Non Medical Prescribing Strategy Non-medical prescribing strategy nd edition M Hart

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1 Non Medical Prescribing Strategy Non-medical prescribing strategy nd edition M Hart

2 Title of Document: Non medical Prescribing Strategy What type of document is it, please circle: Strategy 2 Edition: 2 nd Edition 3 Impact Assessments and Dates: 31 st May Approval History: Non medical prescribing sub-group 19/4/2012 Medicines Management Committee 29/5/ Ratification committee and date ratified: 6 Name of Executive Director Lead: Clinical Governance Committee 14/6/2012 Rick Roberts- Medical Director 7 Name of Lead Officer: Melanie Hart Non medical prescribing and governance lead 8 Name of Responsible Committee: Medicines Management Committee 9 Date Issued: Date that the document was placed on intranet and circulated to staff (to be added by Library). 10 Review Date: June Target Audience: All Non medical prescribers, both Nurses and Allied health professionals and their managers 12 BCHC Document Reference Number: Unique identifying number on database (to be added by Library) 13 Is this document new or a replacement for existing document? 14 Which document(s) should be removed from the intranet? 15 Type of document please circle: Replacement Non medical prescribing Strategy 2009 (only currently published on Medicines Management NMP page) Clinical 16 Summary: This document provides the strategic direction for the continued development and optimisation of non medical prescribing within Birmingham Community Health Care Trust, (BCHC) and to support the delivery of the Corporate and Divisional objectives. 1

3 Contents 1. Purpose 3 2. Introduction 3 3. Background to non medical prescribing 3 4. Definition of non medical prescribers 4 5. Non medical prescribers- the current local picture 5 6. Corporate values and objectives 6 7. Non medical prescribing aims and objectives 7 8. Financial considerations Implementation of strategy References Key documents 13 Appendix 1 Selection Criteria 14 Appendix 2 Option appraisal 15 Appendix 3 Non medical prescribing strategy Implementation plan 17 2

4 1. Purpose This document provides the strategic direction for the continued development and optimisation of non medical prescribing within Birmingham Community Health Care Trust, (BCHC) and to support the delivery of the Corporate and Divisional objectives. It defines the different levels of non medical prescribing and will influence and strengthen service re-design and service compliance with the Care Quality Commission (2010) whilst being responsive to patients. 2. Introduction BCHC is a new organisation and is the largest and most diverse provider of community health care in the country. It delivers core community services in service users homes and other community settings, as well as a range of inpatient sites such as Moseley Hall and West Heath hospitals, the Sheldon Unit and various Intermediate care facilities such as Riverside Lodge and Ann Marie Howes. The Children and Families division delivers core and specialist services throughout Birmingham and the Specialist Division comprises Birmingham Dental Hospital, West Midlands Rehabilitation Centre, citywide services for People with Learning Disabilities and a range of Community Dental Services in Birmingham and the Black Country. The strategy links to other underpinning strategies which support the delivery of non medical prescribing including: BCHC Organisational Development Strategy, Nursing and Therapy Strategy Medicines Management Strategy (in development) Learning and Development Strategy Clinical Quality, Safety and Governance Strategy. The aim of extending prescribing responsibilities, identified by the DH (2006) was to: Increase and improve the management and access to medicines Improve the patient/carer experience without compromising safety Develop and utilise the knowledge and skills of health care professionals more effectively Contribute to the introduction of more flexible team working across PCTs Support the management of long term conditions BCHC embraces these principles to improve our services and how our service users and carers experience them. We can offer patient care through responsive and accessible services whilst reaping the financial benefits through cost effective utilisation of current and future resources. 3. Background to non medical prescribing The origins of non medical prescribing in this country lie in the Crown report (DH, 1989). Following the implementation of its recommendations in 1994, District Nurses and Health Visitors began to prescribe from a limited list of dressings and medicines (the Nurse Prescribers Formulary for District Nurses and Health Visitors). Legislation over subsequent years has further opened up the scope for professionals other than doctors to prescribe medicines Further legislative changes (DH 2006) enabled all suitably qualified nurses and pharmacists to prescribe independently any licensed medicine for any medical condition, (with some exceptions), within their own level of experience and 3

