Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences

Abstract

Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017.Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10).Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings. K E Y W O R D Scolleagues, independent prescribers, independent prescribing, non-medical prescribing, patients, primary care e460 | HINDI et al.

“A little bit more looking…listening and feeling” A qualitative interview study exploring advanced clinical practice in primary care and community pharmacy

“…Changes to the education and training of pharmacists, in particular a move to more cross-sector working and improved contractual frameworks, such as the new English Community Pharmacy Contractual Framework (CPCF), which focuses on community pharmacy becoming a more clinically focussed service, may help to facilitate this [23,24] All but one pharmacist in this study held an independent prescribing qualification and the majority were using their skills in their advanced practice. Several general practice pharmacists described the key role their prescribing qualification played in this, arguing that it instilled patients with confidence and enhances trust in the pharmacist [32,33]. Patient-perceived pharmacist expertise has previously been identified as a predictor of the quality of the relationship between pharmacist/ patient, which in turn predicts relationship commitment, and a positive patient/pharmacist relationship has been associated with the efficacy of self-care for patients with diabetes [34,35].…”

“…All but one pharmacist in this study held an independent prescribing qualification and the majority were using their skills in their advanced practice. Several general practice pharmacists described the key role their prescribing qualification played in this, arguing that it instilled patients with confidence and enhances trust in the pharmacist [ 32 , 33 ]. Patient-perceived pharmacist expertise has previously been identified as a predictor of the quality of the relationship between pharmacist/ patient, which in turn predicts relationship commitment, and a positive patient/pharmacist relationship has been associated with the efficacy of self-care for patients with diabetes [ 34 , 35 ].…”

Medicines prescribed by non-medical independent prescribers in primary care in Wales: a 10-year longitudinal study April 2011–March 2021

“…Open access independent prescribers (NMIPs) relieve pressures on general practitioners (GPs). 9 However, various barriers to the uptake and implementation of non-medical independent prescribing still exist, such as lack of support and confidence, leading to inconsistencies both across and within organisations. 10 11 In Wales, primary care National Health Service (NHS) services are provided through seven local health boards (LHBs).…”

“… 8 It has also been noted that non-medical independent prescribers (NMIPs) relieve pressures on general practitioners (GPs). 9 However, various barriers to the uptake and implementation of non-medical independent prescribing still exist, such as lack of support and confidence, leading to inconsistencies both across and within organisations. 10 11 …”

“…Patients report satisfaction and positive experiences including increased flexibility and accessibility,5 6 and good rapport,7 while practitioners report improved autonomy and job satisfaction despite certain barriers 8. It has also been noted that non-medical independent prescribers (NMIPs) relieve pressures on general practitioners (GPs) 9. However, various barriers to the uptake and implementation of non-medical independent prescribing still exist, such as lack of support and confidence, leading to inconsistencies both across and within organisations 10 11…”