Veterinary nurse prescribing – anything to learn from the story of human nurse prescribing?
Veterinary nurse prescribing – anything to learn from the story of human nurse prescribing?
The possibility that the right to prescribe some POM-V medicines could be extended to veterinary nurses was mentioned in the RCVS Legislative Working Party’s recommendations earlier this year. The Working Party’s mission is to examine the Veterinary Surgeons Act 1966, and to make proposals for reform to ensure that the RCVS can be a modern and efficient regulator. It is keen to allow veterinary nurses to expand their role to enhance veterinary nurse career progression and the utilisation of veterinary nurse skills in practice. Whilst not included in the Working Party’s list of current recommendations, the possibility of veterinary nurse prescribing is in the report under the heading ‘future recommendations’, as an option for enhancing the VN role that does not require changes to the Veterinary Surgeons Act. However, the implementation of any such recommendation would involve legislation to amend the Veterinary Medicines Regulations.
Here, there is a long experience of nurse prescribing of human medicines, the UK being the first country to introduce reforms back in the 1990s. Originally, the Medicines Act 1968 limited the legal right to prescribe human medicines to doctors and dentists. The first move to introduce nurse prescribing came in 1986 with the Cumberlege Report, which reviewed the care given to patients in their homes by district nurses and health visitors. It was recognised that there were circumstances in which a GP would sign a prescription, despite the assessment having been made by a nurse; and that community nurses often wasted time waiting for prescriptions to be written or signed by GPs. The report recommended that community nurses should be able to prescribe, as part of their everyday nursing care, from a limited list of items such as wound dressings and ointments with the aim of enhancing patient access to treatment, improved patient care and more effective use of resources.
A few years later, a government review of prescribing (The Crown Report, 1989) endorsed nurse prescribing, highlighted the circumstances in which it could occur, and led to legislation that gave the power for nurses to prescribe. From 1996, following a pilot programme, community nurses could prescribe from a limited formulary within the context of a care plan. Since then, nurse prescribing has evolved gradually, so now there are two categories of prescriber:
supplementary prescriber: this is based on a voluntary prescribing partnership between a doctor (the independent prescriber) and a nurse (the supplementary prescriber), in which the supplementary nurse prescriber has the ability to prescribe any drug listed in a patient-specific clinical management plan once the patient has been diagnosed by a doctor. Examples in practice are nurses caring for patients with long-term conditions like diabetes and asthma.
Independent prescriber: a further change to the law in 2006 allowed nurses to issue prescriptions on their own initiative (within their area of competence), including first-time prescriptions. In this role, the nurse is responsible and accountable for the assessment of patients with undiagnosed conditions and for decisions about the clinical management required, including prescribing. Further changes to legislation have allowed nurses to prescribe unlicensed medicines and subsequently certain Controlled Drugs. Community practitioner nurse prescribers prescribe independently, but from a limited formulary.
To become prescribers, qualified nurses with a minimum duration of post-registration clinical experience have to gain an additional qualification in prescribing and are identified as prescribers by their regulatory body.
Common drivers in the UK and other countries that have led to nurse prescribing reforms include: a shortage of doctors (especially in rural areas), the rise in chronic conditions, more inter-professional teamwork and an increase in nursing education. Cited benefits of nurse prescribing include allowing the development of new nursing roles, the ability to increase nurses’ autonomy and independence and better job satisfaction. It has also increased service efficiency by freeing up doctors’ time to care for patients with more complex needs. It is possible to imagine similar benefits in veterinary practice.
Prescribing is a complex skill that is high risk and prone to error, and many factors influence its practice. As noted in the Working Party Report, research into the opportunities and the risks of a potential ‘VN prescriber’ role is needed. It is a necessary first step in a process that could take several years.
Andrea Tarr, Founder and Director, Veterinary Prescriber
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References
Cope LC et al. (2016). Nonmedical prescribing: where are we now? Ther Adv Drug Safety 7: 165-72.
Maier CB. (2019). Nurse prescribing of medicines in 13 European countries. Hum Res Health 17: 95.
Public health agency. Nurse prescribing. https://www.publichealth.hscni.net/directorate-nursing-and-allied-health-professions/nursing/nurse-prescribin
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