5 competence, acting in accordance with their own professional regulatory bodies. This has now been further extended to include both unlicensed medicines, mixing of drugs and Controlled drugs, except those used for treating addiction. The Department of Health (2006) stated that Organisations should develop their strategic plan for the use of non medical prescribing to include independent prescribing by nurses and pharmacists. Typically this would involve senior managers and clinicians and the drug and therapeutics committee (or equivalent). They advised that the plan should be approved at Board level and would: recognise the benefits to service users of non-medical prescribing identify a range of clinical areas where service users can benefit identify a way to support and sustain the transition of staff to extended roles and the services they currently provide The purpose of extending prescribing responsibilities to non medical professionals is to: improve patient care without compromising patient safety make it easier for patients to get the medicines they need increase patient choice in accessing medicines make better use of the skills of health professionals contribute to the introduction of more flexible team working across the NHS 4. Definitions of non medical prescribers 4.1 Independent prescribers A prescriber who is legally permitted and qualified to prescribe and takes the responsibility for the clinical assessment of the patient establishing a diagnosis and the clinical management required as well as responsibility for prescribing where necessary and the appropriateness of any prescription issued. All doctors and dentists are Independent prescribers as well as pharmacists and nurses who have undergone the appropriate training and with the likelihood that podiatrists and physiotherapists will also be able to undertake independent prescribing in the future. 4.2 Community Practitioner Prescribers (formerly District nurse and Health visitors) Nurses who have obtained the V100 prescribing qualification as part of their Specialist Practice Qualification (District Nurses, Specialist Community Public Health Nurses, School Nurses,) or those nurses who have undertaken the V150 qualification, may prescribe from a limited formulary of products designed to meet the needs of their patients (Community Practitioner Formulary) This includes dressings, appliances and some prescription only medicines. This formulary can be found within the British National Formulary, (BNF) part XVIIb(i) of the Drug Tariff, and as a separate publication published bi-annually. 4.3 Optometrist Independent Prescribers They can prescribe any licensed medication for ocular conditions affecting the eye and surrounding tissue but can not prescribe any Controlled drugs independently. 4.4 Supplementary prescribers Supplementary prescribing is a voluntary prescribing partnership between an Independent prescriber (Doctor or Dentist) and a supplementary prescriber, to 4

6 implement an agreed patient-specific clinical management plan with the patient s agreement. Supplementary prescribers can be nurses, pharmacists, optometrists, physiotherapists, chiropodists or podiatrists and radiographers. Nurse and pharmacist supplementary prescribers can prescribe all drugs including controlled drugs and unlicensed medicines that are listed on the Clinical Management Plan (CMP). Allied Health professionals are able to prescribe all drugs other than Controlled Drugs. There are no restrictions on the medical conditions that may be treated provided they do so under the terms of a patient-specific CMP. The supplementary prescriber has discretion in the choice of dosage, frequency, product and variables in relation to medicines only within the limits specified by the CMP. More details on Supplementary prescribing can be found at: -MedicalPrescribingProgramme/SupplementaryPrescribing/index.htm 5. Non medical prescribing- the current local picture BCHC currently employs over 500 non medical prescribers, representing 10% of the total workforce across a wide selection of services including; Advanced Nurse Practitioners and Rapid response Complex care and Intermediate Care Integrated Multi-disciplinary teams -District nurses and Case managers Health Visitors In-patient palliative care Neuro-rehabilitation People with learning disabilities Physiotherapy Podiatry School nurses Specialist children s services, including ADHD, palliative care Specialist nurses including: Respiratory, Heart Failure, Parkinsons, Diabetes, Continence, Dietetics and Nutrition, Stoma care, Tissue viability and Lymphoedema, Haemoglobinopathy, Smoking cessation In addition specialist nurses and AHPs employed by other Trusts and organisations provide care and prescribe for BCHC patients in the following areas: Macmillan services Substance abuse General practice Out of hours centres Pharmacy services 5

