Non-Medical Prescribing Annual Report 2014/15

Non-Medical Prescribing Annual Report 2014/15 Carol Threadgall NMP Project Support Officer Chris Prewett NMP Lead Helen Dabbs Deputy Chief Executive/Director of Nursing and Partnerships June 2015 Nursing & Partnerships

CONTENTS 1 Introduction 3 2 Governance Structure 3 3 Introducing the Team 5 4 Non-Medical Prescribing in RDaSH 6 5 Key Achievements 8 6 Training 13 7 Priorities 2015/16 14 Page 2 of 14

1. Introduction As part of the reformation of the NHS, the Department of Health planned to increase the number of prescribers so that patients receive a fast, more efficient service with improved continuity of care. It is more likely that as a patient you will meet an NMP either at your GP surgery or whilst being treated in the Trust. The NMP may help to manage your diabetes, asthma or blood pressure for example, and will help to make your visit smoother and quicker by being able to prescribe your medicines; or may help you with a prescription if needed as part of a minor illness clinic. Non-Medical-Prescribing (NMP) is undertaken by a health professional who is not a doctor. It concerns any medicine prescribed for health conditions within the health professional s field of expertise. Research has shown that NMP has improved the quality of service to patients; there is evidence of not just greater convenience but also of improved clinical outcomes. Nurses, pharmacists and other health professionals, such as physiotherapists, who prescribe are highly skilled in their specialist area. They will have undergone appropriate and on-going training and be as competent to prescribe as a doctor. They are required to demonstrate that they can undertake physical examination and history taking, in addition to possessing assessment and diagnostic skills in the specialist area in which they will prescribe. The training course is intensive and involves a theory and calculations exam. Once the prescriber has qualified, they are required to undertake and record continual development in their area of prescribing to ensure that they keep up to date. Date: May 2. Governance Structure Non Medical Prescribing Model The model will retain the current role and function of the Non-Medical Prescribing Lead but it will be supplemented and enhanced by increasing the recognition and skill of existing NMP Leads / champions. The roles and functions will be supported by a Project Support Officer who will co-ordinate the administration of NMP throughout the Trust. The aim of the model is to enable the Trust to develop and implement an effective NMP Strategy that provides equity across all the unique and diverse Business Divisions and embed the principles of Non-Medical Prescribing which are to: Make more effective use of the skills and expertise of groups of professions Improve patients access to treatment and advice Improve patient choice and convenience Contribute to more flexible team working across the Trust Page 3 of 14

The flow chart below (Fig 1) outlines the governance structure for the leadership of Non- Medical Prescribing. Figure 1: Governance Structure Board of Directors Clinical Governance Group Clinical Quality & Standards Group Medicines Management Committee NMP Group The management and authorisation process is outlined in Fig 2 Figure 2: Management Structure and Authorisation Strategic Lead Deputy Director of Nursing and Standards Non-Medical Prescribing Lead Head of Quality and Standards Service Director Mental Health Service Director Children s Services (Supported by Trust Pharmacy Lead) Project Support Officer Non-Medical Prescribing Champions within each Business Division Page 4 of 14

3. Introducing the Team (From left to right - Chris Prewett, NMP Lead, Helen Dabbs, Deputy Chief Executive/Director of Nursing & Partnerships and Carol Threadgall, NMP Project Support Officer) 3.1 Business Division NMP Champions Each Business Division within the Trust has a NMP Champion who attends the bi-monthly NMP Group meeting. The NMP Group s responsibilities are: To lead and direct Non-Medical Prescribing within RDaSH. To align and develop Governance and Performance Frameworks. To develop and implement a Non-Medical Prescribing Strategy To review and update the Non-Medical Prescribing Policy as required. To develop models of non-medical prescribing. To implement the National Single Competency Framework for non-medical prescribing. To ensure workforce development and non-medical prescribing are linked. To ensure links to other work streams are considered within Business Divisions. Review incidents and identify themes and trends. Page 5 of 14

(Business Division NMP Champions) 4. Non-Medical Prescribing in RDaSH Non-Medical Prescribing continues to develop across RDaSH. The current number of active NMPs across the Trust is shown at Figure 1 below: Figure 3: Active NMPs Page 6 of 14

4.1 Types of Prescriber There are three types of Non-Medical Prescriber within the Trust, which are determined within practitioner roles and responsibilities, they are: Supplementary Prescriber Independent Prescriber Community Practitioner Nurse Prescriber Numbers of each type are shown below: Figure 4: Number of Independent NMPs Figure 5: Number of Supplementary NMPs Page 7 of 14

