Non-Medical Prescribing; Dentists, SP/IPs, PGDs

Question 1

What are the different types of medicines supply?

Answer 1

• Prescription
• Direct from prescriber (wholesale)
• Emergency supply (request of prescriber/patient)
• Patient Group Direction (PGD; specific patient in a specific situation)

Question 2

Who can write prescriptions for human use?

Answer 2

• Doctors
• Dentists
• Independent prescribers
• Supplementary prescribers
• Community Practitioner Nurse Prescribers
  (latter two less common now)
• EEA/Swiss doctors and dentists

Question 3

What prescribing powers do dentists have and how do their scripts differ?

Answer 3

• Legally entitled to prescribe any POMs and most CDs (except some for addiction); considered ‘appropriate practitioners’
• But professional obligation to restrict practice to areas of clinical competence
• And Dental Practitioners’ Formulary (DPF; P1044 BNF) dictated by NHS of what can be prescribed on an NHS script
• NHS scripts are on FP10D Yellow prescriptions (not green/FP10SS)

Question 4

What are Community Practitioner Nurse Prescribers and what are their prescribing powers?

Answer 4

• Primary care nurses that undergo additional training to allow prescribing of ‘simple’ items in the community
• Registered nurses are not normally prescribers by right
• Prescribing limited to Nurse Prescribers Formulary (NPF)

Question 5

What can Community Practitioner Nurse Prescribers prescribe, and how do their scripts differ?

Answer 5

Simple items e.g:

• Simple pain relief
• Laxatives
• Emollients
• Some anti-fungals
• NRT
• Some appliances (dressings/catheters)

Prescriptions have ‘COMMUNITY PRACTITIONER NURSE PRESCRIBER’ at the top, but are still green. FP10CN = Community Nurse

Question 6

What are supplementary prescribers and their prescribing powers?

Answer 6

• They supplement the GP and has the same power to prescribe as long as there is a Clinical Management Plan (CMP) in place by the GP between SP and patient
• CMP e.g. titrating dose up
• Can be a pharmacist, midwife, nurse, chiropodist, podiatrist, physiotherapist, radiographer or optometrist

Question 7

What are independent prescribers?

Answer 7

• Fully autonomous practitioner; prescribe/initiate what they want
  (prescribing NOT diagnosis)
• Focus on one/two areas of practice e.g. asthma, CVS (warfarin clinics etc)

Question 8

What are the different prescribing powers within independent prescribers?

Answer 8

• Nurse/pharmacist: all classes of drugs including CDs and unlicensed
• Optometrist IP: v. restricted list (for ocular conditions affecting the eye and surrounding tissue only)
• Physiotherapists: all POMs plus the following CDs dihydrocodeine, fentanyl, morphine, oxycodone, temazepam
• Podiatrists: all POMs plus the CDs dihydrocodeine and temazepam

Question 9

How are IR prescriptions different from GP ones?

Answer 9

• ‘Nurse Independent/Supplementary Prescriber’
• ‘Pharmacist Prescriber’
  »> Distinguish between supplementary and independent

Question 10

What are the dispensing regulations in the UK regarding prescriptions made by EEA/Swiss registered doctors/dentists?

Answer 10

• Rx issued by doctor/dentist registered to practice in an EEA country/Switzerland may be dispensed in the UK
• Does not include CD Schedule 1-3
• Does not include medicines w;o a UK MA (unlike registered UK practitioners)

Question 11

What is a PGD?

Answer 11

• Written instruction for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment
• Enables semi-autonomous supply of medicinal products
• Intended for POM (but can inc. P/GSL)

Question 12

What medicines are PGDs often used for?

Answer 12

• Immunisations (flu/travel etc.)
• Pain relief in care settings
• EHC (Emergency Hormonal Contraception)
• Extension of clinic function (e.g. STI treatment)
• Wards; nurses giving laxatives etc

Question 13

Where are PGDs used?

Answer 13

To assist:
- NHS bodies: hospitals/primary care authorities (GP/urgent care centres etc.)
- Doctors and dentists (NHS)
- Independent hospitals (private)
- Police (if detained criminals in need of medicines)/prison service/Her Majesty's Forces
- Retail pharmacies (GPhC registered)
>>> Practitioner
>>> Setting

Question 14

Who can a PGD be written by in the NHS and what happens after it’s written?

Answer 14

• Doctor
• Dentist
• Nurse independent prescriber
• Optometrist independent prescriber
• Pharmacist independent prescriber
  »> Authorised by appropriate personnel e.g. senior pharmacist

Question 15

What does the PGD document contain?

Answer 15

Detailed specific information clearly outlining circumstances for supply:

• period of validity
• description of medicinal product/group of products along with clinical indications
• Inclusion/exclusion criteria (age restrictions etc./postcode specific)
• Details for when further assistance should be sought and from whom
• Details relating to: form/strength/dose (inc. max)/frequency/max treatment length
• Any warnings/follow up procedures
• Details of record keeping requirements

Question 16

How long are PGDs normally valid for?

Answer 16

Typically 1 year

Question 17

Who can supply against a PGD?

Answer 17

Everyone basically:
 Pharmacists.
 Registered chiropodists and podiatrists.
 Registered dental hygienist.
 Registered dental therapist.
 Registered dieticians.
 Registered midwives.
 Registered nurses.
 Registered occupational therapists.
 Registered optometrists.
 Registered orthoptists.
 Registered orthotists and prosthetists.
 Registered paramedics.
 Registered physiotherapists.
 Registered radiographers.
 Registered speech and language therapists.

Question 18

Who can’t supply against a PGD?

Answer 18

• Pharmacy technicians (has to be pharmacist)

- Emergency Care Technicians (has to be paramedic)

Question 19

How should a PGD be composed/who should this process involve?

How should it be executed?

Answer 19

• To be drawn up by a multidisciplinary group inc. a doctor/pharmacist and a representative of any HCP expected to supply under the PGD (stated on PGD)
• Appropriate documents to be signed by the above, the clinical governance lead on behalf of the authorising NHS organisation and the individual HCPs working/supplying under the PGD
• Development should involve local prescribing committees e.g. trimethoprim resistance (don’t want more given out off-record)

Question 20

How should medicines stock under a PGD be managed?

Answer 20

Systems should be in place to reconcile stock on patient by patient basis; consider need for stock reconciliation and pre-packed medicines.