Non-Medical Prescribing Strategy 2014-2017 Nursing & Partnerships Directorate Page 1 of 13
Section Contents Page No. 1. STATEMENT OF INTENT 3 2. PURPOSE 3 3. SCOPE 3 4. BACKGROUND 3 5. STRATEGIC GOALS FOR NON-MEDICAL PRESCRIBING 3-4 6. VISION, VALUES AND STANDARDS 5 6.1 Trust Vision 5 6.2 Business Division Visions 5-6 7. CLINICAL GOVERNANCE ARRANGEMENTS FOR NON- MEDICAL PRESCRIBING 7.1 Non-Medical Prescribing Pathway 7 8. NMP DEFINITIONS AND RESPONSIBILITIES 8 9. CONTINUED PROFESSIONAL DEVELOPMENT 8 10. MONITORING COMPLIANCE AND EFFECTIVENESS 9 11. REFERENCES 9 12. GLOSSARY OF TERMS 10 13. APPENDICES: Appendix A NMP Implementation Plan (2014 2017) Year 1 6 10 11-13 Page 2 of 13
1. STATEMENT OF INTENT Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) is committed to ensuring the safety of patients, staff and the public through an integrated approach to Non-Medical Prescribing (NMP). RDaSH recognises the importance of implementing and maintaining effective NMP arrangements in order to underpin the organisation s reputation and performance. 2. PURPOSE This strategy sets out a trust wide statement and vision on how RDaSH plans to develop NMP for the period 2014 2017 to support a range of healthcare professionals by embedding NMP practice across all business divisions. This strategy is supported by the Trust s policy for Non-Medical Prescribing to ensure safe and effective prescribing and is subject to annual evaluation and approval by the Board of Directors. 3. SCOPE The scope of this strategy applies to all levels of staff, from executive level, through business division teams to staff members working directly in clinical services. 4. BACKGROUND The NHS Improvement Plan (2005) identified that patients should have an increased choice in access to a wider range of services, including increasing the range of healthcare professionals who can prescribe medicines to patients. To improve access to medicines, the Department of Health (DoH), through the National Health Service (NHS) Plan (2000) enabled nurses, pharmacists, and some Allied Health Professions (AHPs) to train as NMPs independently or as a supplementary prescriber within an agreed Clinical Management Plan (CMP). 5. TRUST STRATEGIC DIRECTION AND GOALS The implementation of the NMP strategy will aim to deliver the trust s five strategic goals which are outlined in Table 1 below: Table 1: Strategic Goals and Objectives No. Strategic Goal NMP Objectives Delivery Plan 1 Provide seamless care to continuously improve service quality (safety, effectiveness and patient experience) for our patients and carers Develop the NMP Strategy Improve patient care without compromising patient safety Implementation of the NMP Strategy Develop a workforce development plan for NMP throughout the business divisions. Implement the national Single Page 3 of 13
No. Strategic Goal NMP Objectives Delivery Plan 2 Nurture the talent, commitment and ideas of our staff in order to deliver excellent services 3 Ensure value for money and increased organisational efficiency whilst maintaining quality 4 Adapt and deliver services to meet agreed commissioned needs through enhanced multiagency partnerships Improve access to services. Extend patient choice and ease access to medicines to meet their needs. Improve the management of long term conditions Develop the knowledge and skills of nurses, pharmacists and allied health professionals to support new ways of working in line with DoH Guidance 2005. Develop a CPD programme for NMP Supervising Practitioners/Mentors. Optimise prescribing against locally agreed formularies Provide structured support improving patient access to medications Competency Framework (SCF) for NMP. Increase the number of NMPs within the business divisions. Encourage and support NMPs to use their prescribing skills within their role Implementation of a NMP Continuous Professional Development (CPD) programme throughout the trust. NMPs to share good practice across areas within Business Divisions. Develop/adopt and implement relevant locally agreed formularies Quarterly review of prescribing data to identify potential better value prescribing options Review all service developments for benefits for NMP Overview provision of medicines by Patient Group Direction (PGD) Review and implement 5 Maintain excellent performance and governance and a strong market position; and improve further our reputation for quality Develop an effective performance and monitoring process for NMP. NMP Strategy NMP Policy Quarterly Improvement Report (QIR) NMP Forum NMP Database NMP Annual Declaration Page 4 of 13
