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There are many definitions of prescribing, but it usually refers to authorising the use of medicine, often by use of a written prescription. Up until the 1990s, only doctors or dentists were able to prescribe in the UK. Since then, laws have changed to enable different professionals the option of undertaking an approved post-registration training programme to enable them to prescribe.

There are two forms of prescribing in the UK; Independent Prescribing and Supplementary Prescribing:

• Independent prescribing (IP) is where a practitioner is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing. This form of prescribing is most similar to how doctors prescribe.

• Supplementary prescribing (SP) involves a voluntary agreement between the supplementary prescriber, an individual patient, and an independent prescriber (usually a doctor). The agreement about what can be prescribed is set out in a clinical management plan.

Regulations about what medications can be prescribed can differ between professional groups and are also dependent upon which form of prescribing is used (IP or SP). In addition, each individual prescriber may only prescribe for conditions that are within their competence, which is usually set out within an agreed scope of practice.
The UK is world leading in progressing the authority to prescribe to a range of health and allied health professions.

Non-medical prescribing timeline

Timeline for the development of non-medical prescribing in England

-1992-1994 Nurse Prescribing by Community Practitioners introduced. District Nurses and Health Visitors with a Specialist Community Practice qualification were able to prescribe from the Nurse Prescribers Formulary for Community Practitioners.
-2002 Registered Nurses were granted prescribing rights as Extended Formulary Nurse Prescribers
From 2003 Section 63 of the Health and Social Care Act 2001 permitted the introduction of Supplementary Prescribing for Nurses and pharmacists.
-2005 Registered physiotherapists, podiatrists and radiographers were able to train as Supplementary Prescribers
-2006 Independent prescribing for nurses and pharmacists was introduced
-2008 Optometrists were granted Independent Prescribing rights
Changes to the Misuse of Drugs Regulations in 2012 opened up the prescribing of controlled drugs (with some exceptions) to Nurse and Pharmacist Independent Prescribers.
-2013 registered physiotherapists and podiatrists/chiropodists were able to train as Independent Prescribers with profession specific restrictions
-2015 prescribing from a profession-specific list of controlled drugs was legally permitted for physiotherapist and podiatrist independent prescribers.
-2016 therapeutic radiographers were able to train as Independent Prescribers.
-2016 dietitians were able to train as Supplementary Prescribers.
- 2018 registered Paramedics were able to train as Independent/Supplementary Prescribers

As of 2019, the number of registered qualified non-medical prescribers was 87,946:
-36,300 community practitioner prescribers (district nurses, health visitors, school nurses or community nurses) independently prescribing from the nurse prescribers’ formulary for community practitioners
-40,941 nurse independent/supplementary prescribers
-7,846 pharmacists independent/supplementary prescribers
-881 physiotherapist and 341 podiatrist independent prescribers, with a further 991 physiotherapists and 399 podiatrists supplementary prescribers
-105 radiographer supplementary prescribers and 82 therapeutic radiographer independent prescribers
-60 dietitian supplementary prescribers

(Source GPhC & HCPC 2019)


The Nursing and Midwifery Council (NMC 2019), Health and Care Professions Council (HCPC 2013), Royal College of Optometrists (RCO 2015) and General Pharmaceutical Society (RPS 2019) provide Standards of Proficiency for prescribing detailing both educational and practice standards. A multi-professional Competency Framework for all Prescribers (2016) has been agreed by the Royal Pharmaceutical Society which sets out the shared set of skills and knowledge required to prescribe. Links to current versions are provided below.

