Trends over time in prescribing by English primary care nurses: a secondary analysis of a national prescription database

Vari M Drennan,Ruth Harris,Robert L Grant

doi:10.1186/1472-6963-14-54

Vari M Drennan, Ruth Harris + Show 1 more

Open Access

https://doi.org/10.1186/1472-6963-14-54

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Abstract

BackgroundA growing number of countries legislate for nurses to have medication prescribing authority although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The policy intention for primary care was to improve efficiency in service delivery through flexibility between medical and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing activities, over time, in English primary care settings.MethodsA secondary data analysis of a national primary care prescription database 2006-2010 and National Health Service workforce database 2010 was undertaken.ResultsThe numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in 2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the category of penicillins, followed by dressings. However, the category where independent nurse prescribers contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%). In contrast, community practitioner nurse prescribers’ greatest volume and contribution was in the category of gel and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per capita, but the correlations were weak and warrant further investigation.ConclusionsThe percentage of prescriptions written by nurses in primary care in England is very small in comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the prescribing role between nurses and general practitioners.

Highlights

A growing number of countries legislate for nurses to have medication prescribing authority it is a contested issue
The greatest increase was those with independent nurse prescribing qualifications (INPs) from 5014 to 12975 while the Community
A greater percentage of those with independent nurse prescribing qualifications registered with ePACT were actively prescribing in the time period than community practitioner nurse prescriber (CPNP), who decreased as active prescribers between 2006 and 2010 (Figure 2)

Summary

Introduction

A growing number of countries legislate for nurses to have medication prescribing authority it is a contested issue. Some countries have legislated for nurses to have authority to prescribe medicines, as part of national strategies for improving safety and efficiency in access to prescribed medicines, in primary care settings and more countries are considering doing so [2]. There is variation between countries as to the classes of medicines that nurses are authorised to prescribe and the qualifications of nurses with that authority. Nursing professional organisations in many countries have actively sought prescriptive authority [21,22,23,24], some nurses have expressed concerns regarding appropriate training, support and remuneration for this role [25,26,27,28] and ambivalence to a more medically orientated role [29,30,31]. Studies of nurse prescribing to date have drawn prescribing evidence at single points in time or from aggregated data [12,13,35,36], often in relation to programmes targeted at specific patient populations [5,37] or particular types of medicines such as analgesics or antidepressants [38,39]

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