Anna Young shares her work in supporting non-medical prescribers across Sheffield and South Yorkshire, and offers advice for others wanting to change workplace culture
Primary care has the highest proportion of independent or non-medical prescribers (NMPs) in the UK1 and yet there is often a lack of organisational understanding about how to develop this role, and how practitioners can remain up to date and safe within our day-to-day clinical practice.
Historically, organisations have placed the onus to do this on the individual clinician. However, using the Venus model of CPD2 and a systematic review of best practice for my masters degree in advancing practice, I challenged this obligation and have been putting the recommendations into place in Sheffield and across South Yorkshire.
There are many articles on prescribing to read and courses to attend, but how do we know if they fit with the local formulary and referral pathways?
Sitting on the Sheffield Formulary support group, I see how much time and effort is put into developing these prescribing guidelines, including balancing the financial constraints of healthcare, evidence-based practice and working alongside the wider local health providers to ensure a commonality in prescribing practice.
Within this context, I have developed a monthly lunchtime clinical teaching programme looking at topics such as diabetes, reflux, allergic rhinitis, HRT and the menopause, contraception and anxiety and depression in young people. At these events we consider good prescribing practice, using the local formulary and shared decision making. We look at the risks versus the benefits of medication, including when not to prescribe, and deprescribing. These sessions have been evaluated well in terms of increasing prescribers’ confidence, competence and safety.
CPD cannot stand alone, however, and there needs to be a wider framework to support NMPs in primary care, including good governance. With this in mind, I worked with colleagues across the (then) four clinical commissioning groups to draw up such a framework.
It sets out the responsibilities of individual prescribers, their employers and the wider organisation – now the integrated care system (ICS) – in ensuring prescribing practice is kept up to date and safe. This has been an exciting, collaborative, cross-professional piece of work that will provide the foundation for excellent practice and patient safety going forwards.
Working in primary care is not a ‘boundaried’ role. As professionals we need support to develop our prescribing practice to meet the patient needs.
Our professional roles are dynamic, and we need provision to grow our prescribing practice alongside our clinical competencies. The framework we have written sits alongside the new Royal Pharmaceutical Society guidance Expanding Prescribing Scope of Practice3 encouraging the use of mentors and teaching events.
This work is being driven through the local workforce and training hub and is multiprofessional. As roles increasingly overlap in primary care, we need the same provision and support for all who are prescribers, as well as for those who influence prescribing but lack a prescribing qualification, such as GPNs and physician associates.
What I’ve learned
It is not easy to change a workplace culture. Coming in as an ‘outsider’ (a clinician without a strategic role or title) has meant I have needed a lot of persistence and I’ve had to build relationships with the key decision makers. There has been no handbook for this; it has been a steep learning curve driven by my passion to see change for the benefit of both the workforce and of the patients I work with. Finding allies has been key to success – people who believed in the research I had systemised and in the development of NMPs.
I have come to appreciate the power of research. It is difficult for people to find a reason not to do something when they are presented with evidence of best practice and a model of what could work, by someone passionate enough to drive it through.
The first 18 months of this work was done in my own time until I found a paid post at the local workforce and training hub. More people have now come on board, and a team has been built both of supporters and speakers.
Advice for others
There are huge challenges facing a clinical primary care nurse who wants to do a strategic piece of work. It is not part of our core role, and it is hard to get time away from clinical practice to develop the idea. I was fortunate to take part in the CARE programme4 and to work part time, so I was able to develop this outside my paid role.
The beginning is always the hardest part but once momentum builds so does the energy, and people start to listen and hear what is being said. It’s ironic, but the project has benefited from the pandemic in that the widespread use of Microsoft Teams has enabled us to use it as a platform for the CPD lunchtime events, and also for meetings with leaders and organisations across South Yorkshire to promote the work. It would have been a much more difficult process without this.
My success in embedding my research into practice, and witnessing how this has developed my leadership as a primary care nurse, has incentivised me to provide an environment for others to do the same. I am using this platform to speak to the new ICS leaders to ensure that the nursing voice is heard and that our research is used to benefit patients and the wider workforce.
My advice is if you have something that you are passionate about, then go for it.
- Do your research – know your topic inside out. You will be challenged on why things need to change so you need to be prepared to defend it.
- Find your allies – those who respond positively to what you are suggesting. Get them on board.
- Do not be shy – invite yourself to meetings, ask to present, believe in yourself and what you know.
- Persist – if at first you don’t succeed, reflect on why, ask for help and try again.
- Share your journey and your outcomes with others, so we can all learn from each other.
In the few years since my piece of work, we have moved from a position of NMP competence and development being the sole responsibility of the individual to one where the organisation is taking an interest in developing its workforce through targeted CPD events and a supportive framework.
There is much more to do, and the space is now open to do it. The future is bright for NMPs in South Yorkshire.
- Courtenay, M and Gordon, J (2009). A survey of therapy areas in which nurses prescribe and CPD needs. Nurse Prescribing 2009;7(6):255-262.
- Manley K and Jackson C. The Venus model for integrating practitioner‐led workforce transformation and complex change across the health care system. J Eval Clin Pract 2020; 26: 622– 634. Link
- El-Sharkawi R et al.Expanding Prescribing Scope of Practice. London: Royal Pharmaceutical Society, 2022. Link
- National Association of Primary Care. CARE programme. Link