Non-medical Prescribing

What is non-medical prescribing (NMP)?

• Prescribing by specially trained nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers

• Working within their clinical competence as either independent or supplementary prescribers

AKA prescribing by anyone who is not a doctor

What are independent prescribers?

Examples

• Able to prescribe medicines on their own initiative from the BNF

• Doctors

• Dentists

• Nurse IPs

• Pharmacist IPs

• Optometrist IPs

• Since 2013: chiropodists/podiatrists and other physiotherapists

• Since 2016: therapeutic radiographers

What are supplementary prescribers?

Examples

Able to prescribe medicines in accordance with a clinical management plan. This plan is agreed between the supplementary prescriber, a doctor and the patient

• Nurses / midwives

• Pharmacists

• Podiatrists

• Physiotherapists

• Diagnostic and therapeutic radiographers

• Optometrists

• Dieticians

In what other situations can medicines be given by NMPs?

• Patient Specific Direction (PSD): an instruction given by an IP to another professional to administer a medicine to a specific patient

• Patient Group Direction (PGD): a written instruction for the supply / administration of specific medicines by named, authorities health professionals, to a well defined group of patients requiring treatments for a specific condition

How is a Patient Specific Direction (PSD) different to a normal prescription?

Instructions are related to administration of medicines rather than dispensing of medicines e.g. vaccinations

Who can supply/administer under a PGD?

In which act are there exemptions to the general rules on selling, supplying and administering medicines for some groups of HCPs?

Human Medicines Act 2012

Exemptions in the Human Medicines Act 2012 on prescribing for certain HCPs

1. Podiatrists/chiropodists » can give antibiotics

2. Midwives/student midwives » can give nyastatin and vitamin K

3. Occupational health » only registered nurses and drs can supply medicines under occupational health

4. Optometrists » can give antibiotic eyedrops

5. Paramedics » can give adrenaline, naloxone

Exemption to the regulation of sale/supply of POMs

• Does not apply to the administration of POMs specified in Schedule 19

• For the purpose of saving life in an emergency

E.g.

• Adrenaline » anaphylaxis

• Glucagon / Glucose injections » hypo/hyperglycaemia

• Naloxone hydrochloride » drugs overdose

What can doctors prescribe?

Basically everything:

• Licensed drugs - POMs, Ps, GSLs

• Off label and off license drugs

• Unlicensed medicines

• Controlled Drugs (CDs)

• Appliances or chemical reagents listed in part IX of the drug tariff

• Selected List Schemes (SLS)

• Borderline substances (ACBs)

What are off label and off license medicines?

A medicine which is used to treat a condition that can be used to treat another condition

What can dentists prescribe?

• Can only prescribe products included in the Dental Prescribing Formulary

• On an FP10D prescription

What can community practitioner nurse prescribers prescribe?

• Can only prescribe products included in the Nurse Prescribers’ Formulary

What can nurse AND pharmacist independent prescribers prescribe?

• Any medicine for any medical condition

• Any Sch 2, 3, 4 or 5 CD except: diamoprhine, dipipanone, cocaine

What can optometrist independent prescribers prescribe?

• Any licensed medicine for ocular conditions

• NOT authorised to prescribe CDs

What can physiotherapist AND podiatrist/chiropodist independent prescribers prescribe?

• Any licensed medicine that falls within their individual area of competence

• Can also prescribe some CDs

What can independent therapeutic radiographer prescribe?

• Any licensed medicine for any medical condition within their level of experience of competence and the overarching framework for cancer

• Medicines for off-label use

• Cannot prescribe CDs

What can supplementary prescribers prescribe?

• Any medicines as agreed by the patient and doctor as part of a patient’s clinical management plan

• Including any Sch 2, 3, 4 or 5 CDs except: diamorphine, dipipanone or cocaine

What can paramedic independent prescribers prescribe?

• Any medicine for any condition, provided it's within their clinical competence and training.

• Off-label medicines (not licensed for that specific use)

• Selected items from the Community Pharmacy England Selected List Scheme (SLS)

• Specific Controlled Drugs, due to recent legislation:

  • Morphine sulphate (oral/injection)

  • Diazepam (oral/injection)

  • Midazolam (oromucosal/injection)

  • Lorazepam (injection)

  • Codeine phosphate (oral) 

Which prescription forms are available and which prescribers use which for?