6. VISION, VALUES AND STANDARDS 6.1 Trust Vision The trust s strategic vision Leading the Way with Care is supported by this strategy and helps to deliver the trust s strategic objectives. This strategy is responsive to the Quality, Innovation, Productivity, Prevention (QIPP) challenge by offering a strategic, innovative solution to address capacity, quality, efficiency and effectiveness when used within pathway redesign. 6.2 Business Division Visions RDaSH operates a clinical divisional model structured around seven clinical business divisions and serves a population of 850,000 covering Doncaster, Rotherham, North Lincolnshire and North East Lincolnshire with the range of services differing in each locality. The trust also provides some specific mental health services in Manchester. Each business division has developed a vision for delivering NMP within its specific clinical area. The business divisions are: 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. 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 5 of 13
Doncaster Community Integrated Services (DCIS): The vision for DCIS is to provide continued professional development for all nonmedical 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. Children and Young Peoples Mental Health Services (CAMHS): By 2017 our vision is to increase the numbers of NMPs within the CAMHS 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. 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. 7. CLINICAL GOVERNNANCE ARRANGEMENTS FOR NMP In order to ensure the safe and effective NMP for patients is implemented across the Trust (DoH 2006 Improving Patients Access to Medicines: A Guide to Nurse and Pharmacist Prescribing within the NHS in England), NMP is supported by the trust s Clinical Governance Group and Medicines Management Committee. Page 6 of 13
The NMP governance structure is outlined in Figure 1 below: Figure 1: Trust NMP Governance Structure Board of Directors Clinical Governance Group Medicines Management Committee Non-Medical Prescribing Forum Non-Medical Prescribers within Business Divisions The trust is responsible for ensuring that an up to date register of NMPs is maintained and the NMP Policy is up to date. The trust s NMP forum meets bi-monthly and has representation from each business division. This forum provides assurance on the delivery of statutory guidance to the Clinical Governance Group which reports directly to the Board of Directors. 7.1 Non-Medical Prescribing Pathway The trust will identify the number of staff required to be trained as NMPs to ensure there is continuity of service through any workforce movement and that workforce planning is robust for the on-going delivery of this intervention. The NMP pathway process is shown at Figure 2 below. Page 7 of 13
Figure 2: Trust Non-Medical Prescribing Pathway Process Role developed that requires the practitioner to be a NMP This is reflected in the Job description. Authorisation for post to be NMP is sought by Assistant Director as part of the vacancy control process. Prescribing formulary and budget identified Post filled. Staff Member trained to NMP and fulfils requirements laid out in Trust policy checks requirements fulfilled to enable Practitioner to NMP Assistant Director notified that the Post will commence NMP 8. NON-MEDICAL PRESCRIBING DEFINITIONS AND RESPONSIBILITIES The NMP definitions and responsibilities are included in the Trust s Policy for Non- Medical Prescribing. http://www.rdash.nhs.uk/corporateinformation/publications/policies/clinical-policies/ 9. CONTINUED PROFESSIONAL DEVELOPMENT RDaSH will adopt and implement the National Prescribing Centre (NPC) published Single Competency Framework (SCF) for all prescribers. This framework consists of a core set of competencies that underpin good prescribing practice regardless of professional background. Areas of development from within the SCF should be identified between the NMP and their Supervising Practitioner/Mentor on an annual basis and linked to the NMP s PDR to ensure competencies are achieved. The framework can be used to support NMPs to maintain their competence within their scope of practice and identify strengths and areas for development through self-assessment. Page 8 of 13
RDaSH will facilitate NMP CPD development by providing bi- annual NMP Practice Development sessions. The sessions will provide a forum to share best practice, disseminate national and local NMP guidance and provide a link to the therapeutic training programme via the Chief Pharmacist. 10. MONITORING COMPLIANCE AND EFFECTIVENESS The monitoring, compliance and effectiveness of this strategy will be the responsibility of the NMP forum, who will review and update the implementation plan bi-annually (Appendix A). This strategy will be reviewed and updated after 3 years from implementation. 