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Nurse prescribing training and preparation: extended formulary nurse prescribing and supplementary prescribing

  • Last modified date:
    20 October 2010

Guidance on selection and training of nurse prescribers (updated 4 June 2004).

The NMC has now determined a new standard in respect of Independent Prescribing (for the Extended Formulary) and Supplementary Prescribing, and will only validate new recordable courses against that standard. To enable modification of existing Extended Formulary nurse prescribing courses, additional training and preparation has been incorporated to form the new NMC standard for Independent and Supplementary Prescribing at academic level 3.  Existing courses that have been modified (for example to allow for the inclusion of open and distance learning) will need to be re-validated by the NMC. In all such cases the NMC requires confirmation that modifications to existing Extended Formulary courses incorporating the additional requirements for supplementary prescribing have been approved internally prior to the course being offered. 

The responsibility for the content of the detailed curriculum of both the Extended Formulary nurse prescribing course, and the new integrated course that combines preparation for independent and supplementary prescribing, lies with the commissioner of the course. DH expects course commissioners and validators (WDCs and the NMC) to approve only those courses that demonstrate content that is consistent with published guidance.

The Department of Health believes that preparation for supplementary prescribing will take between one and two additional days, together with the course on Extended Formulary nurse prescribing. It therefore decided that the length of a combined course covering both the Nurse Prescribers' Extended Formulary and Supplementary Prescribing should be at least 26 days, plus learning in practice. Of the 26 days taught element, a substantial proportion should be face-to-face contact time. However other ways of learning, such as open and distance learning formats, will also be considered.

The course for Extended Formulary Nurse Prescribers currently attracts 20 CATS points.  How many CATS points the amended course should attract is a matter for HEIs, in discussion with the commissioning Workforce Development Confederation(s). This is essentially an issue of standards and levels of learning. HEIs and WDCs will wish to keep in mind, in the light of credit transfer considerations, the need for consistency in the amount of credit that courses attract.  It is expected that HEIs modifying existing courses will only adjust the credit awarded to acknowledge additional learning related to supplementary prescribing. 

Competency in prescribing

The National Prescribing Centre has also produced a document 'Maintaining competency in prescribing: an outline framework to help nurse prescribers'. This is available from the National Prescribing Centre in Liverpool or from the NPC's website:

Community Practitioner Nurse Prescribers

District nurse and health visitor prescribers will continue to be able to prescribe from the Nurse Prescribers' Formulary for Community Practitioners. They will also be eligible for consideration for training, to qualify as nurse independent prescribers (but see below on the selection of nurses to be trained).

Identifying nurses for extended nurse prescribing preparation in England

1. NHS and GP employers of nurses (for brevity, the term 'nurses' is used throughout to include nurses, midwives and health visitors) in local health economies are asked to identify and prioritise candidates for preparation for prescribing from the Nurse Prescribers' Extended Formulary (NPEF). They will then be asked to nominate a specific number of candidates to take up places on the centrally-funded preparatory courses.

2. Key principles of the extension are that:

  • patient safety is paramount
  • the principal aim is to benefit patients by enabling faster access to medicines, and to benefit the service by freeing up professional time.

3. The criteria below are intended to ensure that:

  • nurses nominated for prescribing preparation are eligible, willing and able to undertake the preparation
  • their subsequent prescribing practice will provide maximum benefit to patients in local NHS health services
  • best value is obtained from the training resources available.

4. This means, for example, that nurses should not be nominated for training for prescribing from the NPEF if they do not wish to prescribe. Nor should they be nominated if they will not have the opportunity to prescribe after training because the items in the Extended  Formulary are not appropriate to their practice. No nurse should be nominated solely because he/she wishes to become a prescriber.

5. Local health economies are asked to identify those nurses who fit the criteria below, and then to prioritise those nurses on the basis of maximum benefit to patients. They will then need to nominate sufficient nurses to take advantage of the centrally funded places available. (If further places are purchased on the approved preparation by local organisations, then the same criteria should be applied to prioritise these places.) Workforce Development Confederation Nurse Prescribing Leads will be monitoring uptake of the preparation, and will be able to advise on the application of the criteria if necessary.

