs may issue computer-generated prescriptions providing the necessary software is available. All prescriptions must have the Non-Medical Prescriber’s name, professional registration number and practice code and must be signed and dated by the named Non-Medical Prescriber only. Non-medical prescribers can be added to more than one practice using their pin/prescriber code. NMPs will need two codes – one identifying them as a prescriber and one that identifies the practice they work for. If an NMP is working in more than one setting e.g. GP and out of hours/urgent care, seek advice from PMOT on how to correctly set them up as a prescriber on the clinical system. A visible audit trial should be maintained.

4.6 Free Samples

NMPs should not accept or use free samples or starter packs. Gifts of minimal value may be accepted e.g. pens, post-it pads. See the CCG Standards of Business Conduct Policy for further information:https://www.enhertsccg.nhs.uk/sites/default/files/documents/Oct2017/Standards-of-Business-Conduct-Policy-v5.1-Final.pdf

All individuals need to consider the risks associated with accepting offers of gifts, hospitality and entertainment when undertaking activities for or on behalf of the CCG or their GP practice. This is especially important during procurement exercises, as the acceptance of gifts could give rise to real or perceived conflicts of interests, or accusations of unfair influence, collusion or canvassing.

4.7 CQC Inspections

When the CQC inspect a practice that employs a NMP in a prescribing role, they would check how the practice:

makes sure the prescriber is and continues to be competent has systems in place to audit all prescribing, including NMPs. The practice should have

evidence of outcomes and learning from these audits available supports NMPs continuing professional development

and that NMPs: are appropriately qualified have their entry annotated on their professional body register have adequate indemnity cover for their NMP role

See https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-95-non-medical-prescribing for further information.


https://www.enhertsccg.nhs.uk/sites/default/files/documents/Oct2017/Standards-of-Business-Conduct-Policy-v5.1-Final.pdf

https://www.enhertsccg.nhs.uk/sites/default/files/documents/Oct2017/Standards-of-Business-Conduct-Policy-v5.1-Final.pdf

5.0 Roles and Responsibilities

The employing practice is responsible for: Ensuring the practitioner has the skills and knowledge needed to carry out the role Providing accurate details of the NMP to register with the CCG Pharmacy and Medicines

Optimisation Team (PMOT). This applies to every practice or cost centre for which the NMP will prescribe

Ensuring the NMP has access to a prescribing budget Including prescribing responsibilities in the practitioners’ job description Annual audit and prescribing review as part of the appraisal process, updating scope of

practice, and changing competencies Notifying the PMOT when a practitioner leaves the practice Ordering NHS supplies such as prescription pads if required

The Pharmacy and Medicines Optimisation Team are responsible for: Registration with the NHSBSA Maintenance of the NMP database

The Non-Medical Prescriber is responsible for: Working at all times within their clinical competence and their Professional Code of Conduct,

and consulting the medical prescriber as necessary. Accepting professional accountability and clinical responsibility for their prescribing practice. Prescribing medicines from the BNF and approved national and local guidance within their

area of competence. Altering the medicines prescribed, within the limits as set in the BNF and local guidance, if

the patient’s progress indicates that this is clinically appropriate. Monitoring and assessing the patient’s progress as appropriate to the patient’s condition and

the medicines prescribed, passing prescribing responsibility back to the Medical prescriber where this is beyond the non-medical prescribers’ clinical competence.

Recording details of prescribing and monitoring activity contemporaneously in the shared patient record wherever possible. If the shared record is not accessible, details should be entered within 48 hours.

Ensuring that they provide evidence based, safe and cost effective prescribing at all times and adhere to the local formulary and guidelines

Ensuring their prescribing competency is maintained by means of continuing professional development (CPD)

Insurance

6.0 Prescribing Practice

6.1 Unlicensed medicines

Not all NMPs can prescribe unlicensed medicines – see table Appendix 4Where an unlicensed medicine is prescribed, the NMP accepts full professional, clinical and legal responsibility for that prescription. The NMP should only consider prescribing an unlicensed preparation when there is no licensed alternative.The medicine chosen and the rationale for prescribing should be clearly documented in the patients’ notes.


6.2 Repeat Prescribing

Non-medical prescribers may issue repeat prescriptions. They are responsible for all prescriptions they sign and remain accountable for their practice.Before signing a repeat prescription the prescriber has a responsibility to ensure that it is safe and appropriate to do so.

