Prescribing responsibilities include:
- improve patient care without compromising patient safety
- make it easier and quicker for patients to get the medicines they need
- increase patient choice in accessing medicines
- make better use of the skills of health professionals
- contribute to the introduction of more flexible team working across the health service
The development of non-medical prescribing within the health service enables suitably trained healthcare professionals to enhance their roles and effectively use their skills and competencies to improve patient care in a range of settings involving:
- management of long term conditions
- medicines management / medication review
- emergency/urgent care/unscheduled care
- mental health services
- services for non-registered patients e.g. homeless
- palliative care
Currently nurses, pharmacists, optometrists, physiotherapists, chiropodists or podiatrists, radiographers, paramedics, dieticians and community practitioners may undertake further professional training to qualify as non-medical prescribers.
Three types of non-medical prescribing
Independent prescribers are responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing. Different professional groups may hold different prescribing rights, for example:
- nurse and pharmacist independent prescribers are able to prescribe any medicine for any medical condition within their competence, including any controlled drug in Schedule 2,3,4 or 5 of the MDR 2002 Regulations, as amended (except Diamorphine, Dipipanone or Cocaine for the treatment of addiction)
- optometrist Independent Prescribers can prescribe any licensed medicine for ocular conditions affecting the eye and surrounding tissue, but cannot prescribe any controlled drugs
- physiotherapists and podiatrists or chiropodists can prescribe any licensed medicine provided it falls within their individual area of competence and respective scope of practice as independent prescribers, but can only prescribe from a limited range of controlled drugs
Supplementary prescribers may prescribe any medicine (including controlled drugs), within the framework of a patient-specific clinical management plan, which has been agreed with a doctor.
Nurses, midwives, pharmacists, physiotherapists, chiropodists or podiatrists, paramedics, radiographers, dieticians and optometrists may train and register as a supplementary prescriber.
Prescribing by Community Practitioners from the Nurse Prescribers' Formulary for Community Practitioners
Community practitioners, formerly known as District Nurses and Health Visitors, are able to prescribe independently from a limited formulary comprising a limited range of medicines, dressings and appliances suitable for use in community settings.
What can Non-Medical Prescribers Prescribe?
Information about what non-medical prescribers can prescribe is detailed in the BNF. Refer also to the following advice issued by DoH.
Controlled drugs are subject to additional legal controls, including restrictions on who can prescribe them, as they carry a higher risk of being misused or causing harm. Supplementary prescribers can prescribe controlled drugs, but only in accordance with a service user’s clinical management plan. Independent prescribers cannot prescribe controlled drugs unless specified in the Misuse of Drugs Regulations (Northern Ireland) 2002, as amended.
Amendments to the Misuse of Drugs Regulations (Northern Ireland) 2002 introduced on 10 May 2012 allow a nurse independent prescriber and a pharmacist independent prescriber to prescribe controlled drugs. Further amendments introduced on 15 November 2019 allow chiropodist / podiatrist and physiotherapist independent prescribers to prescribe from a limited list of controlled drugs for the treatment of organic disease or injury.
Information about training as a non-medical prescriber
Information on how to train as a non-medical prescriber.
- Nurse supplementary and independent prescribing
- Pharmacist supplementary and independent prescribing
- Optometrist supplementary and independent prescribing
- Allied Health Professionals supplementary and independent prescribing
A Single Competency Framework for all Prescribers
The Royal Pharmaceutical Society (RPS) ‘A Competency Framework for all Prescribers’ was first published in 2016 and was later updated in September 2021. The framework was developed and published in collaboration with a multidisciplinary group with representatives from professional regulators, professional organisations, prescribers from all professions, lay representatives and other relevant and interested stakeholder groups from across the UK.
The RPS single competency framework sets out what good prescribing looks like and describes the demonstrable knowledge, skills, characteristics, qualities and behaviours for a safe and effective prescribing role. It is a generic framework that can be used by any prescriber at any point in their career, regardless of their professional background. However, it must be contextualised to reflect different areas of practice, levels of expertise and settings. The framework is for all regulators, professional bodies, education providers, and patients/carers to use.