I understand that from march in secondary care and later for primary care Nurses will be able to prescribe controlled drugs.Nothing on DOH website yet though. i saw it on nurse prescriber website and a release from RCN advisor on prescriber support website
Regards
Simon

Not that it seems to say a lot but there's something new on the NTA website today about nurse prescribing in substance misuse.
http://www.nta.nhs.uk/publications/Nurse_prescribing_2005.pdf

I agree Simon it adds little to what we already now and just tells us that the necessary amendments to Home Office regulations to allow supplementary prescribing in substance misuse services will probably happen in April or May. I am a bit concerned that is appears to put this supplementary prescribing under the control of GPs with a special interest (usually employed by specialist services) or consultants.
In our shared care scheme we have a number of GPs who are very experienced in treating drug users (in fact a number have in the past or still do work for the local specialist service) and who have completed the RCGP Part 2 and are treating in excess of 100 patients – Are they to be cut out of the loop?

Pat

they may well be able to call themselves GPwsIs. If they have done the cert 2 and keep up with their CPD, just because they are not actually employed as one I think they would qualify as one in this context

jim

I have a DH letter which says that "following the 4th Shipman Report the Home Office has laid amendments to the "Misuse of Drugs Regulations 2001" to enable nurse and pharmacist supplementary prescribers to be able to prescribe all controlled drugs. Subject to Parliamentary approval these amendments will come into force on 14th March 2005. This will enable supplementary prescribing of CDs in secondary care. To enable the reinbursement of prescriptions for CDs written by supplementary prescribers in primary care we need to amend the GMS/PMS regulations; subject to Parliamentary approval this will be possible in April/May."
I think this is good news!
What will happen about the blue FP10 (MDA) forms we currently use; will they print nurses pink installment prescription pads?

Beverley Harniman

I am not sure that these things will be happening too quickly, we are still waiting to be able to computer generate prescriptions. There will be some feet dragging. i noticed the consultation document on the DH website it is mentioned on www.nurse-prescriber.co.uk in the forum regarding what to do with Nurse prescribing it may be of benefit to the Nurse prescribers and Doctors to check this out. It certainly seems to me that the formulary should be available for Nurses withing their own scope of practice. The set conditions are a a bit crazy. Last week I had a patient with toothache, but i couldn't prescribe analgesics for him. I could only prescribe independently for uncomplicated back/neck pain or for sprains. This chap has no dentist. The Nurse prescribing was supposed to enable faster access to treatment rather than tie Nurses up with a list of conditions that they can treat for. I guess things are moving in the right direction but patience is not one of my strong points.

Well I think all this sounds like the bees knees. There's far more people need scripting than i can cope with, so the more people join in to help the better as far as i'm concerned. I can always re-train in removing ingrowing toe nails or something.

I hopped in to my CDT session this afternoon, armed with the NTA print out from Simon Morton's link, for the two nurses who are part of their team, the first of whom went a little pale. They are used to me fighting and screaming over the stupid scripts, praying for less bank holidays (and here's another season of them coming up) and I'm not sure will they fancy the job too much.

However i think its an excellent idea. The more scripters the merrier, and maybe there'll be a bit more time to focus on the much more important task of helping people to get a life, or cope with the one they've been given.

There is also a consultation out about vastly increasing the extended formulary and possibly abolishing the restricted conditions which we can prescribe for ( I say we without having my results yet!). Its on the DH website under prescribing. I think the current piecemeal approach will eventually be phased out.

Beverley Harniman

Yes it was I meant in my earlier post.
I strongly hope that the stupid restrictions will be removed too!
Good luck with your course!
Simon
ps then get ready to wait about 2-3 months to get your lilac pads

Hi all,

Recently attended the nurse prescribing conference - there remains much confusion within the ranks about what will happen - however it would appear that by the end of this year the majority of BNF will be prescribable (is that a word?) within the scope of nurses competence. Also chatted with man from RCN - Matt; who assured me that the controlled drug prescribing will be throughout primary care by the summer.

If you have the Phoenix system you can computer generate scripts - as these are the normal 'green' ones I am assuming that when we are able to prescribe CD's via a CMP it will be on the blue script - but I dunno - and if they decide somewhere that we have to have another colour it would well be next year before we can begin to prescribe!!!

Good luck with your results!

Pen

Yes I passed!
Re Penny's comments about the blue scripts do you think we will be able to sign them? Myself and one of the GPs are in process of setting up a prescribing clinic at the local non stat. drugs agency; would be good if it doesn't take ages so I can sign some of the scripts there!