6.3 Controlled Drugs

Not all NMPs can prescribe controlled drugs – see table Appendix 4Prescriptions for schedule 2 and 3 controlled drugs are subject to prescription requirements – see the BNF for more details.They should be limited to a maximum supply of 30 days, and are valid for 28 days from the date it is signed, unless an alternative start date is stated.

6.4 Generics

In general, prescriptions should be written generically, unless directed to prescribe by brand by the CCG Pharmacy and Medicines Optimisation Team or prescribing decision support software e.g Scriptswitch.

6.5 Private Prescriptions

NMPs may write private prescriptions for any medical condition within their level of experience, competence and scope of practice.

7.0 Security and Safe Handling of Prescription Forms

The security of prescription forms is the responsibility of both the practice and the prescriber.

7.1 The Practices Responsibility:

To ensure prescription pads are locked away securely at all times, with access to the key only by the Non-medical Prescriber and/or prescribing administrator

To provide the prescriber with appropriate facilities to maintain the security of the prescription pads.

To keep only minimal stocks of the prescription forms. This reduces the potential number of prescriptions lost if there is a theft or a break-in, and also helps to keep prescription forms up to date.

To record the first and last serial numbers of prescriptions received and subsequently issued to individual prescribers. Note that the prescription serial number is the first 10 numbers (these run in sequence); the final digit is a check digit (and does not run in sequence).

Have in place, systems to monitor/audit the use of prescription forms to deter the creation of fraudulent prescriptions by non-medical prescribers.

7.2 The Prescriber’s Responsibility:

Ordering prescription pads – see Appendix 4 for process Keep records of the prescriptions issued to them by recording the first and last serial numbers

of the prescriptions received. Note that the prescription serial number is the first 10 numbers (these run in sequence); the final digit is a check digit (and does not run in sequence).

Blank prescription forms must not be pre-signed, to reduce the risk of misuse should they fall into the wrong hands


Prescription forms should never be left unattended, especially in cars, on desks and in bags. Prescription forms should not be left on the desk but placed in a locked drawer It is also good practice to record the number of the first remaining prescription form of an in-

use prescription pad at the end of the working day. Such steps will help to identify any prescriptions that are either lost or stolen overnight.

Best practice recommends that, where possible, prescribers (especially those working on a sessional or part-time basis) should return all unused forms to an identified secure facility at the end of the session or working day.

If the prescriber is absent from the practice for any length of time i.e. planned sick or annual leave, arrangements must be made to ensure unused forms are stored in an identified secure facility for the period of absence.

7.3 Loss of FP10 Prescription forms:

The loss or theft of prescription forms should be reported to: Line manager or practice manager. The organisation incident reporting procedures should

be followed. The police Controlled Drug Accountable Officer for East of England NHS England and NHS

Improvement area team at www.cdreporting.co.uk NHS Counter Fraud Authority at https://cfa.nhs.uk/reportfraud

More information regarding handling prescription form incidents can be found in Management and control of prescription forms: A guide for prescribers and health organisations at the following link:https://cfa.nhs.uk/resources/downloads/guidance/Management%20and%20control%20of%20prescription%20forms_v1.0%20March%202018.pdf


https://cfa.nhs.uk/resources/downloads/guidance/Management%20and%20control%20of%20prescription%20forms_v1.0%20March%202018.pdf

https://cfa.nhs.uk/resources/downloads/guidance/Management%20and%20control%20of%20prescription%20forms_v1.0%20March%202018.pdf

https://cfa.nhs.uk/reportfraud

http://www.cdreporting.co.uk/

8.0 Setting Up Independent Non-Medical Prescribers On Clinical Systems

8.1 SystmOne

Pharmacist PrescribersPharmacist prescribers require a smartcard profile based on the RBAC role R1290 - Pharmacist. Note that even though this contains the same RBAC activity codes as other profiles pharmacists may be using, SystmOne will not recognise pharmacist prescribers unless the whole smartcard profile is set to R1290 – Pharmacist (other RBAC activities may need to be added to the overall R1290 profile, depending on individual practice needs). To check whether the profile is based on the correct role open the smartcard portal (Care Identity Service), click the Positions tab and click the link for the relevant profile. The RBAC role will be displayed under the Access Profile Details headingThe pharmacist’s staff details on SystmOne organisational settings will need to be amended to add their GPhC number:


