Legislative changes in relation to prescribing

Significant health legislative transformation experienced in the United Kingdom impacted how the prescription of medicine is undertaken. These changes included the extension of prescription rights to nurses and pharmacists in both private and public healthcare settings. Traditionally, the authority of medicine prescription was only accorded to dentists and medical professionals in the United Kingdom. The need to extend and regulate prescription authority was particularly emphasized by two reports, the 1989 Crown report and the 1986 Cumberlege report, resulting in the extension of prescription authority to pharmacists and nurses. In this paper, I will review the legislative changes concerning prescribing. This will include an explanation of the impact of these changes in my practice with a specific emphasis on accountability and responsibility. Besides, I will explore its probable contribution and influence on health policy and the provision of care as well as critically assess the possible long-term influence on Mental Health Community Crisis Home Treatment Team which happened to be my scope of my practice.

Legislation Background

In the year 2005, the health secretary then declared the health department’s intention to expand prescription authority to include other professionals allied to medicine. Traditionally, the authority of medicine prescription was only accorded to dentists and medical professionals in the United Kingdom. Two view seminal reports, the 1989 Crown report and the 1986 Cumberlege report may account for the change in attitude to expand the authority of prescription. The 1989 Crown report recommended an extension of the prescription right to benefit patients through an optimal exploitation of the health care professional skills while the 1986 Cumberlege report, part of the government’s policy agenda emphasized limiting some prescription authority of certain health care professionals such as district nurses who had only undergone special training. In the year 2000, the governing Labour Party published a White Paper known as ‘The National Health Service Plan’. This white paper was meant to increase the healthcare capacity, shortening the waiting sessions while improving patient experience. The National Health Service (NHS) plan’s purpose compounded with the previous initiatives of change resulted in the creation of supplementary prescription, to be undertaken by pharmacists and nurses. Supplementary prescribers are practitioners working in partnership with doctors or dentists to give prescriptions under an agreed patient-specific clinical management plan (CMP) (Johnson 2013, p.120). While supplementary prescribing was appropriate for complex and long term care, it proved a limitation of impacting care improvement, since undertaking oversight and ensuring accountability was challenging.

Supplementary prescribing meant a substantial increase in the number of people with prescribing authority hence the difficulties of regulating such an increased body of professionals. Prescription by Mental Health Nurses (MHN) was initially initiated in the UK in the year 2001. Since, then over 10, 000 nurses have undertaken educational programs permitting them to act as supplementary or independent prescribers (Christiansen et al. 2015, p.834). This reference is wrong because you are not quoting here. You can only add page when you are quoting.

Estimates as of 2012 indicate that nearly one thousand Mental Health Nurses managed to complete the programs, representing about three percent of the medical workforce (Bradshaw and Pedley 2012, p.268). The prescription program is regulated, mandatory, and requiring a month of theory comprehension and practice. The practice encompasses a medical practitioner’s supervision of nurses’ competencies over 12 days of practice. Following successful completion of the program, the MHN is authorized to prescribe any drug from the British National Formulary. Even though the number of prescribers has increased in the United Kingdom with these legislative changes benefiting complex and long-term care, opponents of expansion of prescription authority highlight efficacy, citing the program as inadequate in preparing nurses (TAY and Xiaofen 2019, p.17).

How the Mental Health Practice Will Change with the Change in Legislation

Different fundamental developments are likely to be experienced as a result of the legislation changes and affect the practice of mental health, particularly to me as a supplementary prescriber in mental health settings. The application of the Mental Health Act rose significantly in the last ten years (Armstrong 2011, p.607). With its introduction, an increased capacity of supplementary prescription will be experienced consequently serving a large number of mental health patients in home care settings. A significant number of mental health patients are still placed in home care settings in several parts of the country because of limited local mental health service capacity. With this legislation allowing more mental health nurses to enrol as supplementary prescribers, the gap between mental health care quality and quantity need and service availability will be narrowed. As a supplementary prescriber, the legislation will allow me the independence of being responsible for the evaluation of mental health patients and implement decisions relating to each case’s management, including prescribing as part of bridging the mental health service gap. Norman et al. (2010) assert that the mental health supplementary nurse prescribers services accord a significant access benefit to patients as much as the consultant psychiatrist. Moreover, there is no significant variation in the patients’ service utilization expenses, even in Johnson’s (2013, p.119) evaluation. The expansion of prescription authority to include more medical allied professionals prescriber has increased mental health prescription capacity. Among the health care professionals included are radiographers, optometrists, physiotherapists, and podiatrists. The increasing need for mental health services is also likely to be addressed by the expansion of prescription authority.