7 6. Corporate values and objectives The non medical prescribing values and objectives can be directly linked with the Corporate values as follows; Corporate value Accessible Responsive Quality Caring Ethical Commitment Non medical prescribing value and objective We will provide a range of services that reach out into the community and meet individual need: ensuring that accessibility to non medical prescribers is equitable for all patients or service users with greater access to healthcare at a time and a place of their choice. This will include a greater choice of delivery models to patients to reduce the need for secondary care visits. We will listen and work with our service users and partners to meet needs and improve health and well being, developing non medical prescribing with their input and feedback We will provide safe effective personalised care to the highest standard by embedding non medical prescribing into sustainable services and a culture of high quality care We will provide our services with respect, compassion understanding and thoughtfulness ensuring that non medical prescribing is culturally appropriate and respects the individuals needs Promoting a culture of dignity and respect we will make morally sound, fair and honest decisions and be openly accountable, through ensuring the efficient use of resources, utilising the specialist skills of non medical prescribers to increase capacity of both general and specialist services where appropriate, making the best use of limited resources and capacity. Through our actions and commitment we will strive to make a positive difference to people s lives. We will value the contribution that non medical prescribers make, improving staff morale and job satisfaction 6

8 This strategy sets out standards that all non medical prescribers have to meet and the organisational framework within which each non medical prescriber will work, and must further be supported by good communication to both service users and carers. 7. Non Medical Prescribing Aims and Objectives 7.1 Recognise the benefits to patient/service users of non medical prescribing A Department of Health commissioned research project into Independent prescribing has demonstrated that non medical prescribing is currently safe and clinically appropriate (DH, 2011). This study also demonstrated that; Acceptability of independent prescribing to patients is high, as evidenced by the majority of patients reporting that they were very satisfied with their visit to their nurse or pharmacist prescriber and Nurse and pharmacist Independent prescribers in England is becoming a well integrated and established means of managing a patients condition and giving him/her access to medicines. It is vital to continually understand the benefits of this enhanced role, to inform future strategic developments and any national or international studies or research will be identified by the Trust non medical prescribing lead, and incorporated into future service improvements Action 1 Regular surveys of service users and carers experience of non medical prescribing will be commissioned by the Medicines Management team, together with continual monitoring of national evaluations of non medical prescribing 7.2 Identify a range of clinical areas where service users can benefit This strategy will ensure that non medical prescribing is implemented in a consistent way across all geographical areas of the Trust, which supports the delivery of high quality services, accessible in an equitable manner both for service users and their carers, and for staff pursuing this advanced role. Additionally we will identify the numbers of staff required to be trained as non medical prescribers to ensure there is continuity of service through any workforce movement and that workforce planning is robust for the ongoing delivery of non medical prescribing. The Non medical prescribing team, working with the relevant service managers as part of their overall business plans will: Identify the current level of non medical prescribers and their geographical distribution Identify future levels of non medical prescribers required to ensure equitable provision Identify the gaps in Non medical prescribing from the above information 7

9 Action 2 The Non medical prescribing lead/ support officer will assist all services to review and develop their non medical prescribing requirements referring to the selection criteria in Appendix 1 and the option appraisal in Appendix Governance To be eligible to prescribe in BCHC, each non medical prescriber must receive authorisation from both their line manager and the Trust Non Medical Prescribing Team. Authorisation will only be given once evidence has been provided that the individual: has the required qualification, through annotation on their relevant professional register that they have provided evidence of the scope of their Non Medical Prescribing practice by submitting the authorisation form (see Non Medical prescribing Policy and Procedures) has a Job description that documents that Non medical prescribing is part of the role described has provided a sample signature Whilst these Governance arrangements provide the individual with vicarious liability cover from the Trust, the NMC also recommends that every nurse prescriber should ensure that they have professional indemnity insurance by means of a professional organisation or trade union body (NMC 2006). The Trust Non Medical Prescribing and Governance team will maintain a register of all those authorised to practice as a non medical prescriber, which will hold the following details as a minimum; the name and title of the prescriber the prescribing qualification their professional registration number the date they qualified as a prescriber the area of clinical practice the mode of prescribing (e.g. FP10s, hospital charts, clinic prescriptions) The Trust non medical prescribing lead will be responsible for ensuring that an up to date non- medical prescribing policy is in place. Action 3 The database for all Non medical prescribers will be maintained according to NMC and Department of Health standards to assure the Trust that we have robust governance arrangements Job description Prescribing responsibilities must be detailed within a practitioners job description and must contain as a minimum, the following suggested statements 8