Figure 6: Number of Community Nurse NMP 5. Key Achievements NMP Strategy The Non-Medical Prescribing Strategy has been developed and sets out a trust wide statement and vision on how RDaSH plans to develop non-medical prescribing over the next three years to support a range of healthcare professionals by embedding non-medical prescribing practice across all business divisions. Each business division has contributed to the Strategy and given their vision for non-medical prescribing as below. The implementation of the NMP strategy will aim to deliver the trust s five strategic goals. An implementation plan is linked to the strategic goals and will be monitored quarterly through the Non-Medical Prescribing Group meetings. Adult Mental Health Services: Our vision within the Adult Mental Health Services is that we will continue to develop and embed the roles of independent non-medical prescribers. We will continue to recruit appropriate staff to these specific roles, which are defined within the care pathways, in order to incorporate New Ways of Working. This improves access to treatments, offering choice and flexible working practices and benefitting the patient experience. What has been achieved? Adult Mental Health Services continue to fully support the development of Non-Medical Prescribers within all areas of service delivery. We have established a senior Clinical Supervision structure with Advanced Nurse Consultants now providing clinical leaderships to the Nurse Consultants within each locality. There is also a forum where Page 8 of 14

these clinical leads now meet on a regular basis to share good practice, learning, research and service development. Within each locality this learning and clinical leadership is cascaded with Non-Medical Prescribing being a key part of these roles. Work is on-going to refine service delivery with a focus upon Nurse Led Clinics to ensure there is a clear prescribing remit within relevant treatment teams. As we become clearer regarding the delineation of NMP roles work is being undertaken to develop more clinics on a consultation basis for more advanced practitioners to ensure resources are being used effectively. As pathways become more established it is now identified where these different aspects of Non-Medical Prescribing can be best implemented with banding and job descriptions reflecting the differences. This can then be considered when any new posts are required. We continue to support further staff to access this training with NMP being identified as a key part of their role. What difference has Non-Medical Prescribing made? As a Business Division with the increasing use of Non-Medical Prescribing we have witnessed an ongoing improvement in relation to medicines and patient care without compromising safety. Improved speed and convenience of access to medicines have been consistently reported as one of the main benefits of non-medical prescribing by patients and health professionals where these services are now established. It has increased the number and flexibility of appointments with Non-Medical Prescribing Clinics becoming an integral part of treatment teams based within the community in particular. As a result, doctors can also make better use of their time and concentrate on patients with more complex and comorbid presentations. We have also noticed an improvement in the continuity of care particularly in areas where we have a high turnover of junior doctors. In these times of financial restraints these roles have been a contributing factor to maximising resources as previously a large number of individuals would have been seen within an Consultant Psychiatrist s Out Patient s Dept. We have generally received in the main positive feedback by shifting to this model using NMPs to improve continuity and self-management of longer term conditions. As treatments perhaps need adjusting or changing this can be done quickly and with little disruption within these clinics. Older Peoples Mental Health Services (OPMHS): We would like to see possible developments of NMP within OPMHS as including: Reaching in to Primary Care to attend to antidepressant initiation / prescribing. Out of hours provision within in-patient units. Management of cognitive enhancers in memory clinics and in memory services. Management of cognitive enhancers, antidepressants and antipsychotics in care homes. Advice / direction of prescribing for acute trusts in-patients through our psychiatric liaison services. Management of prescribing within new developments such in-patient dementia challenging behaviour wards. Pharmacists supporting quality and Trust standards within in-patient and community services, extending the 10 point plan so they can act on it. We envisage that these points could support medical prescribing rather than replace it. Page 9 of 14

Doncaster Community Integrated Services (DCIS): The vision for DCIS is to provide continued professional development for all non-medical prescribers in order to provide a safe and seamless service to the patients/clients within their care. Having more professionals qualified in Non-Medical Prescribing will provide and enhance the patients experience by smarter and more efficient prescribing practice within the community and in-patient areas. What difference has Non-Medical Prescribing made? The introduction of NMP in DCIS has ensured value for money, increased efficiency and optimised prescribing for patients. It has extended patient choice and improved patient access to medications and treatments to meet their needs. Increasing patient choice in management of their conditions and health and reduced waiting times for patients in receiving prescribed treatments. NMP has enabled DCIS to have a work force that is highly skilled and developed in knowledge, skills and competence regarding medicine management. NMP has enabled DCIS to develop roles that require a practitioner to be an NMP to improve the quality of care and scope of care that can be delivered to patients across Doncaster. Children and Young Peoples Mental Health Services (CYPMHS): By 2017 our vision is to increase the numbers of NMPs within the CYPMHS Business Division, to provide greater flexibility, choice and access to medicines for Children and Young People using our services. Drug and Alcohol Services: By 2017 NMP will be firmly embedded in everyday practice. The use of NMP will enable continued delivery of cost effective quality interventions across a wide range of settings. The recovery focus will be supported further via independent prescribing which will include the initiation of treatment, access to rapid titration and detoxification. Ultimately NMP will provide service users with flexible access to pharmacological treatment interventions at the appropriate time and place. What difference has Non-Medical Prescribing made? Over the past year the role of the NMP has continued to evolve and expand across Doncaster, Grimsby and Rotherham. We are offering an increased availability of clinics Page 10 of 14

