Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

Abstract

ObjectivesTo support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders’ views on IP in primary care and identify barriers and facilitators influencing implementation.SettingUK primary/community care.ParticipantsInclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors.Primary and secondary outcome measuresN/A.ResultsTwenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) ‘Preparation’, (2) ‘Training’, (3) ‘Transition’ and 4) ‘Sustainment’. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care.ConclusionsIn order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world.PROSPERO registration numberCRD42019124400.

Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group

“…In terms of perceived facilitators, the Delphi study highlighted ‘NP increases independence in the functions and responsibilities of the nursing profession’, ‘institutional support’, ‘adaptation to new roles and tasks of the nursing profession’, followed by ‘NP favors the autonomy of the nursing professional in the case of chronic care processes’ and ‘NP implies greater visualization and empowerment of the nursing collective within the care process’. These facilitators have also been recorded by other authors (Edwards et al., 2022; Fernández‐Ortega et al., 2016; McBrien, 2015), who concur that the nurse is key to optimal implementation of the prescription.…”

“…(2022) added that concerns about professional boundaries, if left unaddressed, can be divisive and prevent nurses from prescribing and should be carefully considered. The ‘lack of support, information and training by the institution/administration to the nursing staff’ is one of the barriers mentioned by several authors (Edwards et al., 2022; Fox et al., 2022; Naderi et al., 2021) who consider it an organizational‐institutional obstacle that restricts the extension of prescribing, identifying the impact of the NP policy as potentially enabling and/or restrictive. Despite this fact, nurses in Spain have seen the catalogue of medications to be prescribed recently expanded, beginning with treatments for wounds and burns.…”

“…To this, Fox et al (2022) added that concerns about professional boundaries, if left unaddressed, can be divisive and prevent nurses from prescribing and should be carefully considered. The 'lack of support, information and training by the institution/administration to the nursing staff' is one of the barriers mentioned by several authors (Edwards et al, 2022;Fox et al, 2022;Naderi et al, 2021)…”

“…Moreover, it enhances clinical outcomes compared with doctor‐led care and results in high service‐user satisfaction. In addition, its implementation has been associated with effective use of resources, better use of clinical skills and improved services, especially in rural areas (Edwards et al., 2022; Zarzeka et al., 2017).…”

Costs, consequences and value for money in non-medical prescribing: a scoping review

“…The NMP literature has largely focused on assessing the benefits and effectiveness of prescribing authorities without evaluating the costs and resource use. Some other studies have concentrated on topics such as NMP trends and related national policies over time or implementation barriers and/or facilitators of NMP for different professions 1 9 17 24 43. This review demonstrated the lack of evidence on costs, consequences and value for money in NMP by different groups of healthcare professionals.…”