Sorry to appear a bit dense, and this may well be very boring for others, but then they don't have to read it. Can you explain exactly what it is that you need Emis to be doing? I don't see why adding a nurse to the surgery system would be any different from adding a new doctor, (which we seem to have to do every other day because the yoof keep moving and slip through your fingers).
If I can understand what you are trying to get them to do, I know people who maybe could sort it, but i don't think i undersatnd the question to ask. thanks.

I am added as a prescriber, and where on screen when you are writing a prescription it will say return for principal doctor (It will give there initials) I type in SG. But the prescription has to be done by hand. The difference between the Nurse and Doctor prescribing is that all our Doctors computer generated rx has the principals name on the bottom. For Nurses it has to have there name, surgery address and also has to record the Nurses PIN number. This is what the system cannot do. It does not sound hard, and like i said before this was a priority for EMIS maybe 18months- 2 years ago. Also it needs to be able to swap between pescribers if for example it is something the Nurse cannot prescribe. Oh and there has been a lot of controversy about recording Nurse PIN number on prescriptions many Nurses do not like this and wonder why we cannot have a prescriber number same as Doctors. I think ppl thought we would be impersonated. I can't see it as a big issue myself but i know some Nurses were on the ceiling about it.
Hope that makes it clearer, it is not a big thing and i don't understand the problem. Oh one thing for other nurses to be aware is that when i was set up as a prescriber on EMIS, initially it was putting me down as if i had authorised every prescription that i did and we needed to speak to EMIS to give me a choice as to whether i had authorised it or Doctor had.

I have spoken to the home office today, seems no plan re Nurse having handwriting exemption!. Oh and remember no right side on the lilac pads, so guess what nowhere for pharmacist to write on.
I have again phoned EMIS re the computer generated prescribing, told me again this is still in development.
looking at the doctors prescribing code it is 6 numbers, my pin number is 8 characters, i asked them how long it takes to develop 2 extra spaces?????? it has taken them coming up to two years. I have told them i hope they don't pay the development team a lot!.
I said from the start this would not be as easy as it sounds!.
I'm sure even Dr.Fixit couldn't help lol :-)

Have you asked the emis User group? http://forum.emisnug.org.uk/forum/
I understand they like a challenge, though I've only just had a look at their forum myself. I think maybe to post a question ( in the emis-list heading at the top of the list, I think) you may need your surgery emis number as identification.

I had a look at the system at my surgery, and can see that the only people who can initiate prescriptions in their own name, are people registered by your practice manager as "general practitioner" or "GP principal" on your pratcice system and as you say, there are not enough boxes to fill in your pin number where our prescriber number goes, so it seems you could not even get in by mascerading to the system as a GP, unless maybe someone could give you all prescriber numbers like we have? Why can't they? (who is "they"?).
About changes to the Emis system I would ask the User group as I think they have some clout with Emis. I have a colleague I can ask next week as well.
Someone will have to find out where decisions are made at the Home Office, to get you into the hand writing exemption scheme eventually. (where are the grown ups?)
When you get able to computer generate even ordinary scripts, they'll have to give you computer printer friendly scripts, which have a right hand side to them.
I can see your frustration. I presume other people are also battling away to solve these things?

I have reasd the points mentioned so far, but cannot say I believe nurse will prescribe controlled drugs in the way it is being inferred (as a positive development for nurses and clients) and the answer to more effective treatment of substance misuse. The best that will happen in my opinion is CMP's or PGD's for nurses... as this still maintains the control for the medics and enables fees to be charged for shared care, enhanced service provisions etc etc because nurses would be directed to provide this service free (on our lovely lilac pads..how twee)
The nurse who already prescribe 'opiates' work primarily in oncology in my experience, which cannot be compared to substance misuse. The process for being privilaged to prescribe mainly OTC's for nurses is exhaustive and in some ways condesending " It's quite scary..having the power to prescribe these drugs as nurses" (quote from tutor on my course)
I am aware of my cynical slant and do not apologise for it. As for 'equity' of prescribing in substance misuse?....not a chance.

joe,
yes i can only evisage cd prescribing in a cmp,why i am not sure, because although doctor has to agree, the nurse is responsible for the prescribing. So why have a cmp ?? i guess it is a check on what is being prescribed. But then doesn't the ppa look at things like that ??.
Joe i am cynical too after working a long time in this nhs, but remember a cynic is someone who has given up but not shut up.
I hope it means we work more closely with our medical colleagues and not just used as a cheap substitute and a 'Signature'
I hope somewhere down the line it makes my job easier and speeds up prescribing for the patients.
we will see.

Nurse prescribing

Picking up on Joe’s point about payment. If a suitably qualified nurse prescriber worked for a GP practice in Manchester then any services s/he provided would be remunerated in the same way as if they were provided by anyone else in the practice i.e. a GP. It is the practice that is paid to provide a contracted range of services not the individual practitioner.

The following is the extract from the government response to the 4th Shipman report. The first para is a summary of the reports recommendations and the second is what the government is going to do.

"The Inquiry noted, without a formal recommendation, that authority to prescribe is being extended to professions other than doctors and dentists."

"The Government believes that these new prescribers should be authorised to prescribe
controlled drugs where it is clinically appropriate and safe for them to do so, and will
legislate to enable this. New prescribers will be subject to similar arrangements for clinical
governance and professional oversight to those for doctors."

this seems to imply that it will not just be nurses allowed to prescribe. It will probably be supplimentary prescribing I would imagine, but there could be major changes in the future.

jim

Does anyone know if the legislation change for us to prescribe CDs went through Parliament yesterday, as was planned?

