Practical guide for independent prescribers

Pharmacists, nurses, midwives and other allied healthcare professionals (AHPs) who have completed an accredited prescribing course and registered their qualification with their regulatory body, are able to prescribe. Two types of prescribers are:

An independent prescriber (IP) is a practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and can make prescribing decisions to manage the clinical condition of the patient.

A supplementary prescriber (SP) is a practitioner who prescribes within an agreed patient specific clinical management plan (CMP), agreed in partnership by a supplementary prescriber with a doctor or dentist 

The table below is a brief summary of what IPs and SPs can prescribe. In general, an IP can prescribe any medicine for any condition within their clinical competence, whilst a SP may prescribe any medicine within their clinical competence according to the CMP.

It can be difficult to decide whether prescribing is right for you. The following articles describe the day-to-day role of prescribers working in various sectors and can be a starting point to gain an understanding of how the prescribing qualification can be used to develop your own practice and competencies required to be a prescriber:

• The multidisciplinary RPS prescribing competency framework is for all prescribers and sets out a framework to develop the competencies to be an effective independent prescriber.

• NMC Standards for prescribers are a range of standards that set out how nurses and midwives can achieve prescriber status, how prescribing programmes are run and what constitutes safe and effective prescribing practice  
  

• RCN factsheet on nurse prescribing in the UK gives more information on nurse prescribing and the evidence to support it. 

• The British Pharmaceutical Student Association (BPSA) have published an article on Being a Pharmacist independent prescriber.

• Pharmaceutical Journal (access by RPS members and subscription only) - Why this NHS hospital trust asks all its clinical pharmacists to become independent prescribers.

• Pharmaceutical Journal (access by RPS members and subscription only) – Changing faces looks at pharmacist prescriber’s roles in non-surgical cosmetic procedures.

• RCN guide for nurse prescribers provides information on nurse prescribing, including the different types of nurse prescribers

• Pharmaceutical Journal (access by RPS members and subscription only) – The loose ends are sorted. Job done looks at how being a pharmacist prescriber can make a positive difference to patient care.

• Community Pharmacy Clinical Services Review - a review done on clinical pharmacy services and discusses the use of a greater contribution of independent prescribing pharmacists in an integrated pathway approach to patient care. A summary of the review can also be viewed on the PSNC website.

• Pharmaceutical Journal (access by RPS members and subscription only) - Community pharmacist independent prescribers can play key role in GP practices, pilot finds.

• Nursing times – Nurse prescribing is it for you

• Nursing time - Does non-medical prescribing make a difference to patients?

We have worked closely with independent prescribers to produce the following tips to help you overcome the challenges involved in finding a DMP:

• If you work in secondary care, discuss finding a DMP with the clinical director or lead clinician for the area you are intending to practice in. Your Trust or Health Board will have a non-medical prescribing lead who may also be able to help.

• By networking with colleagues, such as doctors (on wards, at your local practices, GPs in intermediate care teams, specialist service, etc) you can find out if they are interested in being a DMP.

• Colleagues and friends who are prescribers may be able to assist you in finding a DMP. 

• Most universities will not permit family members to be your DMP as there would be a conflict of interest. However the family members may suggest other colleagues who could be potential DMPs.

• Contact your local GP surgeries to find a DMP.

• Develop a plan showing benefits of having an IP in general practice, which may influence the practice to invest in training/employing an IP. The Centre for Pharmacy Postgraduate Education (CPPE) Being influential and Business cases may be helpful in making your case.

• Working in GP practices is a good way to work with practitioners that may be able to be your DMP. Our ultimate guide for pharmacists working in GP practices provides guidance on these roles, including information on job applications.

• Understanding the role of the DMP can be useful when having discussions with potential DMPs. The following resources could support you with this:
  • DMP resources on university websites.
  • National Prescribing Centre (NPC) document on Training Non-Medical prescribers in practice (Archived) (supports doctors to prepare for and carry out the role of a DMP). 

• Contact course providers to discuss role of DMP and advice on finding one.

• Discuss with potential DMPs how the role can benefit their own personal professional development and portfolio.