Useful resources

General Pharmaceutical Society Standards for the education and training of pharmacist independent prescribers:
https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-education-and-training-of-pharmacist-independent-prescribers-january-19.pdf

Royal Pharmaceutical Society website information on non-medical prescribing:
https://www.rpharms.com/resources/ultimate-guides-and-hubs/independent-prescribers

Royal Pharmaceutical Society Competency Framework for all Prescribers (2016) https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-02-13-163215-030

NMC Standards framework for nursing and midwifery education (2019):
https://www.nmc.org.uk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/

RCN factsheet on nurse prescribing in the UK (2014): https://www.rcn.org.uk/get-help/rcn-advice/non-medical-prescribers

Health & Care Professions Council website information on non-medical prescribing: https://www.hcpc-uk.org/news-and-events/consultations/2018/consultation-on-standards-for-prescribing/
http://www.hcpc-uk.co.uk/standards/standards-relevant-to-education-and-training/standards-for-prescribing/

Allied Health Professions Foundation Curriculum Framework for Prescribing Education programmes:
http://www.ahpf.org.uk/files/Joint%20OCF%202018%20update%20College%20of%20Paramedics%20March18%20minor%20error%20corrected.pdf?dm_i=2NJF,X7PM,PE8OV,3H0S3,1

Pharmaceutical Services Negotiating Committee information: https://psnc.org.uk/dispensing-supply/receiving-a-prescription/who-can-prescribe-what/

A Competency Framework for Designated Prescribing Practitioners:
https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/DPP%20Framework/DPP%20competency%20framework%20Dec%202019.pdf?ver=2019-12-18-150746-160

General Optical Council website information on independent prescribing:
https://www.optical.org/en/Education/Specialty_qualifications/independent-prescribing.cfm

You answered 'no', or 'other'

If you are from a profession that is not listed and have identified a need to prescribe please contact your non-medical prescribing lead and/or your professional body to enquire about future consideration.
Please continue to work your way through the form to see which other criteria need to be satisfied.

Dietitian

If you are a dietitian, you can undertake training to use supplementary prescribing if you are:

• Registered with the HCPC
• Professionally practising in an environment where there is an identified need for you to regularly use supplementary prescribing
• Have normally at least 3 years relevant post-qualification experience in the clinical area in which you will be prescribing.

AND

• Working at an advanced practitioner or equivalent level
• Able to demonstrate how you reflect on your own performance and take responsibility for your own Continuing Professional Development (CPD) including development of networks for support, reflection and learning.

Information can be found using the link below: https://www.bda.uk.com/practice-and-education/nutrition-and-dietetic-practice/dietetic-workforce/prescribing/prescription-only-medicines.html

If you are considering a NMP course, and are also a member of the BDA, please email edpd@bda.uk.com who will add you to the supplementary prescribing discussion forum, where you can share experiences with others already on the NMP course and/or those who have already qualified as a supplementary prescriber.

Nurse or midwife

You must be a registered first-level nurse, midwife, or specialist community public health nurse.

You need at least 1 year experience in practice post registration. You must be deemed competent by your employer to undertake the programme.

If you are a nurse, there are different options to train as a prescriber:

Nurse independent/supplementary prescriber:
(course code: V300). This course leads to a dual qualification enabling use of independent or supplementary prescribing
The course is open to registered nurses or midwives qualified through UK Universities that follow the Nursing and Midwifery Council (NMC) curriculum.
see RCN factsheet for more definition: https://www.rcn.org.uk/get-help/rcn-advice/non-medical-prescribers.

Community Practitioner Nurse Prescriber (CPNP):
Community specialist practitioners such as school nurses, district nurses and health visitors, prescribe from the ‘Nursing Formulary for Community Practitioners’ (course code: V100). This qualification is often included as part of the specialist practice degree. Community nurses without a specialist practice qualification can also train to prescribe as CPNPs through a separate course.

Further information of the prescribing rights for different types of prescribers can be found on the using the link below:
http://psnc.org.uk/dispensing-supply/receiving-a-prescription/who-can-prescribe-what/

Pharmacist

To train as an independent/supplementary prescriber you must:

• Have at least two years' appropriate patient-orientated experience in a UK hospital, community or primary care setting following your pre-registration year. Have identified an area of clinical or therapeutic practice in which to develop prescribing skills and have relevant up-to-date clinical or therapeutic experience in that area, in addition to the relevant pharmacological and pharmaceutical knowledge.