11. REFERENCES DoH (2000) NHS Plan DoH (2003) Supplementary Prescribing by Nurses and Pharmacists DoH (2004) NHS Improvement Plan: Putting People at the Heart of Public Service DoH (2005) Delivery of the NHS Improvement Plan: Creating a Patient-led NHS DoH (2005) Supporting People with Long Term Conditions DoH (2005) Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists, and Radiographers within the NHS in England DoH (2005) Improving Mental Health Services by Extending the Role of Nurses in Prescribing and Supplying Medication: Good Practice Guide DoH (2006) Our Health, Our Care, Our Say DoH (2006) Improving Patients Access to Medicines: A Guide to Nurse and Pharmacist Prescribing within the NHS in England DoH (2010) QIPP Challenge NPC (2001) Maintaining Competency in Practice: An Outline Framework (Nurses) NPC (2003) Maintaining Competency in Practice: An Outline Framework (Pharmacists) NPC (2004) Maintaining Competency in Practice: An Outline Framework (AHPs) NPC (2012) Single Competency Framework for all Prescribers NHS Modernisation Agency, Department of Health (2005) Medicine Matters Nursing & Midwifery Council (NMC) (2002) Requirements for Extended Independent Nurse Prescribing and Supplementary Prescribing RDaSH Strategic Direction (2010-2013) and Annual Plan including Priorities (2012-2013) RDaSH Policy for Non-Medical Prescribing Various Non-Medical Prescribing strategies and policies from other NHS PCTs and Trusts (including policies and guidance on issues related to supplementary and independent prescribing) Page 9 of 13
12. GLOSSARY OF TERMS AHP BNF CAMHS CMP CPD DCIS DoH HCPC HEI HPC NHS NMC NMP NPC NPF OPMHS QIPP QIR RDaSH SCF Allied Health Professions British National Formulary Children and Young Peoples Mental Health Services Clinical Management Plan Continuing Professional Development Doncaster Community Integrated Services Department of Health Health & Care Professions Council Higher Education Institution Health Professions Council National Health Service Nursing and Midwifery Council Non-Medical Prescribing National Prescribing Centre Nurse Prescribers Formulary Older Peoples Mental Health Services Quality, Innovation, Productivity, Prevention Quality Improvement Report Rotherham Doncaster & South Humber NHS Foundation Trust Single Competency Framework 13. APPENDICES Appendix A NMP Implementation Plan (April 2014 April 2017) Page 10 of 13
Appendix A NMP Implementation Plan (2014 2017) Year 1 No. NMP Objective Action required Lead Target Date Outcome & Date Completed 1. Develop the NMP Strategy Implementation of the NMP Strategy April 2014 Strategy to be ratified via the Clinical Effectiveness Committee - May 2014. 2. Improve patient care without compromising patient safety. Improve access to services. Extend patient choice and ease access to medicines to meet their needs. Improve the management of long term conditions Develop a workforce development plan to increase the number of NMPs within each business division. Implement the National Single Competency Framework (SCF) for NMP. Service Managers Service Managers Supervising Practitioners September 2014 April 2014 Baseline compliance through Annual Declaration March 2015 Develop an audit tool and audit outcomes for patients NMP Project Support Officer December 2016 Audit Q4 2016/17 Page 11 of 13
No. NMP Objective Action required Lead Target Date 3. Develop the knowledge and skills of nurses, pharmacists and allied health professionals to support new ways of working in line with DoH Guidance 2005. Implementation of a NMP Continuous Professional Development (CPD) programme throughout the trust. April 2014 Outcome & Date Completed Reviewed annually Develop a CPD Programme for NMP Supervising Practitioners/Mentors. NMPs to share good practice across areas within Business Divisions. NMPs Quarterly Reviewed quarterly for input to the QIR 4. Optimise prescribing against locally agreed formularies Develop/adopt and implement relevant locally agreed formularies. Chief Pharmacist Ongoing Development and review is ongoing. Any changes to formularies, relevant to staff are reviewed by the Medicines Management Committee and circulated within 2 months of finalisation. Quarterly review of prescribing data to identify potential better value prescribing options. Chief Pharmacist Quarterly Reviewed quarterly Page 12 of 13
No. NMP Objective Action required Lead Target Date 5. Provide structured support improving patient access to medications Review all service developments for benefits for NMP. Business Divisions Ongoing review quarterly Outcome & Date Completed 6. Develop an effective performance and monitoring process for NMP. Overview provision of medicines by Patient Group Direction (PGD). NMP Strategy implemented NMP Policy implemented and reviewed Input to the Quarterly Improvement Report NMP Forums held bimonthly NMP Database maintained NMP Annual Declaration Chief Pharmacist NMP Project Support Officer NMP Project Support Officer NMP Project Support Officer NMP Project Support Officer Current suite of PGD s will be complete by June 2014. May 2014 January 2015 Quarterly Bi-monthly Quarterly March 2014 Review June 2014 - new PGD s will be added as and when - ongoing Reviewed quarterly for input into the QIR. Page 13 of 13