• Pharmaceutical Journal (access by RPS members and subscription) – Working with a designated medical practitioner explains how aspiring prescribers can help DMPs understand their roles.

• The GPhC website has a list of accredited independent prescribing course providers and NMC's course search facility can be used to help find an approved nurse and midwifery prescribing programme.

• Most of the course is self-directed and distance learning, with some face-to-face learning (therefore you may be expected to travel to the university for study days). The GPhC website has a map of GPhC accredited independent prescribing programmes and conversion programmes for supplementary prescribers.

• Information about the course, including an overview, requirements, course details and modules, how to apply, fees and funding can be found on university website. Look at the course content in detail will the course be multi professional?Is there a balance of pharmacology and physical/clinical assessments skills to meet your learning needs?

• Seek support from your organisation, ensure there is a role as a prescriber and investigate any national or regional workforce funding.

• Look at the study day timetable on university website (if available). Some universities may provide weekend courses.

• Contact the university or the course lead for further enquiries.

• Additionally for further information pharmacist members can also contact RPS Professional Support Service and nurses and midwives the RCN advice team online

Before starting your course, you will be asked by the course provider to identify the area of clinical practice that you want to develop your prescribing skills in. You are expected to have up-to-date clinical and pharmacological knowledge within this specialty, allowing you to focus on enhancing your consultation and reflection skills in your area of clinical practice during the course.

When deciding on your area of clinical practice, it is important to consider your competency to prescribe in your chosen clinical area and the prescribing requirements of your patient group. This may include a specialty you currently work in or an area you have identified a prescribing need for. Discuss how you will use your qualification with your line manager, and how this will allow you to improve the care you give to your patients. Be specific with your area of practice and the group of patients you will prescribe for (i.e. Do you want to focus on prescribing for adults, children, will you exclude any patients such as pregnant women, etc).

The GPhC registrant survey provides examples of clinical areas in which Pharmacist IPs commonly prescribe in. Some of these include:

• Antibiotics
• Anticoagulation
• Cardiovascular
• Diabetes
• Hypertension
• Pain management

The Prescriber The expanding role of nurse prescribers gives a breakdown of therapy areas in which nurse independent prescribers use their qualifications in. Some of these include:

• Respiratory
• Minor ailments
• Wound care
• Dermatology   

The Department of Health, Social Services and Public Safety Northern Ireland provides further information on prescribing by Non-Medical Healthcare Professionals .

During your course you may be asked to develop a personal formulary, from which you intend to prescribe from, based on your clinical area of practice. The World Health Organisation’s guide to good prescribing practice manual provides information on developing a personal formulary.

During your course you may be required to build a portfolio demonstrating your competencies in prescribing. It may be based on the RPS prescribing competency framework, which sets out what good prescribing looks like and describes the competencies and outcomes prescribers should be able to demonstrate. Having an understanding of the framework can be useful to build and develop your competencies during your days in practice and also demonstrate how you have achieved these in your portfolio. Our frequently asked questions section looks at other ways you can put the framework into practice.

The Prescribing Competency Framework webinar introduces both existing prescribers and aspiring prescribers to the prescribing competency framework and how it can be used to support prescribing practice.

Accredited training providers for independent prescribing courses are expected to ensure that all qualified Pharmacist IPs achieve the GPhC learning outcomes. Your university may base some of your assignments on achieving these learning outcomes, such as portfolio entries, clinical and observational assessments. Therefore familiarising yourself with the learning outcomes will help you understand what your course objectives are.

You are required to do an Objective Structured Clinical Examination (OSCE) (the term may vary from one course provider to another).

The following resources can support you in developing your clinical and consultation skills:

The following CPPE learning programmes to support the role of pharmacist prescribers and aspiring pharmacist prescribers:

Prescribing gateway

Clinical assessment and history taking skills

Consultation skills in general practice

Consultation Skills

The following NHS Education for Scotland (NES)  resources to support the role of prescribers and aspiring prescribers:

NES clinical skills

Pharmacist Working in GP practices

Wales Centre for Pharmacy Professional Education (WCPPE) have a range of topics that may interest to prescribers and pharmacist training to be prescribers. A full list of resources can be found on the WCPPE website.