Information can be found using the links below:
https://www.pharmacyregulation.org/education/pharmacist-independent-prescriber

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf?ver=2019-02-13-163215-030

https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-education-and-training-of-pharmacist-independent-prescribers-january-19.pdf

https://www.pharmacyregulation.org/sites/default/files/document/accreditation_criteria_learning_outcomes_and_indicative_content_full_programme_2018-19.pdf

Optometrist

In order to train as an independent prescriber, you need to:

• be a registered optometrist

• have been practising in the UK and registered with the General Optical Council (GOC) for two full years before beginning the clinical placement

• train in competencies which focus on the consultation, prescribing effectively and prescribing in context.

Information regarding the regulations around the Independent Prescribing qualification as a whole are detailed in the GOC IP Handbook below and can be found on the website below:
https://www.college-optometrists.org/cpd-and-cet/training-and-qualifications/qualifying-as-an-independent-prescriber.html

Podiatrist

In order to train as an independent/supplementary prescriber you need to:

• Be registered with the HCPC in one of the relevant Allied Health Professions

• Be professionally practising in an environment where there is an identified need to regularly use independent prescribing or supplementary prescribing

• Have normally at least 3 years relevant post-qualification experience in the clinical area in which you will be prescribing.

AND

• Be working at an advanced practitioner or equivalent level

• Be able to demonstrate how you reflect on your own performance and take responsibility for your own Continuing Professional Development (CPD) including development of networks for support, reflection and learning.

Information can be found using the link below (direct download):
http://www.scpod.org/EasySiteWeb/GatewayLink.aspx?alId=36739 (pdf)

Physiotherapist

In order to train as an independent/supplementary prescriber you need to:

• Be registered with the HCPC in one of the relevant Allied Health Professions

• Be professionally practising in an environment where there is an identified need to regularly use independent prescribing or supplementary prescribing

• Have normally at least 3 years relevant post-qualification experience in the clinical area in which you will be prescribing.

AND

• Be working at an advanced practitioner or equivalent level

• Be able to demonstrate how you reflect on your own performance and take responsibility for your own Continuing Professional Development (CPD) including development of networks for support, reflection and learning.

Information can be found using the link below:
http://www.csp.org.uk/publications/practice-guidance-physiotherapist-supplementary-prescribers

Radiographer

Therapeutic radiographers can train as independent/supplementary prescribers. Diagnostic radiographers can train as supplementary prescribers. In order to train you need to:

• Be registered with the HCPC in one of the relevant Allied Health Professions

• Be professionally practising in an environment where there is an identified need to regularly use independent prescribing or supplementary prescribing

• Have normally at least 3 years relevant post-qualification experience in the clinical area in which you will be prescribing.

AND

• Be working at an advanced practitioner or equivalent level

• Be able to demonstrate how you reflect on your own performance and take responsibility for your own Continuing Professional Development (CPD) including development of networks for support, reflection and learning.

More information can be found using the link below:
http://www.sor.org/practice/other-groups/prescribing

Paramedic

Paramedics can train as independent/supplementary prescribers. In order to train you need to:
• Be registered with the HCPC in one of the relevant Allied Health Professions
• Be professionally practising in an environment where there is an identified need to regularly use independent or supplementary prescribing
• Have normally 3 years relevant post-qualification experience in the clinical area in which you will be prescribing

AND
• Be working at an advanced practitioner or equivalent level
• Be able to demonstrate how you reflect on your own performance and take responsibility for your own Continuing Professional Development (CPD) including development of networks for support, reflection and learning

More information can be found using the link below:

https://www.collegeofparamedics.co.uk/COP/Professional_development/Medicines_and_Independent_Prescribing/COP/ProfessionalDevelopment/Medicines_and_Independent_Prescribing.aspx?hkey=04486919-f7b8-47bd-8d84-47bfc11d821a

Other

If you are from a profession that is not listed and have identified a need to prescribe please contact your non-medical prescribing lead and/or your professional body to enquire about future consideration.

