Managing independent prescribing: the influence of primary care trusts on community nurse prescribing

Abstract

Abstract Background Community nurses have been prescribing in the United Kingdom from the Nurse Prescribers' Formulary (NPF) since 1994. Most prescribing for the items included in the NPF is still carried out by general practitioners, although the proportion attributed to nurses is increasing. Objective To describe the methods that primary care trusts (PCTs) have used to influence the prescribing practices of community nurses and to explore the views of nurse prescribers regarding these methods. Method Semi-structured interviews with a purposive sample of 22 community nurse prescribers and five PCT prescribing leads. The transcripts were analysed using the framework method. Key findings PCTs used formularies and guidelines, education and training, individual prescriber feedback and directives to varying degrees to influence nurse prescribing. Some nurse prescribers considered formularies and guidelines to be restrictive. There were few instances of feedback or training being given to prescribers following their initial training as a prescriber, despite a majority wishing to receive both of these. Directives were used to restrict prescribing in a limited number of specific areas. Conclusion Influencing nurse prescribing did not appear to be a priority for PCTs despite this being part of the National Health Service's clinical governance agenda. PCTs will need to engage with nurse prescribers to determine ways to influence prescribing that are in the best interests of patients, nurses, doctors and the Trust.