New guidance to help safe and effective prescribing
Pharmacist prescribers play an important role in the delivery of high-quality healthcare services and in the improvement of person-centred care across many sectors of the health landscape in England, Scotland and Wales. They are well placed to use their knowledge of medicines, and their skills as prescribers, in the existing and various new roles which are being developed and integrated into care models.
The number of prescribers on our register has doubled since 2016 and increased by more than 500 pharmacist prescribers in the past three months. In response to the developments in prescribing we have issued new guidance for pharmacist prescribers.
This new guidance clearly outlines what prescribers need to consider to make sure they provide safe and effective person-centred care.
In practice: Guidance for pharmacist prescribers covers five key areas that pharmacist prescribers must consider in order to prescribe safe and effectively. These are:
1. Taking responsibility for prescribing safely
2. Keeping up to date and prescribing within their level of competence
3. Working in partnership with other healthcare professionals and persons seeking care
4. Prescribing considerations and clinical judgement
5. Raising concerns
The guidance emphasises that pharmacist prescribers must be able to justify their decisions and use their professional judgement in the best interests of the person receiving care, in all contexts, for example when providing a pharmacy service online or when working as part of a multidisciplinary team in a hospital.
Prescribing is often carried out as part of online pharmacy services and our prescribing guidance aligns with our guidance for registered pharmacies providing pharmacy services at a distance, including on the internet.
The guidance for prescribers sets out when they should consider whether any extra safeguards are needed, for example, when prescribing antibiotics online or medicines likely to be abused or misused such as opioids, as part of an online service. It also makes clear that pharmacist prescribers must not make prescribing decisions for high risk medicines based only on online questionnaires, without looking at the person’s medical history or gaining consent to contact the person’s regular prescriber.
The guidance says that all organisations that employ pharmacist prescribers, even those not regulated by the GPhC, must identify and manage the risks involved in providing and managing prescribing pharmacy services. They should have governance arrangements in place to protect patient safety.
Included within the guidance are a range of key questions that prescribers should ask themselves when prescribing to make sure they are providing person-centred and safe and effective care. The guidance also includes links to other sources of relevant information.
Findings from inspections
Below are some examples of good practice by pharmacist prescribers we have seen as part of the inspections we’ve carried out. You can find more of these examples in the knowledge hub section of the inspection publications website.
Prescribing to meet patient need
A community pharmacy in Scotland benefitted local people by delivering services which reflected the needs of the community, prioritising triage and the treatment of common clinical conditions.
The pharmacy used their pharmacist’s expertise to maximise the benefits of the Minor Ailment Service (eMAS). The pharmacist triaged people with any warning symptoms or symptoms lasting more than a few days and were able to prescribe within the eMAS specification. As an independent prescriber, they also prescribed for common clinical conditions.
So that the pharmacy could effectively treat people who presented with symptoms on an ad-hoc basis, the pharmacist prescriber completed additional training at university and by shadowing medical and nursing staff at the local out of hours’ service.
People using the service were free to take prescriptions to another pharmacy, although they were usually dispensed on site.
The pharmacist prescriber was not involved in any aspect of dispensing these prescriptions. Instead, the clinical check was always carried out by the checking pharmacist, who was then able to question the prescriptions issued by either the pharmacist prescriber or GP, if necessary.
Prescribing controlled drugs in partnership with other healthcare professionals
The pharmacist prescriber at a village pharmacy held fortnightly pain management clinics at the local surgery; this demonstrated the value of their input to the GPs. Extra attention was given to patients on new or high-risk medication and resulted in the pharmacist prescriber having a full caseload.
Appointments with the prescriber were thirty minutes long, giving people more time to discuss the available options and address any concerns they had.
Good communication with GPs was key and some of the people being treated were jointly managed or referred by their doctor to the prescribing pharmacist.