Beverley Harniman

yes. Here is the link.

http://www.legislation.hmso.gov.uk/si/si2005/20050271.htm

It does not refer to nurse prescribers but'supplimentary prescribers'. It was passed on the 11th of feb and came into force yesterday (14th).

I'm not sure who ultimatley will be allowed to be 'supplimentary prescribers'. I think at the moment it will apply to nurses and pharmacists.

jim

Most nurses and pharmacists who have completed the prescribing course are supplementary prescribers. Currently pharmacists can only be supplementary prescribers, but nurses can be both independant and supplementary prescribers. It means to prescribe CDs and most other medications a clinical management plan has to be in place. I am glad it has gone through at last!

Beverley Harniman

Well i got the home office stuff through post today, saying it came nto force 14.3.2005. So does this mean that NOW we can prescribe cd's ???. This is not at all clear. on nta website it says from April/May.Also differences between primary and secondary care, no clear reason i can see for this.
Seems I feel a bit like a mushroom. And when i spoke to home office they weren't clear about it either. So who is clear about it ?.
Seems to me no-one is talking to the people on the shop floor and the more i dig about the less i find out.

As far as I understand it the regulations for re claiming the costs of the scripts have to be changed, which they are saying will be April / May. I haven't had anything from the Home Office - whats that?

Beverley Harniman

Hi Simon,

So how comes you are on information exchange terms with the Home Office? I'm with Beverley here and haven't heard anything; I was however speaking to our regional NTA lead yesterday who was under the impression that we were going to be able to prescribe benzo's - but didn't think that CD's were going to be allowed.

Now that it has been passed through under CMP - does this mean that if a patient is released from prison/courts too late to get a continuing script from their doctor that, providing CMP in place, their pharmacist (who knows them, they ususally go there etc), will be able to prescribe - even if only to cover until surgery/CDAS open?

As for remuneration, this could well be a problem - and I do feel that as nurses we will be expected to add this as part of the contract of employment which states 'this contract is not exhaustive' - in other word prescribing CD's will probably not result in a pay increase!!

A colleague who is on the course at the moment for prescribing thinks they are going to open supplementary up further and those nurses not wishing to undertake independent and extended will be able to just do the 'supplementary' part of the course.

I don't want to be a mushroom, I'd rather be a glow-worm; coz a glow-worms never glum; how can you be grumpy - when the sun shines out your bum! (Well it made me smile
pen

Pen
Well I was not aware that your posterior was like the northern lights!.
Anyway, what I got from the home office was the same as what is in Jim's link above. I am not on personal terms with the home office, but got fed up of hearsay etc. so I phoned them. Home office also are not like glow worms. Well no reason why Nurses cannot prescribe benzo's now with a CMP. It does seem quite clear that it is for cd's. But seems there is something missing, it says it has come into force on 14.3.05, but nothing else seems in place.
Renumeration ??? not sure what you all mean ??, you never thought Nurses would be gifted a bit of extra cash for taking on extra resposibility after completing a gruelling degree level course ?. Some people are never happy.
I am not sure why some ppl would want to opt out of prescribing independently, if they do the course then it is up to them. But if nurses don't want to prescribe and, take the responsibility for what they do, then maybe they need to think if prescribing is for them. If they prescribe in a supplementary fashion then they still have to take responsibility for what they prescribe.I think really it boils down to nurses staying within there own scope of practice remembering that if they are prescribing they cannot hide by saying doctor agreed to the cmp, because the nurse prescribed it!. i think we need to steer away from having different levels of prescribers, this will cause confusion for patients, pharmacists and us! and could be a cause of errors. I think we also need to be careful of more crippling conditions brought in such as you can prescribe cd's if you have done this course, asthma meds if you have done that course etc. If all conditions were removed and Nurses prescribed within there scope of practice, then any errors would be up to them and the NMC.
How things have changed, it is like a different world, does not seem 2 mins since i had to wake up an on call doctor because i had a pyrexial patient and needed permission to give 2 paracetamol!!!!.
I guess we will plod on.

I think maybe the powers that be (NOT the northern lights!), made these sweeping decisions regarding nurse prescribing and then decided that nurses are not capable of recognising when they are/are not within the boundaries of their competence and started slotting extra bits in. You would be surprised how few people really understand CMP prescribing and do not recognise - even though they signed the script - that they are responsible for wot they wrote!
In an ideal world where every facet of healthcare knew what everyone else was doing and effective communication was the norm (oh joy!) then we could possibly cope with differeing levels however I am inclined to agree with you that it will cause more than a few problems.

As for those who get the course and don't prescribe - I know lots of 'em, and some while on the course make no secret of the fact that they will not take on prescribing responsibility on completion - who in their right mind would want to go through that horrendous course and not utilise it afterwards?!

Pen

Seems whatever legislation/guidelines have been changed and i believe it is from next thursday Nurses will be able to prescribe cd's, errr but nobody knows yet if we can use blue scripts FP10MDA, there is a bit more info on www.prescriber-support.co.uk (it may not have the hyphen not sure). And I have spoke to Matt Griffiths today, seems it is now up to DOH.
However Penny Harvey was told by home office we could use FP10MDA's.
Anyway I applied for handwriting exemption last week to home office in the hope that one day EMIS will sort out computer generated rx.

I have had an email saying that we will probably get blue installment forms which will be available from the PPA and Astron; it will be clarified on the NTA website.
Meanwhile my mauve pad has arrived today, but no NMC registration - is that going to take another 6 months!!!!

Beverley Harniman

NMC did not take long whem i registered maybe 2 weeks

I got my handwriting exemption through the post today!, maybe I am the first Nurse to have one?.
We await news of the blue scripts while people in the dept. of health scratch there heads and chins!