NHS England are leading work on a proposal for independent prescribing for diagnostic radiographers:

Diagnostic radiographer:
https://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/med-project/radiographers/



Please continue to work your way through the form to see which other criteria need to be satisfied

You answered no.

It sounds as if you need more experience before you can apply for the course. This means you can plan ahead and it is worth looking at the rest of the criteria so that you can ensure you are prepared. If you are unsure about your eligibility, talk to your local NMP lead or Higher Educational Institute. It is worthwhile looking at the rest of the eligibility criteria.

Consider how many questions you got wrong. If there were only a few, do some revision using the ‘revise learning tools’ in SN@P and take the test again. If you got a lot wrong, consider discussing this with your line manager with a view to taking a numeracy course (e.g. NVQ) or make use of online training available through SN@P.

You answered no

For advice on this, consider speaking to your NMP lead, local Higher Educational Institute (HEI), other NMPs in similar clinical areas who may have advice about securing a DMP.

Step 3. Practice Assessor (previously known as Designated Medical Practitioner, DMP)

In order to register on a prescribing programme, and undergo a period of supervised practice (Period of Learning in Practice - PLP) you need to have prior agreement of a named Practice Assessor. The role of the assessor is to direct and support your PLP, and undertake assessment of your clinical practice. This is a role that was traditionally held only by medical prescribers (Designated Medical Practitioners (DMP)).

Recent changes to NMC (2019) and HCPC (2019) regulations means that this role can now be undertaken by other suitably qualified independent prescribers. They must, however, hold the necessary annotation for a prescriber as required by their professional regulator and should be an active prescriber with appropriate knowledge and experience in your area of clinical practice. Depending on your Practice Assessor's professional background they could be called one of the following:
Nurses and Midwives (NMC) - Practice Assessor
Pharmacists (GPhC) - Designated Prescribing Practitioner
AHP (HCPC) - Practice Educator
Doctors (GMC) - Designated Medical Practitioner

NMC and HCPC registrants will also need to have a ‘practice supervisor’ who facilitates your learning experience, similar to a prescribing buddy. This should, unless an exceptional circumstance, be a different person to your practice assessor.

Launched in early 2020 the ‘Designated Prescriber Practitioner Competency Framework’ , developed by the Royal Pharmaceutical Society and multi-disciplinary experts is a new framework that is designed to help Universities running independent prescribing programmes, NHS trusts and boards with independent prescribers, trainee independent prescribers and experienced independent prescribers to understand the expectations for a DPP through standardised competency descriptors.

Please use the following link to access the framework: https://www.rpharms.com/resources/frameworks/designated-prescribing-practitioner-competency-framework

More information can be found in the DMP handbook by the National Prescribing Centre, 2005:

https://drive.google.com/open?id=0B6TgIiIeoYdRVzRoaDhPdFp6T1U

Please note as this is an emerging area requirements may vary while the DPP framework is being adopted across the UK and HEI course providers amend their offering in line with the revised HCPC (2019) regulations.

You answered no

For advice on this, consider speaking to your NMP lead, local Higher Educational Institute (HEI), other NMPs in similar clinical areas who may have advice about securing a practice assessor.

For advice on this, consider speaking to your NMP lead, local Higher Educational Institute (HEI), other NMPs in similar clinical areas who may have advice about securing a practice supervisor.

Step 4. Have you identified a clinical need to prescribe?

To be accepted on the course, you need the support of your employer to confirm that your post is one in which you will have the need and the opportunity to prescribe upon qualifying.
There should be an agreed local need and an agreed therapeutic area in which you will prescribe.

