Pharmacist Prescribing across a NHS Trust - The Northumbria Way

Following changes in legislation, we recognised the potential of pharmacist prescribing to enhance patient safety. Our initiative was to implement pharmacist prescribing across an NHS hospital trust. Rather than create new specialist roles, as many other organisations have tended to do, our focus was on developing and using generalist prescribing pharmacists to enhance our current ward based role. We adopted an approach to prescribing where the prescribing pharmacist, like their medical counterparts, could prescribe any medicine, for any patient, for any condition and in any setting.

Previously our pharmacists would make recommendations to doctors (quite often junior) and the doctors would then prescribe; our model allows the pharmacist to take responsibility for his/her actions by prescribing independently and autonomously. In this context, we no longer just put others' mistakes right; instead we have moved forward in the process and adopted a pro-active role within the wider clinical team.

Over 80% of our pharmacists are either prescribing or training to become prescribers. A recent study of prescribing across the Trust showed that pharmacists at Northumbria prescribed for 40% (182/457) of patients accounting for 13% (680/5279) of all medication orders. In a separate audit looking at errors, from 1415 items prescribed, there were 4 errors (0.3%). http://ejhp.bmj.com/content/early/2014/09/04/ejhpharm-2014-000486.abstract

Pharmacists now prescribe at scale across the Trust. Given the relative safety of the process outlined, our standard operating procedures no longer require that pharmacists’ prescribing is routinely checked. However, we continue to clinically check prescriptions written by doctors and other non-medical prescribers as national research suggests that they have not demonstrated similar levels of safe prescribing performance. This has been accepted as good practice by all staff groups.

We are now training relatively inexperienced pharmacists to prescribe as generalist prescribers as part of our core inpatient service. We expect all clinical pharmacists to develop towards prescribing independently. This process has become embedded across the Trust and we believe this should be standard practice for all hospital pharmacy services. Recently the regional Local Education Training Board pharmacy subgroup, with membership from chief pharmacists across the region, agreed a workforce strategy which included the development and deployment of prescribing pharmacists in the way we have described above.

Our experience is referenced in the strategy and will hopefully support adoption of this model of working on a larger regional scale in Trusts across the North East. This has been submitted for project funding from the Academic Health Science Network, to facilitate spread within the region and beyond. http://www.pharmaceutical-journal.com/your-rps/why-this-nhs-hospital-trust-asks-all-its-clinical-pharmacists-to-become-independent-prescribers/20068078.article?adfesuccess=1