10 Community practitioner prescriber To prescribe medicines, effectively and in context as a limited Prescriber, from the Nurse Prescribers formulary, using evidence based, up to date clinical and pharmaceutical knowledge as appropriate. Independent/Supplementary prescriber To prescribe medicines, effectively and in context as an Independent prescriber from the British National Formulary, using evidence based, up to date clinical and pharmaceutical knowledge as appropriate. Supplementary prescriber To prescribe medicines effectively and in context as a Supplementary prescriber using a Clinical Management Plan drawn up in a voluntary partnership between an Independent prescriber (doctor or dentist) and the supplementary prescriber ensuring the patient s agreement is provided KSF outlines Prescribing responsibilities must also be reflected and detailed within the practitioners Knowledge and Skills Framework and contain the following suggested level descriptors for Non medical prescribing Core 1 Communication Gives clear instructions to the patients about their medication (e.g. how to take it, where to get it from, possible side effects) Core 2 Personal and People Development Keeps up to date with advances in practice and emerging safety concerns related to prescribing Core 3 Health, Safety and Security Prescribes a medicine only with adequate, up-to-date knowledge of its actions, indications, contra-indications, cautions, dose and side-effects. Core 4 Service Improvement Reflects on own prescribing, learning and changing as appropriate. Understands and uses tools to improve prescribing (e.g. PACT data) Core 5 Quality Accepts personal responsibility for own prescribing and understands the legal implications of doing so. Uses the multidisciplinary team to its full extent in prescribing practice. Provides support and advice to other prescribers where appropriate. Core 6 Equality and Diversity Understands the cultural, language and religious implications of prescribing HWB2 or 6 Understands different non-pharmacological and pharmacological approaches to modifying disease and promoting health, desirable and undesirable outcomes, and how to identify and assess them. 9

11 Action 4 All prescribers will be informed of above requirements on qualifying, and any new job descriptions and Knowledge and Skills frameworks being developed will have these included as a minimum 7.4 Support and Governance for non medical prescribers from the Medicines Management Team To realise the benefits and minimise any risks associated with non medical prescribing, the Medicines Management Team will: monitor non medical prescribers work within a clinical governance framework encompassing: patient safety including reporting adverse drug reaction supporting prescribers accountability managing risk monitoring the quality of prescribing and adherence to formulary identifying and remedying poor performance ensure the development and maintenance of the competence of all prescribers to support safe cost effective and appropriate prescribing, through education and mentorship recommend the competency framework tool to be used as part of the annual appraisal which underpins the Knowledge and Skills Framework Indicators and Examples of Application. Action 5 Non medical prescribers activity will be monitored by various means, including Incident reporting and Prescribing data analysis, and supported in practice through development of a medical and nurse mentor database Managing risk The scope of practice for an individual practitioner will vary greatly according to their education and training, experience and their job role. Prescribing competence must relate to this scope of practice and will be monitored by the Medicines management team to prevent inappropriate prescribing. Action 6 The Non medical prescribing team will maintain a register of individual s scope of practice, and prescribing will be monitored against this. 7.5 Non medical prescribers and their managers All non medical prescribers have a responsibility to provide this prescribing intervention to patients/service users and their carers as part of their duty of care. Non medical prescribing should be provided routinely as part of the role and be part of the discussion about care, treatment, rights and options This is not a normal day 10

