Non medical prescribing leads views on their role and the implementation of non medical prescribing from a multi-organisational perspective

Abstract

BackgroundIn the United Kingdom, non-medical prescribing (NMP) has been identified as one way to improve healthcare quality and efficiency. Healthcare organisations are charged with overseeing the clinical governance of NMP and guidance recommends the identification of a lead director to be responsible for its implementation. While over twelve million items are prescribed each year by the 50,000 qualified NMPs its uptake is inconsistent. Several studies have explored the barriers to NMP at a practice level, however little is known about the role the NMP lead and the implementation of NMP from an organisational perspective. The aim of this research was to explore the role of the organisational NMP lead across a range of practice settings within one Strategic Health Authority (SHA) and consider the development of NMP from a multi-organisational perspective.MethodsSemi-structured telephone interviews with 28 NMP leads across one SHA were undertaken by a trained qualitative researcher. Interviews addressed the purpose of the role and difficulties encountered; audiotapes were transcribed, coded and themes were identified.ResultsThe NMP lead role comprised of four main functions; communication, coordinating, clinical governance and support. Factors hampering progress in overseeing the safe development of NMP included lack of clarity about the NMP lead role and responsibilities, strategic support and a lack of protected time. The extent to which clinical governance systems were in place across organisations was inconsistent. Where a strategic approach to its development was adopted, fewer barriers were encountered and NMP was more likely to become embedded within organisations.ConclusionsThe significant contribution that NMP leads play in embedding NMP within organisations should be acknowledged by clearer national guidance for this role and its responsibilities. Greater standardisation and consistency is required of clinical governance systems if quality and safety is to be ensured given the expanding development of NMP. The extent to which NMP is in place worldwide differs. However, our findings will be of interest to policymakers in other countries involved in the development and implementation of this role.

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

“…A lack of support from clinicians, for example, has been cited [43] as a barrier to prescribing by this group however; further research exploring these barriers is required. Overall, levels of support were inconsistent, in-line with previous study findings [15]. That those qualified for less than a year received more support perhaps indicates an increase in governance arrangements to provide support to NMP in recent times.…”

Roles of the non-medical prescribing leads within organisations across a Strategic Health Authority: perceived functions and factors supporting the role

“…This is important as there is a potential risk of further fragmentation as future organisational reforms take place in the English healthcare reform . Consistent with what has been reported elsewhere, core functions of the NMP lead role centred around the promotion of NMP within organisations on a strategic level to higher management, acting as an information conduit by liaising with other professional leads on NMP issues, support for non‐medical prescribers prior to, during and after NMP training, the integration and expansion of NMP within service delivery, and clinical governance. With regards to the promotion of NMP within organisations, some respondents reported a lack of capacity among clinical staff to undertake prescribing training due to them already undertaking other courses of study, and prescribing being seen as less important.…”

“…The provision of support at an organizational level facilitated this process. However, in line with previous work in this area, variations in the scope of the NMP lead role, a lack of clear definition of the NMP lead role in PCTs following reorganisation and an absence of dedicated time for the role impeded this process. In addition, processes used to appoint NMP leads lacked clarity, and varied between trusts.…”

“…Scotland, Wales and Northern Ireland within the UK manage their own health systems and have their own guidance for the implementation of NMP . There is no evidence available that has explored how NMP leads are identified and appointed, and very few studies have explored the scope of the NMP lead role …”

The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey

“…Patients additionally report that they like the continuity of care, comprehensive information and holistic care that they receive from nurse prescribers for their skin conditions (Courtenay et al . ,b). However, since legislative changes in 2006 (DH ), there is no research available that has explored the profile and prescribing practices of these nurses.…”