Nurse PrescribersNurse prescribers can use a profile based on a Nurse Access role (e.g. R8001) on their smartcard, which may need the RBAC activity for their prescriber type adding – B0420 for Independent Prescribing. On logging on to SystmOne for the first time with this role, nurses will be asked to input their NMC number.All other independent prescribers will need to use a GP partner’s PPA ID, which can be set within the SystmOne user profile:

8.2 EMIS WebTo prescribe medication, you need to configure prescriber options in Organisation Configuration for all prescriber types (independent, supplementary and nurse prescribers). You can configure the Medication module settings, such as medication review codes and printing options, in Medication Configuration.Prescribing users Smartcards need to be configured with the correct RBAC activity for the selected prescriber type - B0420 for Independent Prescribing. The appropriate option (e.g. Independent Prescribing) should also be selected in the Authorise Prescriptions field in the Role section of the Add User or Edit User screen. For example, if you are an independent prescriber and have Independent Prescribing selected in the Authorise Prescriptions field, then RBAC activity B0420 Independent Prescribing needs to be added to your smartcard before you can prescribe.

Configure a prescriber 1. Access Users. 2. Select the required user, and then on the ribbon, click Edit User. 3. In the left-hand pane of the Edit User screen, click Role to display the user’s role settings in the right-hand pane. 4. Check that the user has the appropriate job category.5. Click the Authorise Prescriptions field and select the required prescriber type. 6. Click the Stamp User Choice field and select one of the following:

“Own” – to use their own prescribing number (e.g. GPhC/NMC number) “Senior partner” to use the senior partner’s PPA ID


“Specify user…” if Senior partner isn’t available to select a GP partner 7. In the Relationship field, select the required option. For prescribers not directly employed by the practice select “Associated”. Note that independent prescribers prescribing under your practice will use the practice cost code and as such prescribing costs will fall to the individual practice.8. In the Professional Numbers section, type the user’s appropriate professional number(s). The user should know their professional numbers. If you do not complete this information in full, the user will not be able to prescribe.9. In the left-hand pane, click User Role Profiles to display the user’s role profile settings in the right-hand pane. 10. If the user’s smartcard has not yet been synchronised:

Click the RBAC Role field and select the appropriate local profile. In the Prescribing Role field, select Yes. If the user’s smartcard has been synchronised,

the RBAC Role field is greyed out and the Prescribing Role option is not displayed. For the user to be able to prescribe, the appropriate RBAC activity (i.e. their prescriber type) must be added to their smartcard by your RA team.

11. Click OK.


Appendix 1 Application for Admission to the Primary Care Non-medical Prescriber List

All non-medical prescribers must be authorised by this process in advance of their starting to prescribe. This is in addition to and can only follow formal qualification as a non-medical prescriber and registration as a prescriber with an appropriate regulator.

Authorisation will initiate the process of obtaining FP10 prescriptions where these are needed, and will ensure that there is an appropriate budget to cover the costs of prescribing.

Application and Scope of Practice forms are attached below and should be returned to:

Prescribing and Medicines Optimisation TeamEast and North Herts Clinical Commissioning GroupCharter HouseParkwayWelwyn Garden CityHerts AL8 6JL

[email protected]

Received completed forms are then reviewed, and notification of authorisation of entry on to the CCG non-medical prescriber database will be sent to the non-medical prescriber once processed. Following this, non-medical prescribers will then be able to order their prescription pads through PCSE for practice supplies https://pcse.england.nhs.uk/services/supplies/.

*Non-medical prescribers working for an NHS Trust should contact the Pharmacy Team to be added to their prescriber list.


https://pcse.england.nhs.uk/services/supplies/

mailto:[email protected]

Application for Admission to Primary Care Non-Medical Prescribing List

Additional information for applicant to ensure all relevant information is provided

Evidence confirmed and approved by CCG

Title of prescriber(Please circle one)

Mrs Miss Ms Mr

Full name of PrescriberAddress of practice

Email addressProposed start date for prescribingJob TitleType of prescriber Independent/Supplementary/

Community nurse practitionerConfirmation that non-medical prescribing is included in the prescribers job description and will be reviewed at annual appraisalGP practices covered (names and addresses of practices)

Attach separate sheet if prescribing in more than one practice

Professional registration details (i.e. NMC, GPhC, HPC)