NMC approved programmes and courses to build on your clinical competencies for nurses and midwives)

Script is an eLearning programme to improve safety and competency among all healthcare professionals around prescribing, therapeutics and medicines management.

OSCEstop one stop resources for OSCE is useful for all healthcare professionals preparing for clinical or OSCE type assessments.

Prescribing safely, legally and understanding your accountability and responsibility when prescribing is important during your development as a prescriber. The following resources (as well as ones provided by your course provider) help support this:

Medicines Ethics and Practice (access by RPS members only)

RCN Nurse prescribing Advice guides

CPPE Prescribing gateway- sections on prescribing safely and prescribing professionally

NES Resources for pharmacist independent prescribers

WCPPE prescribing

Pharmaceutical Press has a range of text designed to support prescribers in developing clinical, numeracy and pharmacology skills.

Both RPS E-library and NICE evidence search can be useful to access journals and scientific literature online to make evidence based decisions. Other resources to access journals are Embase and Medline. Using filters, narrowing your search and saving searches can be useful way of accessing journals specific to your area of practice.

Juggling your work-life balance along with studying can be challenging Pharmacist Support and RCN get help offer advice on stress and wellbeing offer advice on stress and wellbeing. Your university and tutor may also be able to provide additional support. 

Study groups within your course can be a useful way to learn from peers. Peers from different healthcare backgrounds such as nurses, pharmacists, community, hospital, etc, helps build on your own strengths and fill any gaps in your learning.

Once you have gained your qualification, it is important to get your annotations as a prescriber with your regulatory body before you start prescribing. This requires:

• Nurses and midwives - further details on how to record a qualification can be found on the NMCs adding qualification website.

• Pharmacists completing a form titled annotation on the GPhC register found on the GPhC website. 

It is a regulatory requirement for all registered pharmacists to "Make sure that the professional indemnity arrangement you have in place provides appropriate cover. This means that the cover needs to be appropriate to the nature and extent of the risks involved in your practice"¹

The GPhC website contains information and FAQs on professional indemnity requirements for pharmacists.

NMC have provided information on indemnity arrangement for nurses and midwives, and state: “It is a legal requirement for nurses and midwives to hold an indemnity arrangement in order to be registered with us”^*2

The RCN provide information on their own indemnity scheme. 

The RPS is not regulated by the Financial Conduct Authority and cannot recommend professional indemnity insurance providers, however we have worked with some independent prescribers to provide the following tips on how you may be able to arrange your own indemnity for your prescribing work:

• Understand your job role thoroughly by going through your job description particularly looking at the aspects you will require indemnity cover for.

• Your employer may have made indemnity arrangements for you, we advise you to check if this provides appropriate cover in respect of liabilities that may be incurred for your prescribing role.

• It is a good idea to enquire with several companies so that you are aware of the different types of cover available. Consider factors which could influence your decision such as cost, insurance speciality and specifics of cover.

• If you are sub-contracted to provide prescribing services for a Health Board or CCG, you should ensure that you are indemnified, before undertaking the role.

The RPS has called to have crown indemnity to be extended to all pharmacists. Further information can be found on RPS news.

^{1https://www.pharmacyregulation.org/professional-indemnity-requirements}

^{2https://www.nmc.org.uk/registration/staying-on-the-register/professional-indemnity-arrangement/}

The following are clinical resources to support you with prescribing (NB. This list is not exhaustive):

Local resources and guidelines such as; local CCG /Health Board guidelines, local formularies and your Trust policies.

British National Formulary (BNF) and BNF app.

Medicines Complete (subscription required) is a platform that provides online access to a range of drug and healthcare reference sources.

Clinical pharmacist publications covers the clinical management of various diseases.

Electronic Medicines Compendium (eMC) has up to date, approved and regulated prescribing information for licensed medicines in the form of
Summaries of Product Characteristics (SPCs) and Patient Information Leaflets (PILs).

The National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations for managing specific conditions. 

NICE clinical pathways are clinical flow decision trees designed to help clinicians make decisions.