Dentist prescription form rules

• If dentist is prescribing on a yellow Rx form, can only prescribe from the dental formulary

• If prescribing on a private prescription, can prescribe any medication

Nurse IP prescription form rules

• If dentist is prescribing on a lilac Rx form, can only prescribe from the nursing formulary

• If prescribing on a private prescription, can prescribe any medication

Privately Prescribed CDs

• Private prescribers can only prescribe Sch 2 or 3 CDs privately on a pink private prescription form (FP10PCD)

• All private prescribers have been allocated a 6 digit prescriber identification number which must be included on the FP10CD » this is different to their GMC number which is not legally required

Legal requirement for privately prescribed Sch 2 and Sch 3 CDs

• 6-digit prescriber identification number

• Must be included on the FP10PCD

• (Different to GMC number which is not legally required)

Where should private prescribers be referred to if they require a private prescriber identification number?

Should be referred to their primary care organisation e.g. NHS England Area Team

PINK PRESCRIPTION =

PRIVATE CD PRESCRIPTION

= patient has to pay

Why is this prescription not legally valid?

Has all the correct details but not on a pink FP10PCD

Which CDs can doctors prescribe?

• Sch 2 - 5

• Including diamorphine, dipipanone or cocaine for the treatment of addiction

• Possession and supply of Sch 1 CDs are prohibited except in accordance with Home Office Authority

Which CDs can dentists prescribe?

NHS Dentists:

• Only CDs in the dental prescribing formulary

• On an FP10D prescription

Private Dentists:

• Any Sch 1 - Sch 5 CD

What are pharmacists advised in relation to CD prescribing by dentists?

To challenge dental prescriptions for Sch 2 or Sch 3 CDs for which there is no recognised dental use

Which CDs can nurse IPs and pharmacists IPs prescribe?

• Sch 2 - 5

• EXCEPT diamorphine, dipipanone or cocaine for the treatment of addiction

Which CDs can physiotherapist IPs prescribe?

• Diazepam, dihydrocodeine, lorazepam, morphine, oxycodone, temazepam by oral administration

• Morphine for injectable administration

• Fentanyl for transdermal administration

Which CDs can podiatrist/chiropodist IPs prescribe?

• Diazepam

• Dihydrocodeine

• Lorazepam

• Temazepam

By oral administration

Which CDs can community practitioner nurse IPs prescribe?

Not authorised to prescribe any CDs

Which CDs can supplementary prescribers prescribe?

• Sch 2 - 5

• EXCEPT diamoprhine, dipipanone or cocaine for the treatment of addiction

Which CDs can therapeutic radiographer IPs prescribe?

• Tramadol

• Lorazepam

• Diazepam

• Morphine

• Oxycodone

• Codeine

By oral administration

Which CDs can paramedic IPs prescribe?

• Morphine sulphate by oral administration or by injection

• Diazepam by oral administration or by injection

• Midazolam by oramucosal administration or by injection

• Lorazepam by injection

• Codeine phosphate by oral administration

Benefits of NMP?

• Better and quicker access to services

• Time-saving

• Promotes integrated care

• Makes better use of clinical workforce skills by optimising the use of the available skill mix

• Gives organisations the flexibility to innovate when designing cost-effective quality services e.g. a lot of clinics led by pharmacists/nurses instead of doctors

• Increased choice of services

What were the GPhC requirements to qualify as an IP in the past?

• Be registered with the GPhC

• Have relevant experience in a UK pharmacy setting

• Be able to recognise, understand, and articulate prescriber skills and attributes

• Have an identified area of clinical/therapeutic practice with relevant experience

• Have a Designated Prescribing Practitioner (DPP) to supervise learning

• Complete additional GPhC-accredited training

• Meet 32 GPhC-defined learning outcomes

What did the GPhC-accredited IP training involve?

• Completion of an accredited independent prescribing programme - typically part-time over ~6 months

• Combination of face-to-face teaching and self-directed study

• Minimum of 26 days of teaching and learning activities

• 90 hours (12 days) of supervised practice with a Designated Prescribing Practitioner (DPP)

• Qualification must be recorded with the professional regulator once completed

How do pharmacists become IPs currently?

Integrated prescribing training

• Prescribing skills are built into the MPharm degree and foundation training year

• The GPhC standards now require prescribing competence to be achieved at the point of registration

Supervised practice included earlier

• Foundation trainees are supported by Designated Prescribing Practitioners (DPPs) and clinical supervisors during training, rather than years later.

Registration outcome

• From 2026, all newly qualified pharmacists will be independent prescribers at the point of registration

No extra course after qualification

• The separate IP course is phased out for new entrants.

• Prescribing is core to the pharmacist role, not an optional add-on