Non Medical Prescribing Doing it the Dudley Way

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Non Medical Prescribing- Doing it the Dudley Way

• Clair Huckerby
• Pharmaceutical Adviser Clinical Services and
  Non-Medical Prescribing Lead, Independent
  Prescriber

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Aims

• Evolution of Non Medical prescribing in Dudley
• How the Pharmacists have put this into practice
• The future

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The Evolution of Non Medical Prescribing in Dudley

• Nurse Prescribing
• Pharmacist Prescribing
• Non Medical Prescribing Steering Group
• Non Medical Prescribing Lead
• Service Development
• Training and Education

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Why is Non-Medical prescribing considered a good
idea ?

• To improve health services and patient care
• by improving patient access to medicines
• making better use of skills of all healthcare
  professionals
• more efficient use of resources
• We have come along way

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Expansion of non medical prescribers

• Expansion within nursing profession
• Government Strategy Pharmacy in the future
  implementing the NHS plan - 2000
• patients needs will be better met by some
  pharmacists being allowed to prescribe medicines
  for them directly
• Changes to primary legislation to allow
  pharmacists to become prescribers

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Pharmacists as Prescribers

• First stage was development of Supplementary
  Prescribers (SP)- first cohort of PBPs from
  Dudley qualified in 2004
• Stepping stone to Independent Prescribing
• Independent Prescribers qualified 2006/07 (Dec
  2008- 17 PIPs)
• Still need both SP and IP

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Non Medical Prescribing Steering Group

• To advise, promote and oversee non medical
  prescribing within the PCT.
• Providing an operating framework which will
  inform and advise on Clinical Governance in order
  to support the development of high quality care
  and patient safety in NMP.
• Responsibilities- implementing NMP to enhance the
  quality of patient experience

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We knew it would be a challenge!

• Quality Assurance- Clinical Governance Framework,
  NMP Database, Prescribing visits, audit, ePACT
  analysis, peer review
• Training- commissioning of places, ongoing
  maintenance of competence
• Evaluation- local and national
• Medicines Management Policy
• Strategy for Non Medical Prescribing
• Resource folder for Non Medical Prescribers

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Quality Assurance

• We will work continuously to improve services
• We will value, support and develop all our staff

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Risk Matrix
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Practice Based Pharmacist Service

• The purpose is to promote clinical and cost
  effective prescribing and to ensure the rational
  use of medicines within the Trust
• The Practice Based Pharmacist (PBP) will provide
  the following services
• Level One
• General Medicines Management service- acting as
  an advisory resource to the PCT and the Practice
  in relation to medicines management, repeat
  prescribing
• Specialist Medication Review Service- in line
  with Standards of Best Practice for Medication
  Review, the PBP will use specialist knowledge to
  support the practice and PCT in the review of
  medication
• Level Two
• Specialist Clinical Service- PBPs will be
  involved in the development of the Specialist
  Clinical Pharmacist role. This may involve
  providing clinical services in agreement with the
  PCT and the practice, in line with PCT Policy,
  guidelines and protocols e.g. Independent
  Prescribing as part of a Pharmacist-led
  hypertension clinic.

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Putting it into context.

• Hypertension clinic
• Respiratory Medicines Management Clinic
• Medication Review clinic

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Major benefits we have identified by training
Prescribing Pharmacists

• To our organisation
• Management / reduction of prescribing costs
• Provide role model to other prescribers by
  demonstrating good practice
• Better understanding of factors affecting GPs
  prescribing decisions during patient
  consultations
• Vastly improved multi-disciplinary working
• Retention of motivated staff

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Benefits to the Pharmacist Independent Prescriber

• Increased job satisfaction
• Enjoy patient contact
• Keen to set up their own clinics
• Increased confidence and self esteem
• At leading edge of pharmacy practice
• Eager to extend their range of knowledge and
  competencies in other clinical areas. Our team
  now covers hypertension, CVD, COPD, asthma,
  arthritis, musculo-skeletal disorders, obesity,
  smoking cessation and womens health

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Benefits to Patient

• Multidisciplinary team
• Appropriate use of skills- Medicines expert
• Patients like to speak to Pharmacists about their
  medicines
• Closing the loop!

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Evaluation of Pharmacist Prescribers in Dudley

• Annual Prescribing Review prescriptions written
  in accordance with Governance Framework
• Did they follow formulary and guidelines ?
• Were they within pharmacists declared
  competencies ?
• If not can pharmacist demonstrate extended
  competency ?
• For supplementary prescribers, review CMP
• Patient satisfaction surveys

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Evaluation of Pharmacist Prescribers in Dudley

• Professional development interview with line
  manager
• Audits performed in practice
• Medication reviews performed
• Continuous professional development portfolio
• Cost effectiveness of entire role (not solely
  prescribing)
• Identification of development needs

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Outcomes

• Developing two Pharmacists with a special
  interest
• Developing one Consultant Pharmacist
• Review of PBP Service and Redesign
• Integration of PIP into number of clinical
  services

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Aspirations and Hopes for the future.

• Continue to develop PBP team
• Multidisciplinary clinical supervision network
• Evaluation of PIP at a National and Local Level
• Designing and commissioning annual updates from
  HEIs
• Broadening competencies and specialising