1. Community Practitioner Nurse Prescribing- then, now and onward Dianne Hogg, Queen’s Nurse Non-medical Prescribing Lead, East Lancashire Hospitals NHS Trust; Cumbria & Lancashire NMP leads Network Chair, Health Education North West.

2. A quick reminder Two academic routes in: – V100- part of courses leading to NMC registered/recorded community qualifications – V150- stand alone Rigorous education programme, peer supervision Limited formulary- wound care, continence, emollients, topical antimicrobials.

3. CPNP success story History from 1992 pilots National roll out 1999 embraced in the North West- implemented collaboratively Enabled development of new services and enhancement of existing ones Cost effective.

4. Where are they? Most health visitors, district nurses, few practice nurses/school nurses Community nurses Usually in services where the formulary fits.

5. Why do we (still) need CPNPs? Largest body of non-medical prescribers – over 36,300 Prescribing accuracy very high- audit of 126 FP10s – 3 minor errors (2014).

6. Why do we (still) need CPNPs? High prescribing activity Fits current district nursing structure well Cost effective Good time management/use of nursing skills.

7. Work in progress Some lack of confidence OTC = reluctance to prescribe Minor ailments schemes PACT data doesn’t reflect true picture of prescribing activity. Franklin P (2009) Prescription to Practise, Community Practitioner 82:6

8. Side effects- but not adverse events! Developing workforce Increased focus on medicines Awareness of cost effective prescribing etc Impact on other areas of practice Aware of gaps in knowledge.

9. What else do they do? Audit of 56 responses from 17 CPNPs: Prescribed in 38 instances Whilst they were there they checked their patients’ medicines.

10. What else do they do? They also prevented: – 22 GP home visits – 24 follow up by /referral to another HCP – 9 GP surgery appointments – 1 follow up by consultant.

11. Future of CPNP? New additions to NPF proposed Included in National HV Core Service Specification 2015/6 Wound care, continence, skin care still core areas of specialism.

12. What prescribers say: “Non-medical prescribing allows me to prescribe a treatment change when dealing with non-healing leg ulceration in the community. I know that the patient /carer can pick the prescription up and the treatment can begin at the next dressing change.”

13. “Being a nurse prescriber enables me to complete treatment plans and prescribe appropriate compression hosiery whist the patient is in clinic. This not only results in a quicker service by not having to request from the GP; but is more cost effective by reducing errors and ensuring the required garment is prescribed.” What prescribers say:

14. “Being a prescriber is beneficial to both myself and patients as I can provide and deliver a complete, holistic episode of care” “I have found being a prescriber gives patients a more seamless service and I have greater control over the choice of products and the maintenance of supplies.”

15. What prescribers say: “After completing patient assessments, being a non-medical prescriber enables me to prescribe the most appropriate products/treatments and provide seamless patient care” “My patients get their treatment started much more quickly than before I became a prescriber.”

16. What prescribers say: “I can initiate patient’s treatment immediately. I prescribe as I make my assessment of the patient’s wound, it’s taken to pharmacy straight away by the patient and treatment is started the following day by the community nurse. Before I was a prescriber there was often significant delay ”

17. Themes from comments… Timely Accurate Seamless Cost-effective Holistic Complete.

18. Thank you! Any Questions? Dianne.hogg@elht.nhs.uk