Community mental health services have always played a critical role in the unappreciated role in the provision of mental health care at a localised. Such services encompass the provision of essential support to patients suffering from mental health illness closer to their home settings or communities. It has been the practice since the formation of the generic Community Mental Health Teams (CMHTs) for adults over 30 years ago (Thornicroft 2018, p.640). The application of the Mental Health Act increases the scope of care that community mental health nurses are capable to provide to patients to improve care outcomes. In addition to the essential support offered to patients suffering from mental health illness, the legislation will enable community mental health nurses to prescribe if necessary to ensure better care outcomes.

Impact of Legislative Transformation on my Accountability and Responsibility as a Prescriber. Here you have not named any impact of legislative transformation on my accountability and responsibility as a Prescriber.

Nurses in all spheres of the practice of nursing are expected to be answerable to their practice methodology (King et al. 2020, p.104). In simple terms, the new legislation will call for me to be answerable to all decisions that I might undertake as a mental health prescriber and stand by these decisions. For the reason that nurses are expected to be accountable for their practice actions whether or not they involve prescribing, the mandate of undertaking prescription merely presents an additional challenge to the already existing practice that entails employing critical thinking, knowledge-based, proven practice methodologies to better patient outcomes. Even though mental health care providers do not work autonomously, (without relying on the input of other medical professionals in discharging their mandates) the act of making prescriptions to patients itself is not shared. The legislation, through its purpose, bestows the responsibility of acting independently through critical thinking; knowledge-based, proven practice methodologies to undertake the process of prescription as mental health care deliverer (Fecher and Knight 2012 p.29).

The prescription has been a key subject of focus for the Department of Health for a long time (The 1989 Department of Health initiative and the 1986 Department of Health and Social Services initiative), yet it is only with the recent Mental Health Act that prescription training was extended to all other medical allied professions such as health visitors and district nurses (Ladd and Schober 2018, p.45).  This is not possible as mental health Act is only related to mental health professional. Hence, the prospect of being answerable to decisions of prescription for nurses in mental health care delivery presents a huge learning curve concerning its effective application. The new legislation emphasizes competence initiatives that aim to develop me as a nurse into my new accountability carefully and confidently. This is for the reason that it encompasses aspects that entail improvement of existing mental health care skills and development of new ones through the training program. The aptitude of developing confidence and expertise in any new role takes time and the capability of prescribing mental health is no exception (Diggle 2018, p2). Do you mean prescribing as a mental health? This statement does not make sense.

Some practices and customs of accountability in nursing will certainly be tested and probably reshaped as a consequence of the fresh prescription rights accommodated by the legislation change. The reshaping of these customs will have to be aligned to properly address any responsibility and accountability aspects. As part of exemplifying responsibility, my prescription approach will have to actively assess every single case independently as opposed to following the predetermined menu of articles. Other than clinical efficiency, other norms are always utilized in selecting prescription articles, for instance, compliance, comfort, and cost (Inman 2017, p.92). The legislation transformation advocates for an active approach that considers every possible element that impacts prescription selection before prescribing. This is because in some instances less expensive value prescription articles may prove less economical in the long run, thus an approach solely relying on cost-effectiveness is devoid of responsibility to the client’s outcome (Walter and Terry 2020, p.76).

Health Program/Policy (Which Health Programme or Policy)?

Community Crisis Home Treatment Team mental health program represents part of the new legislation’s larger agenda of modernizing the National Health Service, to function in diverse ways and to transform conventional approaches of perceiving professional responsibilities and roles. The 2000 white paper (Which white paper? Name of white paper) re-affirmed the administration’s intentions of extending the role of nurses, and other medical allied professions such as midwives, radiographers, optometrists, physiotherapists, and podiatrists and health visitors to optimally utilize their skills and knowledge – as well as making it easier for them to prescribe. In its intent, the white paper’s primary purpose was improving patients’ access to advice and treatment, optimal utilization of an expert group of professionals’ knowledge and skills, improving patient convenience and choice, and facilitation of more flexible work teams across the National Health Service (Perrin 2015, p.37).

