24 August 2011
A recent qualitative study, ‘ Non-medical prescribing leads views on their role and the implementation of non-medical prescribing from a multi-organisational perspective’, explored the role of the organisational non-medical prescribing (NMP) lead across a range of practice settings and considered the development of NMP from a multi-organisational perspective. Most respondents reported not having designated time for the role of NMP lead and that very little time was spent within the role.
The study concludes that NMP leads make a significant contribution in embedding NMP within organisations and that this should be acknowledged by clearer national guidance for the role, its responsibilities and workload. The authors also state that managers should provide guidance on the core functions of the NMP lead role and dedicate sufficient time to the role so it can be achieved successfully.
The Department of Health guide to implementing nurse and pharmacist independent prescribing recommended that organisations should develop a strategic plan for the use of non-medical prescribing and identify a lead director responsible for implementation. It also sets out the clinical governance arrangements which are necessary to ensure non-medical prescribing is safe. Lack of a clear strategy at an organisational level has been found to be a major barrier to pharmacist prescribing and prescribing roles that are not embedded within an organisation are rarely sustainable. An evaluation of supplementary prescribing in a mental health setting identified that NMP leads, once appointed, are important to establish and develop the non-medical prescriber role.
What did this study find?
Semi-structured telephone interviews of twenty-eight NMP leads from the East of England SHA were undertaken. The NMP leads interviewed in this new study worked in hospital, primary care and mental health trusts and 50% held a prescribing qualification themselves. 68% reported that they did not have designated time for the role of NMP lead with 79% of participants spending 3 or less hours a week on the role – 54% only spent between 30 and 60 minutes a week.
The research identified that the role of NMP lead has functions in four core areas. These are:
- Information and communication – acting as a point of contact and information conduit between the trust and non-medical prescribers
- Promoting and coordinating NMP within the trust, including integrating and expanding NMP into service planning
- Clinical governance – ensuring that systems are in place and up to date. The study summarised the extent to which NMP leads reported safety and clinical governance systems being in place in their organisation
- Support and training – supporting non-medical prescribers and their supervisors, including direct and indirect involvement in continuing professional development (CPD) provision
Barriers and facilitators to the development and support of NMP were also identified in the study. It was found that trusts with a consistent strategic approach to developing NMP gave greater consideration to processes such as workforce planning; selection of candidates for prescribing training; ongoing support; CPD and organisational preparation for the role with regard to procedures for initiating prescribing. Greater involvement in the various lead role activities was found to be important in alleviating many of the barriers.
Factors found to support the role of NMP lead included:
- Knowledge of NMP and experience as a non-medical prescriber
- Good relationships with colleagues including members of executive teams and directors
- Knowledge and experience of trust-wide issues such as clinical governance, management and legal issues
- Having established policies and procedures
A misunderstanding of the NMP role by colleagues, lack of clarity about the duties of the NMP lead role and lack of dedicated time to complete the role were among the areas of difficulty leads reported facing.
How does this relate to other publications or evidence?
The recently published ‘Evaluation of Nurse and Pharmacist Independent Prescribing’ was reviewed here. It was commissioned by the Department of Health to help inform planning for current and future non-medical prescribers, and covered many different aspects of nurse and pharmacist independent prescribing including operational arrangements for clinical governance and risk management. It highlighted areas where trust management could support NMP. In particular it was suggested trusts could further develop their strategic approach to NMP, to improve the effectiveness of workforce planning. Only about half of trusts in the study reported having a strategy or written plan for the development of non-medical prescribing. A stakeholder workshop identified that the lack of awareness and understanding of non-medical prescribing among commissioners and workforce planners was partially due to the absence of an NMP lead in organisations, and it was recommended that a lead was necessary in all trusts. It was also suggested that the lead should be involved in trust planning and strategy development and the role incorporated into organisational structures. When asked about factors which enhanced non-medical prescribing in their trust, the NMP lead’s own role was the most frequently mentioned. However participants commented that it was a challenging role and the lack of protected time to undertake it was a key issue.
The NPC is currently developing a handbook for organisational NMP leads which is due to be launched later in 2011. The handbook will highlight how critical the NMP lead role is to the success of non-medical prescribing within an organisation, looking at the recent research into the role. It will lay out the core functions and key responsibilities of the lead and give practical guidance in a number of areas including:
- Developing a strategy and policy for NMP
- Workforce planning, service redesign and commissioning NMP services
- NMP forums and steering groups
- NMP information management
- Training and education
- Clinical governance.
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