Numbers of prescriptions issued by nurse practitioners in the UK have risen 49% since new rules in April 2006 gave them powers to prescribe complex medicines, and this is causing some experts to have serious concerns, according to a new report published in Pulse magazine.
Nurses’ knowledge of diagnosis is “pathetically poor,” according to Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines (CSM). “It takes medical students five years to be competent to make a differential diagnosis - only a country with not enough doctors would go down this cheapy line,” Prof McGavrock added.
However, Peter Carter, general secretary of the Royal College of Nursing (RSN), disputes this view. “Nurse prescribing has been a historic move for the nursing profession and it is one of the most successful parts of the current National Health Service reforms. Far from being the problem Prof McGavock suggests, nurse prescribing has proved itself to be an important part of the solution in improving access to medicines and cutting waiting times for patients,” he said.
The majority of nurses who prescribe have at least 10 years' nursing experience before starting their prescribing training and must have either degree or masters-level education, according to Dr Carter. “Far from having a ‘pathetically poor’ knowledge of diagnosis, before they can even access a course, nurses have to be able to demonstrate that they have sufficient assessment and diagnostic skills in the specialist area they will prescribe in. Ultimately, every single nurse prescriber has to be ‘signed off’ by a doctor before they can begin prescribing. With well over 10,000 nurse prescribers currently practising, it appears there are at least 10,000 doctors who would
disagree with Professor McGavock's concerns,” he said.
Following implementation of the new rules last year, nurses have been encouraged to take a post-graduate training course on prescribing, on completion of which these “independent nurse prescribers” are able to prescribe medications for conditions such as diabetes. Another group, “community practitioner nurse prescribers,” receive less intense training and are therefore more restricted in the medications they are permitted to prescribe.
Rosiglitazone up 245%
One of the the findings of the Pulse study, which compared prescribing levels between May 2006 and May 2007, was that prescriptions for the diabetes drug rosiglitazone had increased 245% in the period. Also, those for the antidepressant paroxetine had risen were up 262%. The journal obtained the data from the NHS Business Services Authority, under the Freedom of Information Act.
A spokesman for the Department of Health pointed out that general practitioners still account for 99% of all items prescribed, and emphasised that nurse practitioners undergo “rigorous” training and are required to keep their skills up to date. However, the editor of Pulse, Jo Haynes, commented: “the whole nurse prescribing scheme has been rushed through with only the bare minimum of piloting and evaluation, and it won’t be until academics start analysing the rates of adverse events and prescribing errors that we will know whether it has been a good or bad thing."