Here is a link to the site with the proposal to allow NMPs to prescribe controlled drugs. I haven't read it yet so won't comment now

http://www.homeoffice.gov.uk/documents/cons-2007-indpres?version=1

Heather

Quick off the mark Heather! Just come on line to post the same document. I have not read the consultation yet BUT the Home Office are concerned around the security of controlled drugs rather than clinical skills of the NMP. The following notes are from a NMP leads workshop:

"DH and regulatory bodies are supportive of nurses and pharmacists being able to Rx all CDs and have recommended to Home Office (HO) that this should be changed. HO against this as they want to keep CDs restricted and they see this as making them more easily and widely available. HO is consulting now on this (see website) xxx will send you the link please respond on behalf of the organisation. There main worry is that nurses will “order” lots of CDs and leave in people’s homes and then there will be lots more unregulated CDs around. They are looking at it from a security point of view not clinical. Need to say that there is a clinical need but that it will be managed with integrity and sense with structures around security. HO perception is that there will be loads of nurses and pharmacists doing this."

We need to think how we respond to this as a Substance Misuse Group rather than individually. Perhaps a reply could be formulated under the SMMGP banner?
Look forward to the ongoing discussion>

Graham Parsons.

Heather,
Thanks for that. Graham is right it would look better if this was a group response. Clinical management plans are often a bind and slow down access to treatment. I don't need a Doctor to diagnose Heroin dependence, I need Doctors for other things.

Fully agree. What rubbish to think nurses will leave CDs around people's homes etc! Shows a total lack of understanding / awareness.

i think a group response is a good idea, although i will probably do an individual one aswell. I personally think the move to all independent prescribing was the biggest step with the most things that can go wrong and i remain more anxious about that than CD prescribing. I also think they are getting their concerns a bit mixed up eg if they are worried about large amounts of CDs being prescribed - well that could happen with supplementary prescribing and we can already do that!
Heather

Heather,
Of course you are right and the ability to prescribe almost any drug except some controlled drugs, well we've managed so far.
I've been in more of a tizz prescribing nit lotion than I have prescribing Methadone/subutex.
Ian Hulatt the RCN's mental health advisor was talking at a conference and spoke of Prescribing and clinical governance and he said if getting it right 99.9% of the time would be the same as a major airline crash every 18 days!
http://www.rcgp.org.uk/docs/Nurse%20prescribing%20RCGP.ppt

Simon, would you get in a tizz prescribing diamorphine, dipipanone or cocaine? I know I would! I am concerned there might be a lack of consensus on what consitutes evidence based practice for these drugs.
I am also concerned that I have not seen anywhere a definition of what the adequate competencies for independent prescribing of controlled drugs for addictions are. Can anyone point me to anything on this? If there is nothing, employers will have to define them themselves when appointing independent prescribers, they will constantly have to reinvent wheels, and there is a danger of inconsistency.

susi,
I couldn't see me prescribing those drugs but I do have a palliative care qualification like Macmillan Nurses (They wouldn't have me as I'm an RMN) and this is the essence of the competency. Competency is related to the individual.Nurses must not work outside of the competence they have, which must be the same for Doctors. A Nurse in A&E might be happy prescribing Diamorphine for cardiac pain, I would not. Competence might be about qualifications it might be about experience. Jim Jones I'm sure will be able to talk more about this than I. Currently we have about 200 patients in our service. Two more Nurses have recently joined us (Hi Clare and Sarah)so when they complete the prescribing course all the clinical management plans have my name on them, for them to prescrbe for each patient to cover leave etc. will mean they will also have to have a clinical management plan. In total will need 600 and they will have to see each patient or that is my interpretation and they will have to agree it with one of the Doctors. This does sound like a waste of time. We could have a type of panel where all four of us get together and see all the patients together and put each Nurses name on the CMP and each Doctors. Then of course if a Doctor leaves they'll all have to be done again. The CMP's have to go it's wasteful of appointment times and it doesn't make things any safer if it did I'd be shouting that they have to stay. I do think it must be made so a Doctor is available to refer to and to seek advice. I also think that someone hot off the prescribing course MUST have some sort of supervised practice. I did feel quite vulnerable almost two years ago when I did my first Subutex prescription and I was writing them before anyway, just not signing them. It shows the trust Doctors and Nurses have for each other when they used to blindly sign scripts (In many cases) at least this makes sure the person who signs the script is the person assessing and seeing the patient.

I've phoned and left a message for Chris Edwards who was the chap listed on the link. I think it's about time we had heard something about this now. I think it was supposed to have been sorted this summer but seeing as we are not having one they may have deferred it until we get one so it might be next year.

Is there any news on this yet?

Sorry forgot about this, Chris told me it was expected before parliament at the end of this year. It seems other things had been more urgent, it was thought it may well be favourable. Parliament are probably fed-up of endless expansions and hearing this stuff over and over. Fingers crossed.

ACMD discussing in October and noises are good.

Graham,

Any whispers I've been fishing a bit today, Home office said they wanted an all or nothing approach and report from ACMD has gone to the minister.

This weeks Independent Nurse page 4
'Home office rules out cocaine licences'
The home office has rules out allowing Nurses to apply for licences to prescribe Cocaine to manage drug addiction.The move came after the ACMD advised the govt. to amend legislation to allow Nurse supplementary prescribers to apply for licences to prescribe Diamorphine, cocaine and Dipipanone for the management of drug addiction. .... A home office spokesman said 'We have no intention of allowing nurse and pharmacist prescribers to apply for licences to treat drug users with cocaine. current guidelines do not recommend prescribing cocaine or dipipanone. diamorphine is prescribed on individual need.'
Meanwhile the ACMD also called for independent Nurse prescribers to be allowed to prescribe controlled drugs from schedules 2,3,4 and 5



I don't know about anyone else but I've never thought prescribing Cocaine or Dipipanone would be necessary. I wonder if the ACMD just wanted the equality and to remove adding things on a piece-meal basis as before. It is looking promising, wonder when it will happen?
It was supposed to have been last summer.

I have no interest in prescribing cocaine either. I did hear from a member of the ACMD (who had better remain nameless for now) that they have agreed to independant prescribing of methadone and buprenorphine, so it should happen hopefully!

Beverley,
I hope so and guess it's up to the ministers now so hoping it's sorted soon. It would make life so much easier and enable faster access to treatment which was the original aim. It may also allow greater flexibility and entice more Nurses and Pharmacists to do the course.

CMPs have been an absolute nightmare in a core service, it seriously limits flexibilty and quick response to need if a service user needs re-starting or a review. If there is no CMP in place I cannot do anything regarding prescribing however obvious and clear the need is. It results in delay, frustration all round and increased risk.

Furthermore i have learnt that some doctors insurers do not allow them to sign CMPs, which adds to the mess.

Roll on the change!

Do you put a new CMP in place if you review or re start someone or carry on using the old one?

I am wondering if there is any news on this. I am still having enormous trouble working effectively in a core service. Clinical Managment Plans still only exist for a small percentage of clients (This links to the long gap between doctors appointments discussed on another thread). It is often the case that clients who need easy and/or rapid access to prescribing cannot receive it from me because they don't have a CMP. Long delays then ensue whilst a doctor is sought, this can be days later and adds to the load on busy clinic sessions. The sooner the law is amended the sooner this situation can be resolved and I can use my skill and knowledge more completely.

It went to the minister months ago, any one any inside knowledge?

Hi Jim,
Yes it was supposed to have changed last summer but was delayed. I spoke to the Home Office before Christmas and it was with the minister(s) then. I've just tried phoning the Home office but no reply from the number I have.