NICE Clinical Knowledge Summaries provide easily accessible summary of the current evidence base and practical guidance on best practice. 

Scottish Intercollegiate Guidelines Network (SIGN) produce clinical guidelines containing recommendations for effective practice based on current evidence.

Scottish Government Therapeutic Branch, Effective prescribing and Therapeutics ensure delivery of safe and effective prescribing and use of medicines, within NHS Scotland.

Wales Medicines Strategy Group

UK Medicines information (UKMi) directory can be used to contact your local UKMi centre for clinical enquiries.

Specialist pharmacy services (SPS)

Some clinical resources by therapeutic area include:

SPS which medicines require extra care when switching between liquid and tablet/capsule formulations?

Faculty of Pain Medicine Opioids Aware: A resource for patients and healthcare professionals to support prescribing of opioid medicines for pain

Drug misuse and dependence UK guidelines on clinical management

Department of Health and Public Health England Antimicrobial prescribing and stewardship competencies

RPS Antimicrobial stewardship quick reference guide

Department of Health: Medicine safety: indicators for safer prescribing.

Medicines and Healthcare Regulatory Agency: guidance and toolkit for women and girls on valproate

It is important to keep up-to-date with your prescribing skills. We have highlighted below some ways as prescribers you can do this:

• Attending any local learning or training events.

• Participating in team meetings and learning lunches with other healthcare professional colleagues.

• Workplace mentor/buddy or regular peer reviews can also support on your own professional development. Our mentoring service can be useful to help you find a mentor (Access by RPS member only).

• Networking on professional networks or specialist groups, (such as; Responsible Respiratory Prescribing, UK Ophthalmic pharmacy group, etc). Networks can be found and created on NHS networks. 

• Reading specialist journals and joining other Royal Colleges in your chosen area of prescribing. Examples include; Faculty of pain medicine, British society of gastroenterology, Royal college of obstetricians and gynecologist.

• RPS support alerts (access by RPS member only)

• NICE newsletters and alerts

Over time you will be exposed to patients with various other clinical conditions and as a result be required to expand your area of clinical practice to improve and provide holistic patient care.

A prescriber can prescribe any medicine for any condition within their competence. (See what an IP and SP can prescribe). As well as having a good understanding of the medicines prescribed, it is important to be competent in diagnosing and managing conditions. Highlighting ways to expand your clinical practice through viable resources, learning tools and relevant training can assist in meeting competencies required for diagnosis and disease management. 

The following resources can support with your current or expanding your area of clinical practice. (NB: This is not an exhaustive list and for further details on training or resources you can use to develop your clinical expertise in a specific clinical area pharmacists can contact RPS Professional Support Service and for nurses and midwives RCN advice team online

Clinical resources sections in this guide.

RPS list of accredited training providers and courses

Training course providers such as CPPE, NES, WCPPE, Script and nmprescribing may have courses for prescribing in specific clinical areas of practice

Arranging work shadowing with specialist nurses, pharmacists or consultants in specific areas of clinical practice. Finding out about any events, training courses or networks.

Using your SP prescribing qualification to prescribe in a new area of clinical practice can mean you are engaged with other healthcare professionals involved in the individual patient, whilst developing on your own prescribing skills in that area of practice.

Case study one

David is a qualified IP who gained his prescribing qualification in infectious skin diseases. Whilst visiting relatives in Yorkshire with his family, Diane his 18 year old daughter cut her hand when cooking. A couple of days later, her hand became inflamed and visibly infected.

David decided to prescribe her a course of antibiotics, as they were away from their family GP. Diane had not mentioned to her dad that she had recently started taking the pill and had been on anti-depressants for about 6 months. She did not want to mention this to her dad as she felt uncomfortable and thought that there was no need.

Consideration Points

• Whilst David was trying to help his daughter, he did not have a full history of her medication which can result in drug interactions putting his daughter at risk.

• If Diane had been seen by another prescriber, she may have felt more comfortable to discuss her other medication and share her full medical records.

• Is the prescriber able to remain objective when self-diagnosing or treating family and friends? GMC Prescribing to friends and family: an ethical minefield discusses this further.

