“A pharmacist independent prescriber is a practitioner who is responsible and accountable for the assessment of patients with diagnosed or undiagnosed conditions and for decisions about clinical the clinical management required, including prescribing”(1).
Due to the breadth of the role of a pharmacist independent prescriber, it is important to define the limitations of the area of practice, and to acquire the correct level of indemnity insurance before entering in to any prescribing activities from a recognised broker.
It is also important that a prescriber’s registration with the General Pharmaceutical Council (GPhC) is annotated to indicate that the pharmacist will be an independent prescriber before beginning to practice.
The following reflective statement outlines some thoughts on how to begin to manage risk as a prescriber considers their practice. You may read this and have feedback or suggestions. I absolutely welcome this.
I admit that it is probably not the most exciting blog I have ever written, but a sound knowledge of the legal aspects of practising as an independent prescriber is, in my view, critically important. This blog serves only as a summary.
To ensure structure and consistency to practice I think it is wise to develop a suite of standard operating systems to follow, audit and review as part of ongoing prescribing practice. Each of these SOPs addresses the elements of risk associated with practice, and serves to ensure a consistent approach to practice (2).
The concept of consent is extremely important when practicing as an independent prescriber. I have written an SOP that describes how I will acquire consent before I begin any prescribing activity. It is very important that this process is not rushed, and that the patient clearly understands the role of an pharmacist independent prescriber and exactly what it means for their care (1,2).
Privacy, and conducting consultations in the correct environment is paramount.
Pharmacist independent prescribers must act within their own level of experience and competence.1 To be clear, this means that the prescriber can carry out a complete history, make a diagnosis, and prescribe if necessary, but if the prescriber does not understand the full implications of the prescribing decisions they must refer care back to the medical prescriber.
Errors and learning from practice will happen, and I have a robust strategy to learn from significant events and will act on feedback from other prescribers. I have planned to meet regularly with other prescribers to review our practice. If an event needs to be reported, I will do so through the pharmacy error reporting system, but also through the surgery significant event analysis programme. Learnings should direct continuing professional development, which will reflect the fact that the pharmacist is a prescriber.
I will update my knowledge regularly by attending relevant courses, and as I am a member of the Royal Pharmaceutical Society (RPS) I will use this to network with other prescribers and inform relevant prescribing related CPD activities. I have also set up plans with two other respiratory pharmacists to share good practice and peer review prescribing decisions.
My area of practice is respiratory, so I have created a framework, and written an SOP to lay out exactly where my scope of practice starts and ends.
I have also written an SOP that describes the structure of the clinical pathway that patients under my care will take, and this includes arrangements to hand care back to a medical prescriber if necessary and in what circumstances this should happen.
I have laid out the structure for the brief interventions and also the structure of the review process I will go through in my clinics in an SOP.
Independent prescribing does not require such tight structures or systems, but I felt that as a new member of the extended local GP/healthcare team it would be prudent to really emphasise where my responsibility starts and stops.
At all times prescribers must work within local guidelines, Scottish Intercollegiate Guidelines Network (SIGN) guidelines and also National Institute for Health and care Excellence (NICE) guidelines, where appropriate. Sticking to these guidelines will ensure prescribing practice is not only safe, but also evidence-based.
Finally, I have developed an overarching prescribing policy for my own practice. This is based on the advice given to me by my medical prescribing mentor, my pharmacist independent prescribing mentor, and also the best practice guidance laid out in the NHS education for Scotland (NES) document: A guide to good prescribing practice for prescribing pharmacists in NHS Scotland (1,2).
I hope this blog has shed some light on the implications for pharmacists becoming independent prescribers. I think, like the dispensing process, if the risks are fully understood and importantly, properly managed, then pharmacists should feel empowered to practice as independent prescribers. Professionalism, and using all the support networks available, especially to newly qualified prescribing pharmacists, is essential.
Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in based in Aberdeen.
Follow Johnathan @JohnathanLaird
1. NHS education for Scotland, a guide to prescribing practice for prescribing pharmacists in Scotland. Accessed September 14th 2014 at; http://www.nes.scot.nhs.uk/media/1457463/nesd0061_goodprescribingpractice.pdf
2. Standard operating procedures for operating an asthma independent prescribing service as a community pharmacist, Johnathan Laird, 2014.