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Correspondence to Dr W Baqir, Department of Pharmacy, North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields NE29 8NH, UK; [email protected]
Background
Pharmacists have been prescribing in the UK since 2003, following the success of nurse prescribing. The review of prescribing, supply and administration of medicines (the second Crown Report) in 1999 proposed that new groups of professionals could apply for permission to prescribe in specific clinical areas.1 Pharmacists were among a number of professional groups, including nurses, midwives, physiotherapists, podiatrists, optometrists and radiographers, that were considered for enhancements to their prescribing rights.2 Pharmacists were the second group of health professionals to become non-medical prescribers, following nurses.
Kocić and Stewart argued that internationally, 24% of pharmacists were already undertaking ‘some form’ of prescribing3; the UK approach is to provide a legal framework for roles that clinical pharmacists already undertake.
The journey
Pharmacists were first given prescribing rights (supplementary prescribing) in 2003 following the successful completion of a supplementary prescribing course at a UK school of pharmacy and subsequent registration with their regulatory body.4 The supplementary prescribing model was dependant on a prior diagnosis and an agreed and signed clinical management plan, developed in collaboration with the patient's general practitioner or hospital doctor (the independent prescriber), prescribing pharmacist, prescriber and the patient.1 Once this plan is in place, clinical responsibility and prescribing could be transferred to the supplementary prescriber from the doctor. Clinical management plans were individual to the patient but could be based on local, national or international guidelines. Supplementary prescribing was seen as an opportunity to release additional healthcare resource, using a group of experts to take on some of the responsibilities of doctors. Supplementary pharmacist prescribers could prescribe any licensed medicinal product, including controlled drugs (this was added in 2005 after changes in the law).2 This model of prescribing was similar to the American model of collaborative drug therapy.5
In 2006, pharmacist prescribing rights were extended to independent prescribing, allowing suitably qualified pharmacists to prescribe any medication for any condition, excluding controlled drugs and unlicensed medicines, limited only by their professional knowledge and ability (competence).6 This change gave pharmacists almost equal rights as independent medical prescribers. Subsequent changes in the law...