Pharmacists have a unique and in-depth education in all aspects of medicines and medicines use, essential to the safe on-going monitoring, support and treatment of patients. The Royal Pharmaceutical Society (RPS) is committed to ensuring that patients benefit from this expertise to improve health outcomes.
All pharmacists in direct patient care roles must have access to independent prescriber (IP) training and be enabled to fully utilise these skills to enhance patient care as part of a multidisciplinary approach.
Key Recommendations
1. Patient access to safe and effective healthcare must be enhanced through new models of care and services that enable pharmacist independent prescribers to routinely use their skills and knowledge in practice.
1.1 Patients should benefit from access to pharmacist independent prescribers (PIPs) in their communities. Structured services need to be in place to enable PIPs to have the capacity to fully utilise their skills depending on the needs of their population.
1.2 Workforce planning must take into account the new and emerging roles of PIPs.
More resources are required for the existing pharmacist workforce to undertake advanced clinical skills training and qualify as PIPs.
1.3 In the interest of delivering high quality, safe and effective patient care, all PIPs should have appropriate access to, and be able to input into the patient health record.
2. Develop a clear pathway for pharmacists to become qualified PIPs.
2.1 The underpinning knowledge base for independent prescribing must be included in the MPharm undergraduate degree and pre-registration training year.
2.2 Pharmacists applying to undertake an IP programme should already have completed the RPS Foundation framework to assess clinical competency.
2.3 Experienced non-medical prescribers should be able to take on the role of designated practitioner as part of a multidisciplinary team (MDT) approach to clinical learning.
2.4 PIPs in training should also receive formal input and mentoring from medical colleagues and the wider MDT to benefit from a range of professional skills and knowledge.
Context for change
The NHS must adapt in order to deal with the progressive demands of an increasing and ageing population. With an estimated one in three people living with at least one long term condition1, demand for services is predicted to continue to rise2. Financial constraints and challenges with recruitment and retention of health practitioners3, including general practitioners and nurses4 are well publicised.
There is therefore mounting pressure to find new ways to increase efficiency whilst not compromising quality, ensuring the NHS is making the most effective use of all available skills and resources and that all healthcare practitioners are empowered to work at the height of their clinical competence.5
Caring for the health needs of patients and the public is a multidisciplinary process. Medicines are the most common intervention in the NHS; they can be life-prolonging and life-saving but, if used incorrectly, can also cause harm.6 Patients must therefore benefit from routine access to expert advice from a pharmacist as part of MDT approaches to the prescribing of medicines.
The legislation governing independent prescribing was amended in May 2006 when nurse IP and PIP was introduced. Since this time further changes in legislation have been introduced to extend prescribing rights to other registered healthcare professionals.
Once qualified, a PIP can autonomously prescribe any medicine for any medical condition within their competency, including controlled drugs (with the exception of the prescribing of diamorphine, dipipanone or cocaine for treatment of addiction).
1. Patient access to safe and effective healthcare must be enhanced through new models of care and services that enable pharmacist independent prescribers to routinely use their skills and knowledge in practice.
Where there is a clear opportunity for improving access to care, local planning arrangements must integrate PIPs into core models of care. This will contribute to improved patient flow and efficiencies, ensuring patients are able to see the right health professional at the right time and in the right place, from specialist clinics in secondary care through to prescribing for patients in their own home.
The skills of PIPs can help to build greater capacity and capability within the NHS workforce and ease pressure in areas such as acute and emergency care and primary care, including out of hours services. Current barriers which inhibit these developments must be addressed to ensure the investment in producing more pharmacist prescribers is a positive addition to patient care.
The development of the health and social care workforce should be based on the needs of patients, with a focus on disease prevention and new, flexible service models tailored to local population needs. Services and care settings require to be integrated with consistent leadership across the health and social care system.7