Pharmacist Independent Prescribing Models in the United Kingdom

After qualifying the PIP can prescribe unconventionally any medicine for any medical conditions which matches with their competency levels such as the controlled drugs with the exception of drugs which are used for the addiction treatment. A research paper discussed about the models of pharmacist prescribing in the United Kingdom: 1) the pharmacist supplementary prescribing (initially denoted as dependent prescribing in the crown report) and 2) the Pharmacist Independent Prescribing (PIP). The practice of independent prescribing was formulated in the year 2006, maintaining the guidelines of the legislation. The definition of the independent prescriber “a practitioner responsible for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing”. Due to the uniqueness of the subject there is not much evidence available about the subject in the United Kingdom. It is estimated that about 53,572 registered nurses, 3845 of pharmacists and 689 health care professionals (physiotherapists, optometrists, radiographers and podiatrists) are supplementary and independent prescribers in England. Independent prescribing may also include both the Patient Group Directions (PGD) and the supplementary prescribing as a part of their duties. About 2 – 3% of the group of pharmacist are authorised to prescribe the medicines independently. The study results also indicated that the independent prescribing by the pharmacist is also safe from the clinical point of view. Pharmacist reported to have communicated with the patients concerning the medicines approved by the national guidelines, about the issues that results in effective medicine intake by the patients but concerns regarding the adverse effects of the medicines and the opinions of the patient regarding the choice of medicine is not taken into consideration. For PIP the primary care is considered the major area for prescribing and one third of them were also prescribing in the secondary care NHS Trust setting (Tonna, et al, 2008; Bourne, et al, 2016).

The number of different primary care trust models services (PCT) and the number of PIP reported to be working in these services are:

The different Non Medical Prescribers (NMP) in the secondary care or acute foundation Trust:

The number of PIPs in the mental health foundation trust:

The changes in the involvement of PIPs after the IP training:

A pilot study in 2012 formulated the concept of MESH (Medicine Support At Home Service) service. The pharmacist following the MESH practice performs a detailed and complete review on medicine, they work with patients to organise their organization and also communicates with their family and care givers, GP, the community pharmacist along with the other health realted professionals to provide continuity to the service, can reduce the un needed poly pharmacy, reduces the waste of resources and therefore strengthens the resources of NHS. It is considered to be an emerging model of care delivery by making use of the skills of the pharmacist who helps the GP and the other primary care providers (Bardet, et al, 2015; Nuttall, et al, 2019).

Conclusion:

The practice of PIP in England is considered to be a well incorporated and developed condition for managing the different conditions of patient and giving the patient access to the medicines they need. The practice is considered to be safe and clinically appropriate and most of the trusts are establishing the core clinical governance and the strategies of management for the purpose of non medical prescribing. Several evidences have also established the fact that patients are also satisfied with PIP.

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References:

Tonna, A.P., Stewart, D. and McCaig, D., 2008. An international overview of some pharmacist prescribing models. J Malta Coll Pharm Pract, 14, pp.20-26.

Bourne, R.S., Baqir, W. and Onatade, R., 2016. Pharmacist independent prescribing in secondary care: opportunities and challenges. International journal of clinical pharmacy, 38(1), pp.1-6.

Latter, S., Blenkinsopp, A., Smith, A., Chapman, S., Tinelli, M., Gerard, K., Little, P., Celino, N., Granby, T., Nicholls, P. and Dorer, G., 2011. Evaluation of nurse and pharmacist independent prescribing.

Bardet, J.D., Vo, T.H., Bedouch, P. and Allenet, B., 2015. Physicians and community pharmacists collaboration in primary care: A review of specific models. Research in Social and Administrative Pharmacy, 11(5), pp.602-622.

Nuttall, D. and Rutt-Howard, J. eds., 2019. The textbook of non-medical prescribing. John Wiley & Sons.