According to the Royal College of Nursing (2012), supplementary prescription such as those undertaken by community mental health nurses in conjunction with other mental health professionals have the potential of increasing professionals (nurses) autonomy for positive patient outcomes. Evidence also depicts that nurse prescribing advances patient care outcomes and quality by making sure access to treatment and medicine in good time through its flexible approach. The contrary case would call for patients to wait for doctors. Our program Community Crisis Home Treatment Team mental health program, in which community mental health nurses in conjunction with other mental health professionals’ work together exercising autonomy for community out positive patient outcomes.

The Home Treatment Team is an essential component of the Crisis Care Concordat 2014 and forms part of comprehensive borough-based crisis services, alongside the Mental Health Liaison, Day Treatment Team, and Crisis Café. Crisis Care Concordat 2014 is an arrangement between agencies and services involved in the care and support of individuals in crisis. According to NICE guidelines, home treatment constitutes an alternative to hospital admission, according to the same treatment with a comparable outcome (NHS England 2016, p.302). The Community Crisis Home Treatment Team mental health program is purposed to reduce hospital admission and increase service user satisfaction, help service users ensure their independence during a mental health crisis. The team constitutes a multi-disciplinary group of professionals and support workers who offer short term assistance to persons who are in a mental health crisis or who need intensive community support after discharge from the hospital. The team also gate-keeps all referrals for inpatient care, carries out assessments of people referred by GPs for urgent assessment, and responds to calls on the Trust Crisis line. The team includes psychiatrists, a clinical specialist occupational therapist, a clinical psychologist, social workers, community mental health nurses, and senior support workers. Community Crisis Home Treatment Team mental health program target population are adults experiencing mental health problems, from all backgrounds, who are experiencing mental health illnesses and who may require hospital admission, or who may need to stay in the hospital for longer without the support of the Home Treatment Team.

References

Armstrong, A., 2011. Legal considerations for nurse prescribers. Nurse Prescribing, 9(12), pp. 603-608.

Bradshaw, T. and Pedley, R., 2012. Evolving role of mental health nurses in the physical health care of people with serious mental health illness. International Journal of Mental Health Nursing, 21(3), pp. 266-273.

Christiansen, A., O’Brien, M.R., Kirton, J.A., Zubairu, K. and Bray, L., 2015. Delivering compassionate care: the enablers and barriers. British Journal of Nursing, 24(16), pp.833-837.

Diggle, J., 2018. How do nurse prescribers demonstrate prescribing proficiency?. Diabetes & Primary Care, 20(2).

Fecher, I. and Knight, J., 2012. A framework for independent prescribing of intravenous fluids. Emergency Nurse, 20(7).

Inman, P., 2017. Nurse prescribing in mental health: Does it still make sense?. Nurse Prescribing, 15(2), pp.91-93.

Johnson, S., 2013. Crisis resolution and home treatment teams: an evolving model. Advances in Psychiatric Treatment, 19(2), pp. 115-123.

King, R., Taylor, B., Talpur, A., Jackson, C., Manley, K., Ashby, N., Tod, A., Ryan, T., Wood, E., Senek, M. and Robertson, S., 2020. Factors that optimise the impact of continuing professional development in nursing: A rapid evidence review. Nurse Education Today, p.104652.

Ladd, E. and Schober, M., 2018. Nurse Prescribing from the global vantage point: The intersection between role and policy. Policy, Politics, & Nursing Practice, 19(1-2), pp.40-49.

NHS England, 2016. Leading change, adding value. British Journal of Healthcare Assistants, 10(6), pp.302-303.

Norman, I.J., Coster, S., McCrone, P., Sibley, A. and Whittlesea, C., 2010. A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study. BMC Health Services Research, 10(1), p. 4.

Perrin, L., 2015. Embrace your autonomy: be proud to be a nurse prescriber! All new specialist community public health nursing students about to undertake the V100 prescribing course and those who have recently qualified as community practitioners should embrace their prescribing role, says Louise Perrin. Community Practitioner, 88(2), pp.36-39.

Royal College of Nursing. Policy and International Department, 2012. RCN fact sheet: Nurse prescribing in the UK. RCN.

TAY, J.L. and Xiaofen, K.H.O.O., 2019. Community Nursing in the United Kingdom: Applicability to Singapore. Singapore Nursing Journal, 46(1).

Thornicroft, G., 2018. Improving access to psychological therapies in England. The Lancet, 391(10121), pp. 636-637.

Walter, J. and Terry, L., 2020. Factors influencing nurses’ engagement with continuing professional development activities: A systematic review. British Journal of Nursing.