Beverley Harniman

Well done, I know how difficult it is!. Think I did more wqork for that prescribing course than I did for my RMN!.
Just trying not to get too excited re the time it will take to set this up. Like i said previously, EMIS still haven't sorted it so we can computer generate prescriptions. But for sure the restrictions need removing. Often I am in a position where a patient needs a drug that i can prescribe and one i can't. This just slows things down and i end up not prescribing. So must be many other Nurses in the same position, and it is wasteful if Nurses are put on an expensive time consuming course learning skills that are not used enough!. Oh and it was supposed to speed up access to medecines for the patients, so things need a lot more flexibility. And clinical management plans need looking at again.

Simon

I'm with Simon, can't remember being so fraught over a course and so relieved when the result came in.

I am lucky with the Phoenix system I can run off FP10's and sign them (but if that is your system do NOT tick the supplementary prescriber box in the set up - just the extended nurse prescriber - otherwise you have Supplementary Pharmacist prescriber across the top of your scripts!).

As for signing the blue scripts, we should, with CMP be able to sign as we would with our other scripts, I don't know if there will be any further training or if the RCGP certificate will be mandatory for those who could be signing meth/sub scripts. However, for staff in secondary care who will be signing for CD's there will be no 'specialist' certificate, so they could just go on time worked within the speciality and a period of supervised prescribing for CD's (dunno if 'they' really know).

All that aside, well done, now you can scare yourself silly signing your own scripts - and probably find, as with Simon, that 50% of what you need you can't prescribe anyway so you still have to wait for a doctors signature!

Delighted to share the load with you. Simon, what is it you are waiting for Emis to do? I wonder if other Emis users could help, if you describe your problem.

As for controlled drug prescibing, and blue scripts, I imagine you will all have to get the famous Home Office Handwriting Exemption certificates before you will be able to computer generate them, in the same way that we docs do. I wonder if the Home Office will be surprised to get so many new applications, and from Nurses!.

Its a brave new world.

Judith,
the problem with EMIS is that they still have not sorted out the software so Nurses can computer generate prescriptions. It was a priority must be 18 months- 2 years ago. So until this is sorted we have no chance with EMIS and home office for hand writing exemption. Whenever I have phoned them they cannot say how long it will take before software is complete. Other systems seem to have been able to do this. And it needs to be flexible to be able to switch between what the Nurse can prescribe and what Doctor can and alter name on bottom of rx accordingly.
We will plod on. Keep chipping away.
Have to keep reminding myself early days and have to be cautious.
Hope as many people as possible reply to the consultation document on DOH website.
regards
Simon

hmm interesting. Is there a plan for them to develop a whole separate prescibing section for nurses, which flashes up to tell you when you are not allowed to prescribe something? Surely you can use the same system that we use? It is easy enough to tell the system your name, status and number, which would then automatically print out at the bottom of scripts when you are logged in as yourself, and could announce to the world that you are a nurse prescriber, or whatever the title is, then you could just prescribe what you are allowed to? Is there some complication i don't understand about this? probably.

I don't think we understand it either!! I can see how frustrating the independant formulary currently is; for e.g we can prescribe H2 receptor antagonists for gastric disturbance, but not PPIs, which are usually the preferred treatment; crazy! Meanwhile I shall now wait for ever for a pad and NMC registration. We have EMIS so scripts will have to be hand written, to everyone's frustration here!

Beverley Harniman

but i still don't understand why having emis means you have to hand write. what have other systems got that emis's not got?

For some obscure reason it appears that at the moment the only system which allows electronic printing is Phoenix - however this involves going into set up, via administrator and putting in UKCC (they kinda missed NMC!!) number etc., and the system will not recognise you until you have handwritten some scripts and been OK'd by the PPA. This system then works in exactly the same way as if a GP were prescribing - flashing contra-indications etc., but prints your name and number on the script. Might be worth trying the set-up side of things - just to see if any will work - if not contact Matt at the RCN who is the nurse prescribing lead there and needs to know the major problems which prevent those qualified from actually prescribing (including the fact that, other than via CMP, we can't prescribe the things which really would streamline and improve patient service), Barbara Stuttle at Castle Point and Rochford, PCT in Essex is also worth contacting.

PEn

Judith et al,
only thing EMIS has not got is it's finger out! May be of benefit for practice managers and Doctors to have words with them to encourage them. Seems I got nowhere with EMIS maybe it needs a big push from ppl who pays them the dollars
regards
Sleepless in Barnsley