The development of nurse prescribing in mental health services: Outcomes from five national surveys 2004–2019

Abstract

Aim This study aimed to explore data from national surveys of nurse prescribing in England's National Health Service mental health services. Background Nurse prescribing is increasing worldwide. Reports describing long‐term developments after implementation are rare. Methods Five surveys were distributed to all mental health organisations between 2004 and 2019. Results Response rates increased from 54% (n = 45/83) in 2004 to 79% (n = 42/53) in 2019. The estimated proportion of mental health nurses who were prescribers increased to 4.3% by 2019. Distribution between clinical practice areas did not change significantly over time, with the largest numbers in community mental health teams. The proportion of nurse prescribers actively prescribing increased from 76.4% in 2014 to 87.8% in 2019. Independent prescribing became the predominant approach, with supplementary prescribing rarely used as the sole model within organisations. The scale of implementation varied markedly between organisations. Conclusions Although nurse prescribing in mental health services has grown over time, growth has slowed and is variable at local level. Implications for Nursing Management Organisations considering the introduction or growth of nurse prescribing should note the evidenced preference for an independent prescribing model to date and consider how to avoid unwarranted variation in nurse prescriber role distribution.

Analysis of changes in the national mental health nursing workforce in England, 2011–2021

“…A national survey of mental health nurse consultants in England identified 35.7% of respondents as prescribers (Brimblecombe et al, 2019). A repeated survey of all trusts providing mental health services in 2014 (Dobel‐Ober & Brimblecombe, 2016) and 2019 (Brimblecombe & Dobel‐Ober, 2022) provides information as to the distribution of nurse prescribers and the models of prescribing in use. In 2019, there were an estimated 1583 MHN NPs in the NHS (Brimblecombe & Dobel‐Ober, 2022), extrapolated from responses from 79% (42/53) of Trusts matched against the total number of MHNs in England as reported by NHS Digital (2022).…”

“…for training courses and ACP roles are rapidly growing in number internationally (Schober, 2018) (Brimblecombe & Dobel-Ober, 2022). Marked, and yet, unexplained, differences in numbers of nurse prescribers between trusts have remained a constant feature of the distribution of nurse prescribing.…”

“…Although the limited evidence available from randomized control trials suggests that nurse prescribing is safe and can provide beneficial clinical outcomes (Noblet et al, 2018), the lack of mental health specific controlled trials is argued to have contributed to wide variation in usage (Brimblecombe & Dobel-Ober, 2022).…”

Characteristics of prescribing activity within primary care in Scotland 2013–2022 of general practitioners, nurse, pharmacist and allied health prescribers: A retrospective cross‐sectional study

“…Research has been undertaken investigating the patterns of prescribing practice by nurse prescribers compared to doctors within community palliative care (Ziegler et al, 2018), mental health (Brimblecombe & Dobel-Ober, 2022) and in some of the devolved health services within the United Kingdom (Deslandes et al, 2022).…”

“…Research has been undertaken investigating the patterns of prescribing practice by nurse prescribers compared to doctors within community palliative care (Ziegler et al, 2018), mental health (Brimblecombe & Dobel‐Ober, 2022) and in some of the devolved health services within the United Kingdom (Deslandes et al, 2022). Albeit progress to understanding the impact of this practice in care provision has been made, there appears to be a lack of empirical studies reporting the patterns of routine prescribing practice within primary care in Scotland.…”