You answered 'no'

If not, consider the following resources and actions which can help you to develop a case to help your manager/organisation to understand whether there is a need for your role to include prescribing:

A) UNDERSTAND POTENTIAL BENEFITS
• Think about the key benefits that prescribing offers to your practice.
• Watch the video below where NMP students discuss the impact of prescribing.
• Talk to others within your existing professional network to find out how prescribing may be used in your specialist area. Are there regional or local specialist groups or NMP groups that you can contact to find out how NMPs in similar roles to you demonstrate a need for prescribing?
• Discuss with your manager how your patients currently obtain prescriptions for their medicines and your potential prescribing role

Activity: Use the following checklist to record which benefits are most relevant to your practice.

Video: Will there be any effect on safety and quality of care?

If the below video does not automatically load, please click here to access it.

B. Gather information to support NMP

• Consider undertaking a clinical audit to demonstrate need (e.g. recording time spent ‘door hanging’, i.e. waiting for a doctor to write a prescription when you could do this if you were a prescriber, number of times you need to ‘hand over’ your patient to another prescribing health professional because you can’t prescribe etc.)

• The ‘Primary care physiotherapy cost-calculator’ hosted by the Chartered Society of Physiotherapy was designed for physiotherapists to help demonstrate the value of new posts, including the role of prescribing. It can also be useful for other professions as a framework to calculate costs and benefits of prescribing:

http://www.csp.org.uk/professional-union/practice/evidence-base/primary-care-physiotherapy-cost-calculator

C. Align your case to national & local strategy

Set out a case to demonstrate how prescribing would fit with your organisational NMP strategy, or other organisational strategy

If PGDs are used extensively in your service, consider making reference to the following guidance that recommends that PGDs should only be used if there is no alterative
NICE guidance on use of Patient Group Directions (PGDs): https://www.nice.org.uk/guidance/mpg2/chapter/Recommendations#considering-the-need-for-a-patient-group-direction

Consider making reference to key policy documents and national strategy documents, or reviews that may support NMP within your area:

USEFUL LINKS
• NMP a quick guide for commissioners
https://www.associationforprescribers.org.uk/nmp-guide-for-commissioners-published/
• How to write a business case for pharmacists NMP
https://www.sps.nhs.uk/wp-content/uploads/2012/06/How20to20write20a20Business20Case2020NMP.pdf
• Carter review calls for more clinical pharmacists:
http://www.pharmaceutical-journal.com/news-and-analysis/carter-review-calls-for-more-clinical-pharmacists-to-be-deployed-by-nhs-trusts/20200670.article
• Specialist areas: e.g. NMP in the management of substance misuse
http://www.nta.nhs.uk/uploads/nmp-in-the-management-of-substance-misuse.pdf
• ‘AHPs into action’ document
https://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/
• NHS England 5 year forward view
https://www.england.nhs.uk/five-year-forward-view

Step 5. Prescribing budget

To facilitate being able to prescribe once you have qualified, we recommend that all potential prescribers consider who is going to be paying for items prescribed before applying for the prescribing course.

You answered 'no'.

If no, speak to your manager or whoever commissions your service as they will need to agree your prescribing budget as part of the commissioned service.
If you are working in primary care, the Clinical Commissioning Group will ultimately need to agree this.

Below is a list of aspects to consider when choosing a course:

• Is the course approved for your profession?

• Location (distance for travel, access to library resources)

• Structure of course and mode of study (how much is online? Is attendance in weekly blocks or one day per week?)

• Academic study level 6 or 7 (degree or master level)

• Higher Educational Institute entry criteria -have you previously studied at minimum of level 6? (or 7 for most pharmacy courses). If not, what does the HEI offer in way of study skills? If it is more than 6 years since you have undertaken study, you might consider accessing study skills:

https://www.how-to-study.com/study-skills-articles/preparing-to-study.asp

You answered 'no'

Look up local university provider (see HCPC register link below), contact your local NMP lead or trust learning and development department for advice and information about local provision.

HCPC registered of approved education and training programmes:
http://www.hcpc-uk.org/education/programmes/register/

You answered 'no'

Speak to your manager or trust learning and development department for advice.