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Table 4 Barriers and Facilitators to non-medical prescribing

From: Non medical prescribing leads views on their role and the implementation of non medical prescribing from a multi-organisational perspective

  Facilitators Barriers
Justifying need (n = 14) ❖ Trust strategy & commitment to promote and fund NMP
❖ Expectations of course and intended NMP role are discussed with interested candidates and their DMPs. Having a defined set of patients/conditions e.g. role as specialist nurse
❖ Lack of strategic approach in organisations
❖ Lack of support from managers & clinicians
❖ Overly restrictive trust strategy to expanding the number of NMPs
❖ Lack of vision and/or evidence of benefits of commissioning services in new and developing areas e.g. community based pharmacists
Finding a practice supervisor (n = 18) ❖ Having an established relationship with potential DMP
❖ NMP lead support for inexperienced DMPs
❖ DMPs who have already been a mentor and have positive experience of NMP
❖ Lack of support when developing NMP in new areas of practice
❖ Lack of financial incentive to act as DMP
❖ NMP candidates who have to find and secure DMP support in different setting to their usual area of practice, e.g. those working across a number of GP practices
Preparation for prescribing role (n = 23) ❖ Systematic and structured approach to selecting students for NMP training, e.g. use of national criteria
❖ Trusts who provide additional training to ensure students have pre-requisites for NMP training e.g. numeracy training, assessment and diagnostic training, mental health pharmacology module
❖ Students are prepared for the prescribing programme with respect to course content & amount of learning that is required
❖ Having a well defined prescribing role that is agreed between NMP and their manager
❖ Inconsistent approach to selection process ❖ Lack of awareness (amongst candidates and managers) of NMP course academic content and requirement
❖ Inappropriate expectations (amongst candidates, manager or clinicians) with respect to remuneration and how prescribing qualification will be used in practice
❖ Relevance of NMP programme to non-community based nurses
❖ Inconsistent methods of academic assessment of NMP between different education providers
Confidence & ongoing support (n = 19) ❖ Trust provision of NMP support groups, meetings and networks
❖ NMPs receive support (from NMP lead, DMP or Peers) during initial implementation and role transition
❖ NMPs receive ongoing support from other NMPs and their own clinical team (including clinical supervision)
❖ Supplementary prescribing used as means to build confidence
❖ A lack of support approach within trust
❖ Lack of understanding about, and access to appropriate CPD for prescribing role
❖ Providing support for community & mental health based NMPs
❖ A lack of confidence to negotiate prescribing responsibility within mental health settings or problems defining individual scope of practice
❖ Restrictions imposed by enforced use of supplementary prescribing
Practicalities & legalities (n = 11) ❖ Procedures for registering and governing NMP up-and-running in organisation ❖ Confidence reduced by the time lag between course completion, registration with professional body as NMP, and implementation of role
❖ Implementing NMP across range of providers in primary & secondary care
  1. (NMP = non medical prescribing, DMP = designated medical practitioner, GP: general practice, CPD = continuing professional development)