As nobody has dared venture here yet I feel quite privileged - but I'll get over it  :o)

I'm interested if my colleagues working in A&E and Walk In Centers that are able to prescribe feel they are not allowed to do so because of PCTs insisting on the use of PGDs.  As a V300 independent nurse prescriber working in general practice as a Nurse Practitioner ( yes I am qualified at degree level as one) I am able to prescribe any medication that is within my competencies. We do have 1st and 2nd line choices for many things so I do try to stick with what the doctors also prescribe, but can make a decision to use an alternative (and await any feedback from the Practice for spending too much money). That's how i can give our patients a more holistic one consultation quality service.

In my opinion, and it is just that, if a nurse has attained a prescribing qualification at V300 level they should be able to use this skill rather than have the decisions made by a Patient Group Directive. In some areas nurses may only prescribe what is in the stock cupboard or are very limited.

There, we've got a start point - any one else like to comment and share their views?

Martin, I read your post with interest.

I was amongst the first cohort of nurse prescribers so can well understand the frustration that you might be feeling!

It is likely that you are the first nurse with this new skill within your area of practice, so will have to assist your employers in dealing with this precedent.  

Have you actually found out what the organisational barrier is - for example, it might be that there is not an allocated prescribing budget, with on site dispensing of a limited selection of PGD drugs?

 There is no reason why you cannot prescribe alternative medications using an FP10 if you are qualified to do so, and I believe that with a well planned rationale and some assertion, that you can contact your PCT Non Medical Prescribing Lead to order some FP10 pads from Instron. You will likely have to reassure your manager that you will continue to prescribe using the in-house formulary whenever possible, as unjustified fears of rocketing drug budgets and 'loose cannon' nurses might be another reason for his/her reticence.  In my experience this can take a frustrating few weeks when you try to set up a new project. but do persevere because it is worth it in the end.

thanks for your input Mandy,  I have no problems prescribing and have my own FP10s so can, and do prescribe as I believe appropriate but bear in mind cost implications.  There are quite a number of INPs in my area now as well that have get togethers every few months.

I don't think we have a problem in surgeries but more in PCT governed establishments like Walk In Centers and A&E in hospitals.  It is in these areas that PGDs are used and restricted prescribing may be more of a problem and frustrating for qualified INPs. Unfortunately it would seem not many nurses look at the blogs so we have had no input from those working in PCTs as yet. However I agree with your comments and these may well be pertinent to nurses in other parts of the country that are not as lucky as myself.

Hi Martin,

I am a Nurse Practitioner (like you - a qualified one) & a V300 prescriber in the Isle of Man. I work in a rather inappropriately named MIU, as we deal with anything that comes through the door from splinters in fingers to medical emergencies. We do not have PCT's here so do not have the same difficulties and restrictions as yourself, though the cost of prescribing is audited closely - PGD's are available in the department so that my nurse practitioner colleagues can function effectively albeit with limited scope. I am currently the only non-medical prescriber in our unit but there are places available on future courses for other NP's to qualify as V300 prescribers if they wish to do so. These courses are relatively new to the Island - only been up & running for a couple of years. I did my training 5years ago in the UK and am fortunate to have had no restriction imposed on my prescribing (other than within my own level of competence) with no requirement to use the departmental PGD's. With both prescribing & PGD's we try very hard to follow current evidence & review guidelines at regular intervals & I have been known to argue the case for no prescription - much to the exasperation of the doctors! (sometimes easier & quicker to give the patient what they want syndrome) I too would be interested to hear from other A&E/MIU/Walk in Centre practitioners. 

Lesley Kewley

Hi All

 I too work in an MIU dept within a PCT  in London and have done so for almost a year now . I Qualified in 2006 as an E.I.S.N.P while working in a Walk -in Centre. I was not only allowed to, but was expected to prescribe once I had gained the qualification. However when I was interviewed for my present role I was advised that because I was the only prescriber in the unit, I would not be able to prescribe because when I was not on duty it would place too much pressure on my colleagues as the patients would have become used to the service and would return expecting further prescriptions. I am somewhat frustrated by this  because our PGD's are  very limited, and none of my colleagues want to undertake the course. A year on do you think I should revisit this  with my manager. I am fourtunately, able to use my prescribing in my local OOH's

 Any comments would be welcome

 Noreen Arnett

Noreen, hi, this must be extremely frustrating - clearly you are not able to use your skills to their full potential. We have undertaken several studies at Reading University in the area of nurse prescribing. It is evident from our findings that in many general practice settings, services have become dependent on the capacity of the nurse to prescribe. However, in some of these settings, if the nurse prescriber goes off on A/L or is sick, there are not enough prescribers in the practice to deal with the increased workload created by the nurse prescriber. It would seem to me that prescribing needs to be taken into account by those involved in workforce planning in these situations - and in the  MIU in which you work. Your nursing colleagues need to be encouraged to undertake the prescribing course - they need to be shown the benefits that prescribing will add to their practice. Why don't they want to undertake the prescribing programme? Perhaps they have some misconceptions that need to be dispelled?. Good luck - I hope that this helps.

Molly      

Yes I'm interested as to why your colleaguesa re reluctant to do the prescribing course. Do you think they don't want the added responsibility? Is it related to being paid for taking on such responsibility?  I'm baffled by the concept that nurses skills are being relied upon one minute then excuses are made about there being an inadequate number of nurse prescribers the next.  It seems that nurses are relied upon more than the medical profession wishes to concede. GPDs are not what the V300 qualification is about, any nurse can follow them.

As a qualified nurse practitioner and prescriber i have a problem with alternating environments. i work autonomously in my day job with no problems other than restrictions of local formulary and of course scope of practice. however if i undertake extra work in a walkin center or OOH unit i cant prescribe!. a GP wouldnt have this problem. a qualification and competence dont just disappear when you leave a room. if you have personal indemity surely it shouldnt be an issue?

Also for the person qualified and unable to use it. how short sighted to allow you to undertake the course with presumably support and then not allow you to use it -hardly cost affective in this current climate.i think nurses are reluctant to undertake prescribing because of the responsibility, politics and probably lack of support in cpd.i also think that renumeration for that extened responsibily is an issue in many places.

I work in a Walk in Centre as an autonomous  Nurse Practitioner and am a qualified Independent and Supplementary Nurse Prescriber. As not all of our NP's are Nurse Prescribers (but we are very near to attaining that!), we do have PGD's that they work from. However, those of us that are Nurse Prescribers are encouraged to use our prescribing skills and issue prescriptions to our patients whenever possible.

Obviously, we follow the PCT's guidelines on such things as appropriate antibiotics etc; but are free to prescribe within our Scope of Practice and this is of great help, especially in the treatment of children. As most of us come from diverse backgrounds, we are able to use peer support to its greatest potential and thus implement our prescribing skills to their fullest use.

I know from one colleague in the acute Trust, that it is not always easy for them to prescribe within that environment and would be interested to know how Nurse Prescribers working within a ward or department, are able to implement their prescribing qualification?