Supplementary prescribing

Supplementary prescribing

Supplementary prescribing involves a partnership between a medical practi-tioner (independent prescriber) who establishes the diagnosis and initiates treatment, a supplementary prescriber who monitors the patient and pre-scribes further supplies of medication and the patient who agrees to the supplementary prescribing arrangement.

A clinical management plan is drawn up for each patient which includes demographic data, the condition to be treated, the treatment with medicines and information detailing when the patient should be referred back to the independent prescriber. Figure 10.1 provides an example template for a clin-ical management plan; other examples are available online. Prescribing information included in clinical management plans can refer to an agreed limited amount of information and dosage adjustments that the supplemen-tary prescriber can make or, more usually, to a locally or nationally agreed clinical guideline or pathway, for example, the British Thoracic Society’s asthma guidelines.

The supplementary prescribing model is the one initially recommended for pharmacists by the Crown report and subsequently put into statute in 2003. The profession found this model to be somewhat unwieldy and pursued independent prescribing; this was made possible in May 2006.

Supplementary prescribing is championed as the efficient model for the management of long-term therapies within primary and secondary care. It has been used in hospital practice to establish pharmacists within out-patient clinics and provided a sound basis on which to build prescribing practice for pharmacists. A supplementary prescriber, using a clinical management plan, may prescribe a wide range of items, summarised in Text box 10.2.

Box 10.2 Medicines available to pharmacist supplementary prescribers

Pharmacist supplementary prescribing

Any general sales list, pharmacy or prescription-only medicine prescribable at National Health Service expense. This includes the prescribing of:

• antimicrobials

• ‘black triangle’ drugs and those products suggested by the British National Formulary to be ‘less suitable’ for prescribing

• controlled drugs (except those listed in schedule 1 of The Misuse of Drugs Regulations 2001 that are not intended for medicinal use)

• products used outside their UK-licensed indications (known as ‘off-label’ use). Such use must have the joint agreement of both prescribers and the status of the drug should be recorded in the clinical management plan

• unlicensed medicines