12 to day function for all staff, but is an enhanced role for those specifically trained and who have received authorisation to use their skills, as identified by the service need and as stipulated in this strategy. Non medical prescribers and their team managers must ensure that: the provision of non medical prescribing to patients/service users and carers is built into their day to day practice non medical prescribers are supported and supervised to ensure relevant patients/service users are identified, that the intervention is fully explained to them and their carers, and that agreement is gained and that this is recorded. Where non medical prescribers are not actively using their qualification, a programme of support will be offered to them to identify and overcome the barriers to their prescribing, and to re-introduce the principles of prescribing practice. Managers are responsible for undertaking an annual appraisal of each non medical prescriber, to ensure that they are practising in a safe and effective manner, are maintaining their competencies, and are adhering to their role requirement. Where managers are of a different discipline to the non medical prescriber and further support in this process is required, they should discuss this with the Trust Non medical prescribing team for advice and / or involvement. 7.6 Support and sustain the transition of staff to extended roles and the services they currently provide During the selection of appropriately skilled staff to undertake non medical prescribing training, each manager should ensure that; there is not an alternative form of supplying medicines to the patient target group. For example the use of Patient Group Directions within the School Nursing service to deliver the national vaccination programme is the safest and most appropriate method of supply as opposed to nonmedical prescribing all applicants put forward for prescribing training enter the prescribing programme voluntarily. There should be clear understanding of how this fits within their current scope of practice and future personal/service and practice development through the process of appraisal and KSF. Any ongoing application to undertake training to become a non medical prescriber will only be considered where the individual has demonstrated the ability to diagnose in their area of speciality (NMC 2006), and is able to accept higher levels of clinical responsibility. Such ability must be confirmed on the application form for the course. All applications must have confirmation that the necessary infrastructure will be in place to allow them to prescribe (NMC 2006), or that an identified role is available, in their area of specialty, to prescribe in, on completion of the course. The Department of Health (2006) stipulates that All individuals selected for prescribing training must have the opportunity to prescribe in the post that they will occupy on completion of training. The therapeutic area(s) in which they will prescribe should also have been identified before they begin training to prescribe. To ensure that this requirement is met and that there is equitable access to this potential 11

13 career development, each manager must put in place procedures for interviewing prospective candidates to access the prescribing course. Once the above are all completed the Trust Lead/Support officer for non medical prescribing will also interview the prospective candidate before agreeing to the training and funding. There are three key principles that will be used to prioritise potential applicants: Service user safety Maximum benefit to service users and the NHS in terms of quicker and more efficient access to medicines for them Better use of the professional s skills (See Appendices 1 and 2 for details of selection criteria and option appraisal for current methods of prescribing, administering or supplying medicines) Action 7 Managers will be supported by the Non Medical Prescribing team to ensure that appropriate prospective Non Medical prescribers are identified 8. Financial considerations The University fees for non medical prescribing training are paid for out of the Learning Beyond Registration budget and is a limited resource each year. Therefore it is imperative that all the above criteria for recruitment and selection of prospective candidates to undertake the training are adhered to, to ensure that this budget is maximized to its full potential. There is no extra funding to provide backfill for students whilst undertaking the course, or for paying Designated Medical Practitioners who mentor Independent prescribing students. Non medical prescribing does not necessarily increase costs, as it is not a new population that is receiving the prescribing intervention, but an existing one that is being prescribed for by an appropriate person in the appropriate setting, i.e. the non medical prescriber is a substitute or replacement. However a prescribing budget must be identified before embarking on the prescribing course or developing a service, which may come from within the service for specialist services, or from existing GP practice budgets. Action 8 Robust selection of potential non medical prescribing candidates will continue to ensure that financial resources are used appropriately and that there will be both genuine need and an appropriate support/supervision structure for non medical prescribing in the service that the practitioner works 9. Implementation of the strategy The detailed action plan developed for the implementation of this strategy will drive the actions via a co-ordinated approach working in partnership with the relevant personnel to ensure its aims are achieved. (Appendix 3) 12

14 10. References Care Quality Commission (2010) Regulation outcomes and judgement framework. Department of Health (2006). A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the NHS in England. London: HMSO Department of Health (2011) Evaluation of Nurse and Pharmacist Independent Prescribing. DH policy research project Department of Health (1989) Report of the Advisory Group on Nurse Prescribing. (The Crown Review). London: HMSO. NMC Nursing and Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers. London: NMC 11. Key documents BCHC Non medical prescribing policy and procedures BCHC Medicines management policy 13

