Non-medical prescribers

Types of nurse prescriber

Nurses, Midwives, Pharmacists and other allied healthcare professionals (AHPs) who have completed an accredited prescribing course and registered their qualification with their regulatory body, are able to prescribe.

The two main types are:

• Community Practitioner Nurse Prescribers (CPNP)

These are nurses who have successfully completed a Nursing and Midwifery Council (NMC) Community Practitioner Nurse Prescribing course (also known as a v100 or v150 course) and are registered as a CPNP with the NMC. The majority of nurses who have done this course are district nurses and public health nurses (previously known as health visitors), community nurses and school nurses. They are qualified to prescribe only from the Nurse Prescribers Formulary (NPF) for Community Practitioners. This formulary contains appliances, dressings, pharmacy (P), general sales list (GSL) and thirteen prescription only medicines (POMs).

• Independent Prescribers (IP)

Independent prescribers are nurses who have successfully completed an NMC Independent Nurse Prescribing Course (also known as a v200 or v300 course) and are registered with the NMC as an IP. They are able to prescribe any medicine provided it is in their competency to do so. This includes medicines and products listed in the BNF, unlicensed medicines and all controlled drugs in schedules two - five.

Those who have successfully completed the supplementary part of the prescribing course are also able to prescribe against a clinical management plan. Supplementary prescribing is described by the Medicines and Healthcare products Regulatory Agency (MHRA) as:

"a voluntary partnership between an Independent Prescriber (IP-er) and a supplementary prescriber (SP-er)," (e.g. nurse, pharmacist) "to implement an agreed patient-specific clinical management plan (CMP) with the patient's agreement."

The RCN acknowledges that some nurse prescribers are registered midwives.

The Misuse of Drugs Regulations covers all of the UK except Northern Ireland. This legislation divides controlled drugs (CDs) into five schedules corresponding to their therapeutic usefulness and misuse potential.

On 23 April 2012 changes to these regulations allowed nurses and midwives who are qualified as nurse independent prescribers to prescribe all controlled drugs listed in schedules two- five where it is clinically appropriate and within their professional competence (except for cocaine, diamorphine and dipipanone for the treatment of addiction). Changes also allowed nurse independent prescribers to mix any controlled drugs listed in schedules two-five prior to administration with another medicine for patients who need drugs intravenously.

Amendments to the Misuse of Drugs Regulations (Northern Ireland) 2002 were introduced on 10 May 2012 to allow a nurse independent prescriber and a pharmacist independent prescriber to prescribe controlled drugs as described.

There are two types of prescribers:

• An independent prescriber is a practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and can make prescribing decisions to manage the clinical condition of the patient.
• A supplementary prescriber is a practitioner who prescribes within an agreed patient specific clinical management plan (CMP), agreed in partnership by a supplementary prescriber with a doctor or dentist.

The table below is a brief summary of what IPs and SPs can prescribe (this does not include CPNP).

In general, an IP can prescribe any medicine for any condition within their clinical competence, whilst a SP may prescribe any medicine within their clinical competence that is included in the patient specific CMP.

From the NMC website:

The NMC Code

Standards of Proficiency for Nurse and Midwife Prescribers

Other resources:

Medicines and Healthcare products Regulatory Agency (MHRA) can provide information on legislation and medicines and medical devices

NICE Medicines and Prescribing Centre provides support for medicines and prescribing.

Country-specific guidance is also available at the following websites by searching for ‘nurse prescribing':

England: Department of Health

Northern Ireland: Department of Health

Scotland: NHS Scotland

Wales: Welsh Government