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Supplementary prescribing FAQ

  • Last modified date:
    23 March 2010

Q: What is supplementary prescribing?

A: Supplementary prescribers are responsible for the continuing care of patients who have first been clinically assessed by an independent prescriber. Supplementary prescribing is a voluntary partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient-specific clinical management plan with the patient’s agreement.

Q: What medicines are supplementary prescribers able to prescribe?

A: A supplementary prescriber can prescribe any medicine, including controlled drugs, for any condition within their competence. The scope of supplementary prescribing is an issue to be agreed in the patient’s clinical management plan, and will be for the medical judgement of the independent prescriber. 

Q: What sort of training is provided for health professionals to enable them to qualify as supplementary prescribers?

A: Higher education institutions prepare course curricula for prescribing training that the regulatory body is asked to approve. Further information on training is available in the Department of Health implementation guide and on the regulatory bodies websites.

Q: Who will be responsible and liable for the actions of supplementary prescribers?

A: Supplementary prescribers are professionally accountable for their own actions, including prescribing decisions. Where a health professional is appropriately trained and qualified as a supplementary prescriber, and prescribes as part of his or her duties with the consent of their employer, the employer may also be vicariously liable for the actions and decisions of their staff. The Department’s guide to implementation of supplementary prescribing, advises all supplementary prescribers to ensure that they have professional indemnity or insurance, for example through membership of a professional organisation or trade union.

Q: What is the legal position if a supplementary prescriber prescribes outside the Clinical Management Plan?

A: If a supplementary prescriber prescribes a Prescription Only Medicine outside a Clinical Management Plan they will be acting illegally under the terms of the Prescription Only Medicines Order, and could be subject to sanctions under the Medicines Act.
If something other than a Prescription Only Medicine is involved, supplementary prescribers have a dual accountability:

  • to their employer
  • to their statutory regulatory body, the Nursing and Midwifery Council (NMC) , the Royal Pharmaceutical Society of Great Britain (RPSGB), the Health Professions Council or the General Optical Council.

A supplementary prescriber who prescribes a non-POM without the agreement of a Clinical Management Plan could potentially be subject both to:

  • disciplinary proceedings by their employer
  • action by the regulatory body should a charge of professional misconduct follow.

Q: Are supplementary prescribers able to issue private prescriptions?

A: Supplementary prescribers may also issue private prescriptions for any medicines covered by the Clinical Management Plan.

Q: Are supplementary prescribers able to prescribe or supply blood or blood products on the NHS?

A: Blood, including the cellular elements that are packaged for use as ‘packed cells’ and platelets, is not considered to be a medicinal product and is therefore outside the ambit of the Medicines Act and its subsequent amending Regulations. The ‘prescribing’ of blood for a patient is not therefore appropriate for independent or supplementary prescribing or for supply under the terms of a Patient Group Direction. Health professionals should discuss the current local policy regarding ordering of these products with their Trust's haematology department. Consideration could be given to developing local guidelines for the ordering and supply of blood, based on the format of a PGD.

However, products derived from the plasma component of blood such as blood clotting factors, antibodies and albumin are considered to be medicinal products and are required to have marketing authorisations. These products may be prescribed by health professionals under a supplementary prescribing arrangement, provided they are included in the necessary Clinical Management Plan.

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