15 Appendix 1- Selection criteria MECHANISMS FOR NURSE, PHARMACIST AND AHP PRESCRIBING Eligible Professionals Community Practitioner Prescriber 1 st Level registered nurse. Minimum 2 years post reg experience Ability to study at Level 3 and competence in history taking, clinical assessment and diagnosis Nurse Independent Prescriber/ Pharmacist Independent Prescriber/Optometrist Independent Prescriber 1 st level Registered Nurse/Midwife: minimum 3 years post-reg clinical nursing experience, one year preceding course in field that will be prescribing. Registered Pharmacist: Minimum 2 years post reg experience, one year preceding course in field will be prescribing Registered optometrist Minimum 2 years post reg experience ALL Evidence of ability to study at level 3 and competence in history taking, clinical assessment and diagnosis. Supplementary Prescriber 1 st level Registered Nurse/Midwife: At least 3 post-reg clinical nursing experience Registered Pharmacist: At least 2 years post reg experience Registered Podiatrists. Physiotherapists and radiographers; At least 3 years post-reg experience Registered Optometrist At least 2 years post reg experience ALL: Evidence of ability to study at level 3 and clinical competence Preparation for prescribing Statutory requirement for prescribing Integrated into Specialist Practitioner degree programme, or attendance at V150 prescribing programme, 10 taught days and minimum 10 days supervised learning in practice Annotation against name on NMC register Nurse Independent/Pharmacist prescribing course (BSc or MSc level) days at HEI +12 days Learning in Practice with a designated medical practitioner Nurses, Pharmacists and AHPs Approx days+ at least 12 days learning in Practice with a DMP. Optometrists- between 3 and 12 days in clinical practice depending on previous prescribing qualification Distance Learning: minimum 8 days contact time, 10 personal study days and 12 days Learning in Practice with a DMP. Nurses: Annotation against name on NMC register Pharmacists: Annotation against name on RPSGB AHPs: Annotation against name on HPC register Optometristsendorsement on GOC register 14

16 Appendix 2 An option appraisal of current methods of prescribing, administering or supplying medicines by non- medical prescribers This guide is intended as a tool to illustrate the full range of options open to health services, their advantages and disadvantages. It is intended to inform the decision making process when services are considering new options, based on the potential benefit for patients. Consider the following points in relation to the service: How would any change to current prescribing or supply arrangements improve the service you offer your patients? Are existing independent prescribers able to prescribe for all patients without unnecessary delays/time wasting? Consider the conditions you aim to treat, and the competencies of the staff working within your service: does the NPF meet your requirements for prescribing or do they need to prescribe from the whole BNF? Are any controlled drugs involved? Do you need to prescribe or administer only, or do you also need to prescribe medicines for patients to take home? Would patient care be compromised in any way by proposed changes, i.e. is it safe? Are the medicines involved well established, i.e. not black triangle? Are all the medicines involved licensed? The table overleaf outlines the current options available for all non medical prescribers. It is possible to use a combination of methods of prescribing, i.e. an Independent or Community Practitioner prescriber may use a PGD in certain situations, for example during the flu campaign, or an Independent prescriber may wish to use a Clinical management plan for patients when an unlicensed medication is the treatment of choice. 15

17 Option A Community Practitioner Option B Independent prescriber Possible advantages for service and patients Responsive holistic service Limited range of products available Complete service offered- no delays Complete range of products available (with the exception of some CDs) Possible disadvantages for service and patients Prescribing Prescribing practices might not practices might be consistent not be Prescribing consistent responsibility not Prescribing shared responsibility Less control over not shared budget Potential to prescribe outside of competency Less control over budget Option B Supplementary prescribing Wider range of products than Options A &B Allows prescribing of controlled drugs Encourages more consistent practice than options A&B Allows prescribing of unlicensed medications Allows review of prescribing by a second practitioner Allows greater involvement of patient as they agree clinical management plan Diagnosis and clinical management plan must be agreed with independent prescriber Patient specific Relies on good communication between independent and supplementary prescriber Option C Patient Group Directions Promotes consistent clinical practice Detailed guidance included in PGD Allows for supply to large numbers of patients Takes time for PGD to be written and ratified Little scope for clinical judgement Clinical conditions must be pre-defined or within agreed scope of practice Limited to locally determined accredited individuals who must be suitably trained Option E Referral to Doctor May be safest for some patients with multiple complaints May be safest if there are concerns about interactions with existing medication May lead to delay in obtaining treatment 16

