Non Medical Prescribing (NMP)
End of Calendar Year Report
Author Mark. T. Lees
Department Practice Development Centre
Approved By Non Medical Prescribing Group
Date Approved December 2008
Review Date December 2009
The purpose of this paper is to highlight the current Non Medical (NM)
Prescribing position within NHS Lanarkshire.
It will explore the perceived challenges existent within the current state and
propose some potential recommendations for future practice
• NM Prescribing was established within NHS Scotland in 1996 – including
NHS Lanarkshire, on a phased implementation process (after a pilot in
England 1994) in Primary Care for District Nurses, Public Health Nurses
(formerly Health Visitors) & some Practice Nurses from a restricted
• In 2001 NM Prescribing was extended to include a wider range of
medicines and a wider range of professional disciplines (e.g. acute
hospital nurses – minor ailments, minor injuries, palliative care etc and
latterly Allied Health Professionals and Pharmacists). Again NHS
Lanarkshire has been involved in rolling this out.
• NM Prescribing initially started its roots as supplementary prescribing and
has evolved and developed to include independent prescribing.
• NHS Lanarkshire continues to work within current NM Prescribing
legislative framework as directed by Scottish Government and that
determined by regulatory bodies (e.g. NMC / HPC / RGBPS)
• Within the three acute hospital sites in NHS Lanarkshire (Hairmyres,
Monklands & Wishaw) there are a small number of NM Prescribers from a
variety of clinical backgrounds.
• Primary Care (at the moment) continues to support the majority of Non
Medical Prescribers within NHS Lanarkshire. Although its Practice Nurses,
Public Health Nurses (Health Visitors) and District Nurses and in areas
• Access to the previous Drug Administration Coordinator (Acute) NM
Prescribing database has been difficult to obtain (access has been
obtained to some of that information now). However, the accuracy of this
information now is questionable.
• Primary Care NM Prescribing database is administered and updated on a
regular basis by the Associate Director of Nursing for Long Term
Conditions (Frances Leckie) with no recourse to administrative support.
• There is no clarity about prescribing practice within Acute Division,
although from Primary Care this information can be identified to all extent
from PRISMS – the national prescribing database.
• There is no single system approach to identifying, recruiting and funding
potential NM Prescribers in NHS Lanarkshire.
• The organisation currently accesses its NM Prescribing courses from a
range of Higher Educational Institutes (University of West of Scotland,
Glasgow Caledonian University & Queen Margaret University) often based
on personal (as opposed to organisational) choice.
• No single system approach has been designed to developing and
supporting current and future NM Prescribers in their roles within NHS
Lanarkshire (e.g. for issuing of unique prescribing numbers, prescription
pads, prescribing updates and formulary (BNF) issuing.
• There is no definitive current list / database of NM Prescribers in the
organisation (different databases / lists are currently held by different
people in different locations).
• Inconsistencies exist in the format to which this information is held (both
electronic and paper information held at present).
• There appears to be a time lag (in Acute) from completion of the NM
Prescribing course to practice (especially for staff requiring prescription
Actions to Date
• A fully constituted NHS Lanarkshire Non Medical Prescribing Group
chaired by the Executive Director for NMAHP.
• Appointment of a Practice Development Practitioner for Non Medical
Prescribing and administration support.
• An NHS Lanarkshire Non Medical Prescribing Action Plan.
• Development of standardised NHS Lanarkshire Non Medical Prescribing
• Work ongoing to the joint appointment of a Pharmacist to the Non Medical
Prescribing Course at University of the West of Scotland.
• Development of an NHS Lanarkshire NM Prescribing policy.
• Development of a Clinical Governance Framework to support the service
need for NM Prescribing with NHS Lanarkshire.
• Establish a clear NHS Lanarkshire pathway for NM Prescribing, from
application to practice (sustainable operational procedures).
• Work closely with the HEIs to ensure access to the most appropriate NM
Prescribing course is available to meet the needs of NHS Lanarkshire
workforce – e.g. involvement in reviewing course materials, availability /
access to courses locally etc.
• Work towards the development of a NHS Lanarkshire (Acute and Primary
Care Operating Divisions) live NM Prescribing database.
• Development of an NHS Lanarkshire annual monitoring / review process
to establish if NM Prescribers are continuing to develop and maintain
• Formulation of an NHS Lanarkshire continuing professional development
pathway to assist practitioners to maintain knowledge, skills and
competence in NM Prescribing.
Non Medical Prescribing is complex and not without risk; this complexity and risk
requires both robust management and governance.
Whilst NM Prescribing is important for the future, it is also important to ensure
that clinical policy such as the Symptomatic Relief Policy and Patient Group
Directions are also considered as useful tools to assist in delivering effective and
efficient medicines management. However, these too require to be rigorously
established implementation, monitoring and reviewing