• Is David absolutely sure that antibiotics are needed or has his clinical diagnosis been hindered as the patient is a family member?

• RPS Antimicrobial resistance and stewardships looks at importance of prescribing antibiotics appropriately.

Case study two

It is a Sunday afternoon and Jane is at the airport due to catch her flight in 50 minutes. She remembers she has forgotten her salbutamol inhaler. Having obtained her prescribing qualification in mental health last year she decides to write a private prescription for herself as this would be the easiest option.

Concerned that the pharmacist may pick up on her self-prescribing and refuse supply (as this has happened before), she decides to not discuss her situation with the pharmacist and use a different patient name on the prescription instead of her own name.

Consideration Points

• There was no access to other prescribers and Jane needed her medication. Jane saw this as the easiest option, however has not considered the ethical implications for self-prescribing.

• Would a discussion with the pharmacist on her options have been more sensible? Had Jane done this, the pharmacist may be able to discuss other viable options, such as an emergency supply, or national PGD in Scotland.

• Jane acted in a dishonest manner by making up the patient’s details to obtain the medicines. Again discussing this with the pharmacist may have been more sensible. Would the pharmacist have been satisfied with Jane self-prescribing? Could this be fully audited and documented to make it more viable?

• Additionally, it is concerning that Jane has done this before, is it likely she will continue to self-prescribe, even when not in an emergency situation?

 Further Support

Medicines ethic and Practice (MEP): The professional guide for pharmacists (Access by RPS member only) discusses self-prescribed prescriptions and prescriptions for close family and friends.

General Medical Council (GMC). Ethical guidance

Case study one

Mo is working in a community pharmacy as the responsible pharmacist. He is conducting a consultation for making a supply of travel medicines to Mr Botang via a PGD. During the consultation, Mo realises the PGD has expired and therefore a supply cannot be made. Mo is aware that Mr Botang is due to travel in three days and needs the medicines today, so he decides to write a private prescription as he is also qualified as an independent prescriber.

Mo asks his pre-registration trainee to dispense the medicines, he conducts the final check and completes the supply. After Mr Botang leaves the pharmacy, the trainee mentions he read that you should only prescribe and dispense for the same person where exceptionally it is in the interest of the patient.

Mo felt that it was in the interest of the patient to issues a prescription as he is travelling soon, however would it have been an option to signpost Mr Botang to another pharmacy, to have the prescription dispensed and a different pharmacist carry out the clinical check?

Consideration Points

• It is important to consider the risks involved in prescribing and dispensing for the same patient. The prescribing, and supply of medicines prescribed should normally remain separate functions performed by separate healthcare professionals in order, to protect patient safety. In exceptional circumstances where you need to prescribe and dispense to the same person, do take measures to ensure a safe supply for example by conducting a risk assessment and taking a mental break between prescribing and dispensing activities.

• Maintaining a full audit trail and documenting reasons for decisions would be good practice and could include annotating the prescription.

• By signposting to another pharmacy, an additional clinical check would have been made by another pharmacist and any potential errors could be picked up.

• Could Mo have discussed this with Mr Botang and suggested an alternative pharmacy? If there is another pharmacist working the following day would an alternative option be to ask Mr Botang to pick up the medicines the next day.

• Although Mo felt he was acting in the interest of the patient, the pre-registration trainee rightly mentioned guidance from the MEP. Further guidance can be found in NES A guide to good prescribing practice for prescribing pharmacist in NHS Scotland, the archived document Review of prescribing, supply and administration of medicines (the Crown Report)  

Case study two

Adam is a community pharmacist IP. He has recently qualified as a prescriber for minor illness and often runs minor illness clinics at the pharmacy during the week alongside a second pharmacist who carries out the clinical checks. Ms Richards attends the pharmacy quite visibly annoyed and upset. She has been to the out of hours service who have stated they will send a prescription to the pharmacy. Adam has not received the prescription yet. The pharmacy closes in 15 minutes and Adam knows that Ms Richards is going to Dorset the following day to visit her daughter.