18 Appendix 3 Executive Director: Non Medical Prescribing Strategy Implementation Plan Rick Roberts Lead officer/ Non medical Prescribing and Governance Lead: Non medical prescribing and Governance Support Officer Head of Medicines Management: Melanie Hart (MH) Gill Weale (GW) David Harris (DH) OBJECTIVE ACTIONS LEAD TIME COMMENT Trust policy in place MH July 2011 Review on 2 yearly basis 1 Establish clear direction, philosophy and standards for non medical prescribing Trust agreement of non medical prescribing strategy MH April Raise awareness of this strategy Post on Intranet Raise awareness through committees and newsletter MH/Comms MH May 2012 Review annually 3 Staff are supported in the use of non medical prescribing, which is consistent across areas KSF profiles for all non medical prescribing roles as detailed within strategy are utilised MH/All NMPs and managers Jan 2013 Based on Agenda for Change: the NHS knowledge and skills framework 4 Managers are supported to ensure that non Annual appraisal of competence based on KSF profile Individual line managers Current and ongoing Based on National Prescribing Centre: 17

19 medical prescribers are practising in a safe and effective manner and are maintaining their competencies 5 Divisions are assured that they are getting value for money from staff in an enhanced role Competency framework document in place Ongoing supervision adhering to NPC competencies Provision/facilitation of appropriate learning and CPD Line managers to report back any concerns, based on supervision and appraisal Non medical prescribing lead/support officer to be involved in appraisals where line managers are not familiar with prescribing role and expectations MH/GW DMPs, Mentors, MH, GW Individual line managers Non Medical Prescribing Lead/Support officer Current and ongoing June 2012 and ongoing Maintaining Competency in Prescribing Based on NMC Guidance for Continuing Professional Development Adherence to NMP job descriptions 6 The Trust is assured that delivery of care is improved through increased patient choice, easier access to medicines, and through no compromising of safety Service user satisfaction survey completed PALS service in place for the reporting of complaints and praise Systems in place for the reporting of and learning from adverse incidents MH/GW Patient experience Head of PALS and complaints Clinical Risk Manager Datix reporting June 2012 and ongoing Adherence to CQC judgement framework 7 Divisions/service managers will develop non medical prescribing for all service areas as identified within this strategy framework Build into business plans and relevant workforce planning Managers develop process for interviewing interested candidates, for applying for the non- medical prescribing course Divisions Annually May 12 onwards April 12 and annual thereafter Trust strategic objectives 18

20 Raise awareness in teams of their role in providing non medical prescribing to patients/ service users and carers Managers/ Ongoing NMC, HPC and RPS standards 8 The Trust can identify numbers of non medical prescribers it has employed at any one time 9 Maximise the use of non medical prescribers Develop a database of appropriate Designated medical practitioners Register of all non medical prescribers maintained, including designation of prescribing levels Identify if all non medical prescribers on register are actively prescribing MH/GW MH/GW Already in existence April 2012 and ongoing Identify reasons for non prescribing 9 Patient/Service user and carer involvement is embedded in the Trust s approach to non medical prescribing 10 Quality and cost effectiveness of non medical prescribing in use in the Trust is monitored against Trust formularies and national standards Provide support and education for inactive prescribers Annual audit against a representative sample of those receiving non medical prescribing service across the Trust Annual audit against a representative sample of those receiving non medical prescribing service across the Trust Monitor through PACT data reports Report outcomes to Medicines Management and Clinical Governance Committee MH/GW MH/GW MH March 2012 and annual thereafter May 2012 and annual Support from Patient Experience team Wound care, antibiotic formularies. Medication Appropriateness Index 19