The changing nature of prescribing: pharmacists as prescribers and challenges to medical dominance

Abstract

This paper investigates the potential threat to medical dominance posed by the addition of pharmacists as prescribers in the UK. It explores the role of prescribing as an indicator of professional power, the legitimacy and status of new pharmacist prescribers and the forces influencing professional jurisdictional claims over the task of prescribing. It draws upon 23 interviews with pharmacist supplementary prescribers. Data suggest that the legitimacy of pharmacists as prescribers, as experienced in the workplace, has been aided by: (1) blurred definitions of prescribing; (2) the emphasis on new prescribers' competence urging pharmacist prescribers to limit their areas of clinical practice; and (3) a team approach to patient management. Competence, self-limitation on practice and the benefits of team working as part of the ideology of patient safety were thus an important influence on pharmacists' jurisdictional claim over prescribing. While pharmacists have successfully negotiated a role for themselves as prescribers, medicine has retained its high status, relative to other health professionals and with patients; it controls the knowledge base relevant for prescribing practice and has managed to develop an 'overseer' role over the process of prescribing. Prescribing, as an indicator of medicine's autonomy of control over their work and professional status, has changed. Yet the extent to which new prescribers have been able to threaten the professional dominance of medicine is debatable.

Pharmacist prescribing in Northern Ireland: a quantitative assessment

“…This mirrors what has been reported in earlier studies of pharmacist prescribing; Lloyd et al [13] reported that there were major concerns voiced over pharmacist involvement in diagnosis as doctors considered this their defining role and appreciated that pharmacists themselves would be uncomfortable with diagnosis. Similarly, were two aspects of the prescribing process where pharmacists felt the least competent: conducting clinical examinations and making initial diagnostic decisions [20]. Pharmacists in this study [20] conveyed that they were not used to carrying out physical examinations of patients and many had selected pharmacy as a profession because they did not want 'to get their hands dirty' [20].…”

“…Similarly, were two aspects of the prescribing process where pharmacists felt the least competent: conducting clinical examinations and making initial diagnostic decisions [20]. Pharmacists in this study [20] conveyed that they were not used to carrying out physical examinations of patients and many had selected pharmacy as a profession because they did not want 'to get their hands dirty' [20].…”

“…This has been found elsewhere [19]; this may be because pharmacists are particularly well placed to make an impact on patient safety due to their high risk aversion/ safety focus [17]. Respondents in a study by Weiss and Sutton [20] felt that the addition of new prescribers would improve safety and access by ensuring that prescribing decisions were documented, and taken responsibility for, by a prescriber who was available in a timely manner. It has been argued that recognising levels of competency is crucial in managing prescribing decisions for all health care professionals (HCPs).…”

“…Implicit within a prescribing consultation are historytaking, clinical examination skills and the diagnostic and therapeutic decision-making processes [20]. In this present study there was a general view that pharmacists were least confident at undertaking physical examination of patients.…”

Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review

“…NMPs assert that they adhere strictly to evidence-based practice (28) , yet this may not always be the case (32,33) . NMPs have disparate professional backgrounds but unlike doctors, none comes from a tradition of sometimes paternalistic relationships with patients or from a position at the top of the healthcare hierarchy (34,35) . It may be that their prescribing decisions are informed by different or additional influences to those of doctors.…”