Adam decided to take Ms Richards to the consultation room. Using the skills he has gained as a prescriber carries out a clinical examination, checks if she is taking any current medication and issues her with a private prescription for Amoxicillin. As there are no local pharmacies open, Adam dispenses and checks the prescription himself making the supply to Ms Richards.

Consideration Points

• It is important to consider the risks involved in prescribing and dispensing for the same patient. The prescribing, and supply of medicines prescribed should normally remain separate functions performed by separate healthcare professionals in order, to protect patient safety. In exceptional circumstances where you need to prescribe and dispense to the same person, do take measures to ensure a safe supply for example by following a procedure, conducting a risk assessment and taking a mental break between prescribing and dispensing activities.

• Maintaining a full audit trail and documenting reasons for decisions would be good practice and could include annotating the prescription.

• There was no second check involved (as there is during the week with a second pharmacist) to ensure Adam would have not made any clinical errors in prescribing. Had the prescription been taken to another pharmacy, the pharmacist may have discussed penicillin allergies with Ms Richards.

• Could Adam have suggested that Ms Richards have the prescription (he prescribed) dispensed when she had arrived in Dorset the next day, therefore benefiting from an additional clinical check.

• There is a conflict of interest as a private prescription has been issued. Did Ms Richards need a private prescription? She is a patient of the NHS and is entitled to a NHS service. See BMA The interface between NHS and private treatment: a practical guide for doctors in England, Wales and Northern Ireland for further guidance

• The GPhC and RPS believe that pharmacists and their teams should be aware of and use all relevant standards and guidance, both regulatory and professional, to deliver patient-centred care and good quality outcomes. Read more in our joint statement. Professional standards for all prescribers are set out in the prescribing competency framework.

• Further guidance can be found in NES A guide to good prescribing practice for prescribing pharmacist in NHS Scotland, the archived document Review of prescribing, supply and administration of medicines (the Crown Report)  

Further Support

MEP Prescribing and dispensing to the same person (access by RPS members only) 

Case study one

Amelia has started her new role at a GP practice. She has gained her prescribing qualification and hopes to be running clinics reviewing and prescribing for diabetic patients. After completing her induction, she discusses this role with the practice manager and partners, who suggest she should start by signing general repeat prescriptions explaining as a prescriber this is part of her role. She does not feel comfortable with this as many of the patients are not diabetic and have not been reviewed by herself. However as Amelia has started a new role she does not want to cause any issues, so she agrees to do this.

Consideration Points

• To prevent being in this position, at the start of her contract Amelia could have questioned her role at the surgery and exactly what this would entail, discussing with the practice manger and partners the type of patients she will be prescribing for and clarifying if she will be running her own clinics for diabetic patients. Determining this before accepting a position could prevent you from being in situations that you may feel incompetent to prescribe in.

• Although Amelia does not want to cause conflict at her new place of work, it is important to remember she is responsible and accountable for every prescription she signs. The GMC guidance on Good practice in prescribing and managing medicines and devices looks at repeat prescribing in further detail.

• The archived document from the Department of Health Improving patients' access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England -discusses the responsibility and accountability of prescribers. It is important that each individual prescriber is aware of the limits of their skills, knowledge and competence.

• Going forward, Amelia may consider increasing her competencies and knowledge in certain therapeutic areas. Attending training sessions for the management of certain patient groups may be useful.

• It may be useful for Amelia to discuss a framework by which she can refer any repeats outside of her competency. She may find that although not in her original scope of practice, her previous experience as a healthcare professional means that it is wider then diabetes. She is then content to be responsible for the repeats of patients on other medications such as antihypertensive providing the appropriate monitoring requirements have been carried out. Additionally, this may give her the opportunity to expand her scope being exposed to a wider range of clinical areas and to use it as a learning opportunity for her continual professional development.

• It may be useful for Amelia to discuss any concerns with the practice manager/partners and before any framework is set out to ensure her indemnity providers cover her to sign repeats.

