Non-Medical Prescribing; Dentists, SP/IPs, PGDs Flashcards
What are the different types of medicines supply?
- Prescription
- Direct from prescriber (wholesale)
- Emergency supply (request of prescriber/patient)
- Patient Group Direction (PGD; specific patient in a specific situation)
Who can write prescriptions for human use?
- Doctors
- Dentists
- Independent prescribers
- Supplementary prescribers
- Community Practitioner Nurse Prescribers
(latter two less common now) - EEA/Swiss doctors and dentists
What prescribing powers do dentists have and how do their scripts differ?
- 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)
What are Community Practitioner Nurse Prescribers and what are their prescribing powers?
- 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)
What can Community Practitioner Nurse Prescribers prescribe, and how do their scripts differ?
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
What are supplementary prescribers and their prescribing powers?
- 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
What are independent prescribers?
- 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)
What are the different prescribing powers within independent prescribers?
- 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
How are IR prescriptions different from GP ones?
- ‘Nurse Independent/Supplementary Prescriber’
- ‘Pharmacist Prescriber’
»> Distinguish between supplementary and independent
What are the dispensing regulations in the UK regarding prescriptions made by EEA/Swiss registered doctors/dentists?
- 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)
What is a PGD?
- 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)
What medicines are PGDs often used for?
- 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
Where are PGDs used?
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
Who can a PGD be written by in the NHS and what happens after it’s written?
- Doctor
- Dentist
- Nurse independent prescriber
- Optometrist independent prescriber
- Pharmacist independent prescriber
»> Authorised by appropriate personnel e.g. senior pharmacist
What does the PGD document contain?
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
How long are PGDs normally valid for?
Typically 1 year
Who can supply against a PGD?
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.
Who can’t supply against a PGD?
- Pharmacy technicians (has to be pharmacist)
- Emergency Care Technicians (has to be paramedic)
How should a PGD be composed/who should this process involve?
How should it be executed?
- 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)
How should medicines stock under a PGD be managed?
Systems should be in place to reconcile stock on patient by patient basis; consider need for stock reconciliation and pre-packed medicines.