Criteria for centrally-funded places on preparatory courses

6. The following criteria should be applied when identifying potential candidates for preparation:

Legal criteria to prescribe

To be legally eligible to prescribe applicants must:

  • be a 1st level registered nurse or registered midwife
  • have valid registration on the NMC professional register
  • have successfully completed the nurse prescribing preparation, and have a mark against their name in the professional register indicating that they hold this qualification.

Other criteria

To be accepted for entry to the programme of preparation, the applicant must:-

  • be capable of study at level 3 (1st degree level)
  • have at least three years post-registration clinical nursing experience (or part-time equivalent); most nominees are likely to be at E Grade or above.
  • have a medical prescriber willing to contribute to the nurse's 12 day learning in practice element of preparation, and a period of supervised prescribing post-qualification. The medical prescriber will also be required to participate in the assessment process. Full information on the curriculum, and preparatory materials, will be available to these medical prescribers before the course begins.
  • have the agreement of his/her employing organisation to allow attendance and completion of all elements of the prescribing course, the necessary period of supervised prescribing following qualification as a prescriber, and continuing professional development
  • have a commitment from his/her employer to enable access to a prescribing budget and make other necessary arrangements for prescribing practice, on successful completion of the course
  • occupy a post in the employment of an NHS organisation or GP practice in which, because of the nature of the patients seen by the nominee, he/she is likely to be able to prescribe.

Prioritising

7. There are likely to be many nurses in any local health economy who meet these criteria. The following principles should be used to prioritise amongst applicants:

Maximum benefit to patients: where nurse prescribing would save patients waiting for a prescription for items prescribable by nurses to be obtained from another prescriber, or seeing a doctor as well as the nurse solely for the purpose of obtaining a prescription. So priority nominees would be:

  • nurses who run their own clinics or services (e.g. nurse-led units, outpatient clinics, PMS pilots, minor illness clinics), or
  • nurses who work in isolation from other prescribers (e.g. nurses working with the homeless or travelling families, in intermediate care facilities, community hospitals), or
  • nurses who could complete episodes of care by prescribing (e.g. emergency nurse practitioners in A&E departments, family planning clinic nurses, nurses working in GP practices)

Best value from training resources: intended to ensure that the nurse has sufficient opportunities to prescribe to maintain competency and confidence, and so protect patient safety, and that the maximum number of patients benefit from his/her prescribing expertise.So priority nominees would be:

  • nurses who are likely to be able to prescribe for several of the medical conditions set out in the Drug Tariff and elsewhere on this website
  • nurses with additional qualifications whose professional expertise is likely to facilitate prescribing for the specified medical conditions e.g. specialist practitioners, clinical nurse specialists in relevant areas, nurse consultants, nurse practitioners.

8. The extension of nurse prescribing is also intended to extend the benefits of nurse prescribing beyond primary care: we will be looking for a mix of primary and secondary care nominees for centrally-funded preparation.

Other considerations: supplementary prescribing and Patient Group Directions

9. In considering nominees who fit the above criteria, health economies will want to consider whether supplementary prescribing, which has been introduced from April 2003 for nurses working with more complex conditions, such as chronic diseases and mental illness, is more appropriate for some nurses than independent prescribing. Supplementary prescribers are able to prescribe for a patient once the patient has been assessed by a doctor and a Clinical Management Plan has been drawn up, with discretion to alter dosage, frequency and active ingredient of medication within the limits of the agreed Clinical Management Plan.

10. Patient Group Directions (PGDs) enable nurses to supply and administer  prescription-only medicines to patients under the generalised directions of a doctor. As we have already made clear in the guidance on the use of PGDs, the majority of care should be provided on an individual, patient-specific basis. However there may be situations in which a PGD offers greater advantages for patient care than independent nurse prescribing: for example, in immunisation programmes which use centrally supplied vaccines, and in out of hours care where supply is likely to be quicker and more convenient to the patient than prescribing.

The aim should be to ensure that only those nurses able to make maximum use of nurse prescribing for the benefit of their patients are nominated for the nurse prescribing preparation and training.

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