Independent and Supplementary Prescribing: Prescribing in practice: how it works

Williams (1997) cites that at least 25 per cent of the total population in the UK has a skin complaint of which 19 per cent will consult their general practitioner (GP). Therefore, caring for patients with dermatological conditions represents a significant workload for health professionals in primary care. Future dermatology services are aimed at improving dermatology services within primary care (Evans 2001) and reducing the waiting times for patients to be seen in secondary care (Irvine 2003). This has already resulted in the development of nurse-led clinics in primary care for patients with chronic inflammatory skin disease (Bowcock and Bailey 2002, Mateos 2002, Penzer 2000, Rolfe 2002a). Eczematous conditions, psoriasis and acne represent the three main chronic relapsing diseases, which can be managed more effectively in a primary care setting (Rolfe 2002a). Recent legislative changes surrounding the prescription of medications will enable nurse-led clinics and pharmacy services to complement GP and secondary care dermatology services (Bowman 2000, Department of Health (DH) 1999, 2000, 2002, 2003, Medicines Control Agency 2002). For example, some of the topical and systemic medications used in dermatology are now available for nurses to prescribe independently. Furthermore, the advent of supplementary prescribing has meant that both nurses and pharmacists are able to prescribe from practically the whole of the British National Formulary (BNF) for patients with dermatological conditions through the use of Clinical Management Plans (CMPs). The competency frameworks such as those developed by the National Prescribing Centre (NPC 2001), the Nursing and Midwifery Council (NMC 2003) and National Health Services (NHS) Scotland (NHS Education for Scotland 2003) have enabled practitioners to acquire general prescribing competencies and those specific to dermatology in order for them to work competently in the role of prescriber. These include competencies in relation to: n Clinical assessment of the patient’s skin. n Assessment of the patient’s physiological, psychological and emotional response to a given dermatological diagnosis. n Assessment of the patient’s response to therapeutic interventions and so the implementation of effective and safe therapeutic interventions. n Provision of support and information. This article describes how independent and supplementary prescribing can be used by non-medical prescribers in the treatment management of patients with dermatological conditions. Prescribing in practice: how it works