Case study two

It is a Monday morning and Jai is covering a hospital ward for his colleague, who is unwell. Whilst on the ward he notices that one of the doctors has forgotten to sign the drug chart for a patient who has been recently admitted. The patient is due to have their medication administered and Jai knows that the hospital policy does not allow for the administration of medication without a prescriber’s signature. The doctor who wrote the chart is not in and the other doctors are currently in a team meeting. The ward nurse suggests Jai (an IP) signs the chart so that the medicine can be administered. Jai signs the chart as requested by the nurse. Jai was not aware that the prescriber had intentionally not signed the medication chart as they were not sure of what the patient was on at the time. The medication chart was to be removed, but this was forgotten as it had been a busy weekend.

Consideration Points

• Although Jai’s intention was to ensure that the patient got the medication in time, he assumed the prescriber had forgotten to sign the medication chart.

• If Jai had discussed this with other colleagues in over the weekend, he would have realised medicines where not signed intentionally.

• There has been no formal clinical assessment of the patient by Jai or a discussion with the patient to check if the medication he has signed for were correct.

• Jai’s actions has put the patient at risk of taking incorrect medication.

• It is important to remember not to prescribe under pressure from peers or colleagues, as once signed Jai is responsible and accountable for every prescription he signs for. Carrying out the appropriate due diligence can ensure patient safety and reduce the risk of errors. 

Further Support

GMC Prescribing guidance: Sharing information with colleagues

GMC A-Z ethical guidance

GMC Repeat prescribing and prescribing with repeats

Case study one

Alex is an IP who has spent a year working in a GP practice running his clinics, he has recently started a new role as a prescriber working remotely doing telephone consultations for out-of-hours. Whilst he has some experience of telephone consultations during his time at the GP practice, this was only for patients that he had seen at some point during his clinics and had a good understanding of their medical records.

Alex is a bit concerned about prescribing remotely for a range of patients that he has not seen before and prescribing outside of his competency. He does not want to turn the role down as he feels it is good for his development as a prescriber.

Consideration Points

• With remote services becoming increasingly popular, it is important that any prescriber feels both competent and safe to provide this service for their patients.

• Alex needs to remember he is accountable and responsible for each prescription he signs.

• Is there a process for when he can refer a patient to a medical prescriber whilst working remotely? Is he able to distinguish when a patient may need a physical examination and where to signpost the patient to?

• Making a list of all the additional skills required for remote prescribing could be useful, such as improving history taking skills. Could he undertake any additional courses or training that would support him in remote prescribing?

• Discussing with other prescribers how they may prescribe in this environment, considering a workplace mentor can help.

• Again, it is important to remember Alex is responsible and accountable for every prescription he signs. The archived document from the Department of Health Improving patients' access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England -discusses the responsibility and accountability of prescribers.

Further Support

GMC Prescribing guidance: Remote prescribing via telephone, video-link or online

GPhC Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet

GMC Remote patient consultations and prescribing

• RPS Prescribing competency Framework
• Medicines Ethics and Practice (access by RPS members only)
• RPS Independent prescribing: Controlled Drugs
• MHRA Off-label or unlicensed use of medicines: prescribers’ responsibilities
• GMC Guidance for all doctors who offer cosmetic interventions
• HEE New qualifications unveiled to improve the safety of non-surgical cosmetic procedures
• NHSBSA Medicines Optimisation - generic prescribing
• BMA The interface between NHS and private treatment: a practical guide for doctors in England, Wales and Northern Ireland
• NHS England Items which should not be routinely prescribed in primary care: Guidance for CCGs
• NHS England Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs

• GPhC In practice: Guidance on consent
• GPhC In practice: Guidance on confidentiality
• NMC the code for Nurses and Midwives
• RCN Guidance on consent
• RCN Guidance on confidentiality
• GMC Confidentiality: good practice in handling patient information
• GMC Consent: patients and doctors making decisions together

• RCN executive nurse network
• RPS Foundation Programme
• RPS Faculty
• RPS mentoring service
• CPPE
• WCPPE
• NHS Education for Scotland
• Association for prescribers
• Script Safe prescriber

• RPS Policy document on independent prescribing
• GPhC Council meeting - Consulting on education and training standards for pharmacist independent prescribers 
• GPhC seeks views on supervising independent prescribers in training