Stakeholders’ views of UK nurse and pharmacist supplementary prescribing

J Health Serv Res Policy 2008;13:215-221
© 2008 Royal Society of Medicine Press


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What’s this?

Original research

Richard Cooper ,
Claire Anderson,
Tony Avery 1,
Paul Bissell 2,
Louise Guillaume 2,
Allen Hutchinson 2,
Joanne Lymn 3,
Elizabeth Murphy 4,
Julie Ratcliffe 5,
Paul Ward 6

Centre for Pharmacy, Health and Society, University of Nottingham, Nottingham, UK;
1 Community Health Sciences, University of Nottingham, Nottingham, UK;
2 Section of Public Health, ScHARR, University of Sheffield, Sheffield, UK;
3 School of Nursing, University of Nottingham, Nottingham, UK;
4 School of Sociology & Social Policy, University of Nottingham, Nottingham, UK;
5 School of Nursing and Midwifery, University of South Australia, Adelaide, Australia;
6 School of Medicine, Flinders University, Bedford Park, Australia

Correspondence to: Richard.cooper{at}

Objectives: Supplementary prescribing (SP) by pharmacists and nurses in the UK represents a unique approach to improving patients’ access to medicines and better utilizing health care professionals’ skills. Study aims were to explore the views of stakeholders involved in SP policy, training and practice, focusing upon issues such as SP benefits, facilitators, challenges, safety and costs, thereby informing future practice and policy.

Method: Qualitative, semi-structured interviews were conducted with43 purposively sampled UK stakeholders, including pharmacistand nurse supplementary prescribers, doctors, patient groupsrepresentatives, academics and policy developers. Analysis oftranscribed interviews was undertaken using a process of constantcomparison and framework analysis, with coding of emergent themes.

Results: Stakeholders generally viewed SP positively and perceived benefitsin terms of improved access to medicines and fewer delays, alongwith a range of facilitators and barriers to the implementationof this form of non-medical prescribing. Stakeholders’ viewson the economic impact of SP varied, but safety concerns werenot considered significant. Future challenges and implicationsfor policy included SP being potentially superseded by independentnurse and pharmacist prescribing, and the need to improve awarenessof SP. Several potential tensions emerged including nurses’versus pharmacists’ existing skills and training needs, supplementaryversus independent prescribing, SP theory versus practice andprescribers versus non-prescribing peers.

Conclusion: SP appeared to be broadly welcomed by stakeholders and was perceivedto offer patient benefits. Several years after its introductionin the UK, stakeholders still perceived several implementationbarriers and challenges and these, together with various tensionsidentified, might affect the success of supplementary and otherforms of non-medical prescribing.

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