Declaration by Non medical prescriber and employing organisation : (Please Sign each box below)The NMP employer accepts responsibility and accountability to ensure the NMP works within their scope of practice and the service specification / contractual arrangements with the CCG and NHS EnglandThe NMP will work within scope of practice and principles of clinical and cost effective prescribingThe NMP will adhere to NHS England, CCG and national formulary guidelines on choice of product (prescribing will be monitored by the CCG)The NMP will undertake and provide audits or similar as requested by the practice/CCG to demonstrate adherence to local/national prescribing guidanceConduct medicines safety audits and report to practice/CCG and implement safety recommendations as appropriate.Work with CCG staff and others to improve practice and cost effective careControlled Drugs- Will comply with all procedures audits etc as required by NHS England Accountable Officer

Signature Date1. Non medical prescriber:Name:


2. On behalf of Employing organisation:Name

Title(Adapted from Western Sussex PCT, with permission)


Appendix 2 Intention to Prescribe Scope of Practice Statement

Name: Date:

Role: Base:

Please complete form electronically, enlarging where necessary, then print and sign.Disease area where prescribing is intended

Evidence of competence to prescribe in this area

Recent CPD supporting prescribing in this area: (include dates)

Please state guidelines or attach protocols worked to

e.g. asthma e.g. details of experience or asthma diploma with date and awarding body, etc

E.g. Formal updates, courses attended, journal articles studied. Please give as much detail as possible.

e.g. BTS guidelines or locally approved protocols developed by/for non-medical prescriber

!

Do you receive clinical supervision? If so, please give a brief description including frequency and name of supervisor.

Details of how this will be reviewed annually such as through objectives and incorporation into your annual appraisal process

Have you identified any CPD needs relating to prescribing and if so, how do you plan to address these needs?

My intended scope of practice has been discussed with the clinical manager / practice GP prescribing lead

Non-medical prescriber signature: .........................................................

GP lead/clinical manager signature: ………………………………………………………


Appendix 3 Prescribing Rights Summary

TYPE OFPRESCRIBER

OFF LABELPRESCRIBING(prescribing outside theterms of manufacturersproduct licence)

UNLICENSEDMEDICINES(medicines with noproduct licence)

CONTROLLED DRUGS(CDs)

IndependentNursePrescriber

YES YES YESAny CD listed in schedules 2 – 5 for any medical condition. Exceptions for the treatment of addiction.

Independent Pharmacist Prescriber

YES YES YESAny CD listed in schedules 2 – 5 for any medical condition. Exceptions for the treatment of addiction.

Independent Optometrist Prescriber

YES NO NO

Independent Physiotherapist Prescriber

YES NO Morphine (oral / inj)Fentanyl (transdermal)Oxycodone (oral)Dihydrocodeine (oral)Diazepam (oral)Lorazepam (oral)Temazepam (oral)

Independent Podiatry Prescriber

NO NO NO

Independent Paramedic Prescriber

YES NO NO

Independent Therapeutic Radiographer Prescriber

YES NO NO

Nurse/Pharmacist Supplementary Prescribers

YES within CMP YES within CMP YES within CMP

AHP Supplementary Prescribers

YES within CMP YES within CMP NO

Community Nurse Practitioner Prescribers

NO NO NO

Complete HCT incident form - Taking measures to prevent incident occurring


Appendix 4 Prescription Pad Ordering Process


Are you a newly qualified non-medical prescriber or is this the first

prescription pad ordered in your current employment?

GP practice to contact PCSE to order prescription pads


NO

Are you registered with your professional body as a prescriber?

YES

Send registration form and payment to your professional

body and wait for your amended statement of entry

NO

Are you authorised and registered with ENH CCG PMOT to prescribe?

Complete the Application for Admission to Non-medical

Prescribing List Form & Scope of Practice Statement

NO

YES

Contact CCG PMOT data analyst to order prescription pads at least

two weeks before the prescription pads are needed

YES



Appendix 5 Lost and Stolen Prescriptions


Are you sure that the prescriptions are lost or

stolen?

Is it during working hours?

YES

Retrace your steps and perform a thorough investigation

NO

Prescriptions found?

YES

NO

Report according to your employers’ incident reporting

procedures

Contact: Line manager Police Controlled Drugs Accountable

Officer for East of England NHS Counter Fraud AuthorityStating number of prescriptions lost, serial numbers, where, when & how the prescriptions were lost/stolenReport according to your employers’ incident reporting procedures

YES

Report to the police, stating: Number of prescriptions lost Serial numbers When & where lost/stolen

NO

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