which enable a continued delivery of cost effective quality interventions across a wide range of settings. Clinics are now operating daily in Doncaster and Grimsby. More frequent appointments are now available for those clients wishing to exit treatment providing individual detoxification regimes which can be reviewed frequently. We also offer increased appointments for clients who are new in treatment, this enables service users access to rapid titration to a therapeutic level quickly and safely. Duty slots are now available which cover prison releases, hospital discharges and any urgent problems. In addition DNA clinics are now operating. Service users are encouraged to collect their prescriptions at appointment. This promotes safer prescribing and encourages service users to engage and take personal responsibility for their treatment and care plan, Rotherham service is currently being restructured. Within the new model the plan is to increase prescribing capacity and nurses have been identified as suitable to do their training. Across the business division there is currently one nurse completing training and another 3 have already secured a place to commence in September. There is exciting progress with The New Beginnings detox facility. New Beginnings will be offering increased detoxification beds for more complex clients with drug and alcohol problems. We are currently in the process of recruiting a Non-Medical Prescriber to support the medical cover and provide daily access/availability to prescribing on site. Within the substance Misuse Service it is envisaged that the role of the Nurse Prescribers will continue to expand in the future which will continue to increase the flexibility and access to pharmacological treatment interventions at the appropriate time and place. Learning Disability Services: We have a vision that Senior Specialist Nurses working within Learning Disabilities in specialities such as Dementia, Autistic Spectrum Disorder and Epilepsy. Will be autonomous practitioners utilising higher level advanced practice skills to clinically assess and treat, including the ability to independently prescribe where clinically indicated. The introduction of Non-Medical Prescribing will promote greater collaboration between medical and non-medical colleagues and will support medical prescribing rather than replace it. Policy Development The Non-Medical Prescribing Policy was ratified by the Clinical Effectiveness Committee on 9 January 2014 and is available on the Trust website. The Standing Operating Procedure (SOP) for Non-Medical Prescriber Registration with the NHS Business Services Authority (NHSBSA) (DCIS only) was developed and is available on the Trust website. The registration process is undertaken by the NMP Project Support Officer and continues to progress. Page 11 of 14

Single Competency Framework (SCF) The Single Competency Framework was published in 2012 and gives a clear common set of competencies underpinning good prescribing regardless of professional background. This framework consolidates the existing profession specific prescribing frameworks and updates the competencies in order to provide a single common framework that is relevant to doctors, dentists and non-medical prescribers. The framework can be used to help healthcare professionals prepare to prescribe and help NMPs to identify strengths and areas for development through self-assessment. All NMPs within the Trust are working towards the SCF programme as agreed by their mentor/supervising practitioner. NMP Web-Page The Non-Medical Prescribing web-page has been developed and is live on the Trust s intranet under Nursing and Partnerships Directorate and linked to the Prescribing and Medicines Management web-page. Annual Declarations The completed NMP Annual Declarations have achieved 100% across the Trust for the last two years compared to 52% during 2012/13. A breakdown by each business division is shown at Figure 1 below: Figure 7: Completed Annual Declarations These statistics are reported through the NMP Quarterly Improvement Report and presented at the NMP CPD Days. Page 12 of 14

Audit A Trust-wide audit based on the NMP Annual Declarations submitted covering the period 1 April 2013 to 31 March 2014 has been undertaken. This audit is to ensure there is documentary evidence to support CPD activity and prescribing competence which were declared by both the NMP and their mentor/ supervising practitioner. Overall the results were good achieving >90% in all criteria. Where results did not achieve 100% will be addressed in the Action Plan and monitored through the bi-monthly NMP Group meetings. Future audits will involve: 6. Training Prescribing practice activity Spot checks of NMP Portfolios to sample evidence in support of the Annual Declarations. The current number of individuals undergoing training either via the Specialist Community Public Health qualification or an NMP University Course is shown at Figure 5 below: Figure 8: Number of NMPs undergoing Training 2015/16 Page 13 of 14

6.1 Continuous Professional Development (CPD) NMP CPD development days are organised twice a year. During 2014/15 there were 93 NMPs who attended these development days. The sessions provide an opportunity for NMPs to: Receive national and local updates Link in with the Medicines Management Therapeutic training programme Interact/network with other NMPs to discuss case studies/share good practice where NMP crosses boundaries with other Business Divisions Undertake practical training sessions, ie management of common skin conditions 7. Priorities 2015/16 In 2014 the Trust developed its two year Quality Improvement Strategy in which it has identified 4 domains of quality: Patient Safety Clinical Effectiveness Patient Experience Our Staff The Non-Medical Prescribing priorities during 2015/16 highlighted below will support the implementation and delivery of the Quality Improvement Strategy within the 4 domains of quality: Support Allied Health Professions within the Trust as NMPs Host a regional NMP Conference to showcase good practice to deliver safe and effective prescribing across all areas of the Trust Develop a patient survey to use at nurse-led clinics on their NMP experience to ensure that patients are at the centre of the NMP process Page 14 of 14