The dispensing team at the Update Pharmacy is having a regular review meeting. Brenda, the dispensing technician, has raised the topic of prescriptions from non-medically qualified prescribers.

"The range of health professionals who can write prescriptions seems to be increasing all the time, and I'm confused about who is entitled to prescribe and what they can and can't prescribe," she says.

"Me too," adds relief pharmacist Lydia Allen.

Pharmacist David Spencer says: "What concerns is me is whether we are in any way responsible or liable if one of these prescribers prescribes something they are not entitled to or is outside their sphere of competence, and something goes wrong.

"We need to write ourselves a guide to refer to when in doubt. Could I ask you to do it, please, Brenda? I could give you half a day for it, if Lydia could come in and cover in the dispensary."

"OK," replies Brenda, "I'll have a go, but could you help with setting out the main headings, David?"

Questions

1. What groups of health professionals, apart from medical practitioners, can now prescribe?

2. What types of nurse prescribers are there and what can they prescribe?

3. What types of pharmacist prescribers are there and what can they prescribe?

4. What is the status of the other non-medical prescribers?

5. How can non-medical prescribers be identified?

6. What liability do pharmacists have for dispensing prescriptions written by non-medical prescribers?

Answers

1. Nurses, pharmacists, optometrists, physiotherapists, radiographers, podiatrists.

2. a) Community practitioners (district nurses and health visitors); only items from the Nurse Practitioners' Formulary (NPF) in the BNF

b) Nurse independent prescribers (NIPs) (formerly known as extended formulary nurse prescribers); any licensed medicine for any medical condition within their competence, including some Controlled Drugs (listed in the BNF and MEP).*

3. a) Pharmacist independent prescribers; as for NIPs but cannot prescribe any CDs, including Schedule 5 P medicines (eg. co-codamol tablets) that can be sold OTC in pharmacies*.

b) Pharmacist supplementary prescribers; any drug included in a clinical management plan agreed for the individual patient by the independent prescriber (a doctor) and the supplementary prescriber. This can include any CD and instalment prescriptions for addicts.

4. Supplementary prescriber; as for pharmacists.

5. Prescription forms are lilac in colour, personalised and annotated with the prescriber's status.

6. a) Community practitioners: pharmacists will not be paid for any item supplied that is not in the NPF.

b) It is PCTs' role to ensure that independent and supplementary prescribers prescribe appropriately and within their competence. Dispensing pharmacists' liability does not extend beyond their normal duty of care.

* Note: On April 1 an amendment to the Prescription Only Medicines (Human Use) Order 1997 enabled pharmacist and nurse independent prescribers to prescribe all CDs. However, at the time of going to press the necessary amendment to the Misuse of Drugs Regulations 2001 had not been made, so prescribing of CDs (except for the limited range already allowed for NIPs) cannot yet begin.