A Community of Practice for Non-medical Prescribing Leads

The group has developed clear terms of reference which are continually reviewed and revised as necessary. They include both operational and strategic areas.

For the past 8 years the group's terms of reference is:

Objective of the group –

To provide a forum for Non-medical Prescribing (NMP) Leads to share best practice; raise the profile of NMP and promote NMP as a valuable service delivery option.

Aims:

• To share information on local governance; policy; strategy and practice development that supports non-medical prescribing.
• To link with other similar groups, particularly those in the Southern area, in order to ensure consistency of approach and sutainability of the group.
• To work in collaboration across all providers of NHS services in the South West Region.
• To help interpret, implement and monitor national policy; guidance and legislation.
• To engage with Clinical Commissioning Groups and Education Boards in order to promote strategic development of non-medical prescribing to deliver the QIPP agenda.
• To provide peer support for Non-medical Prescribing Leads.
• To share research; service evaluation and audit information.
• To provide a forum for sharing and spreading innovation and best practice, e.g. through sharing case studies and examples of evidence-based practice.
• To act as a problem-solving forum for NMP issues.
• To work together on the development of continuing professional development [CPD] and competency frameworks.
• To engage with commissioners of training and Higher Educational Institutions [HEIs], to review future options for funding the NMP course.
• To engage as a group with the NICE (Medicines and Prescribing Centre)
• To consider and, where appropriate, respond to consultations on developments and changes in practice.
• To lobby the relevant bodies including the Chief Nursing Officer, Department of Health or Home Office, NHS England and professional bodies when necessary.

The Non-medical Prescribing Leads group was set up as a result of a perceived need for consistency in the approach to the (then) new initiative of non-medical prescribing. This was identified through peer communication and as part of the non-medical prescribing course evaluations, and a literature search. There was a widespread view, since proven in our evaluations, that without such a group many organisations would spend time and resources unnecessarily reinventing the wheel.

It was felt that one of  the benefits of such a group would be to be able to demonstrate the value of non-medical prescribing to employers, and to demonstrate that this has benefited patients

The proposed group was discussed widely and, as a result, is based around multi-disciplinary and cross-organisational working. The input for the South West Regional Non-medical Prescribing Lead, Plymouth University, and that of the NICE Medicines and Prescribing Team, was instrumental in helping get the group off the ground. It was felt that the South West Region would benefit from a unified group. Particularly due to the size of the areas it covers and the geographic isolation of some of the organisations.

In setting up the group we were influenced by work carried out in Cornwall on peer supervision, which provided a useful model to work from.

Reference: Turner S (2011) Developing a non-medical prescribers’ peer supervision group. Nursing Standard. 25, 29, 55-61.

Initially the group was met to discuss implementation on non-medical prescribing in the region and share information on the challenges and successes in doing this across the area.

The first meeting involved facilitated discussions around priorities and practical advice for this new role.  As time progressed the group refined its terms of reference and began to look at specific clinical projects and action learning. At this point we began to look at specific medicines and prescribing guidance and the NICE Key Therapeutic Topics. We invited the NICE Team to come and deliver sessions, and feeding back on our progress via the NICE Medicines and Prescribing Associates Network and the NICE Medicines and Prescribing Affiliates Networks.

The structure is now as follows:

Leading the Group - The group is currently chaired by the Non-Medical Prescribing Lead - Royal Devon and Exeter Foundation NHS Trust /Non-Medical Prescribing Lead - Northern Devon Healthcare NHS Trust.

Frequency of meetings –  6 monthly

Contact in between meetings – the group has an email link which helps resolve day to day issues, share information for future planning and develop the agenda for the next face to face meetings.

Membership – all Non-medical Prescribing Leads in the South West; Non-medical prescribers working on specific projects; Leads from the Higher Education Institutes who deliver the course, and anyone involved in developing non-medical prescribing in service areas.

Members may choose to bring a professional colleague to the forums or send a delegate in their place where appropriate. The group does not report to another group or fit into any formal structure.

Challenges:

One of the key difficulties in establishing the group was to ensure it remained relevant and was beneficial to the attendees and their organisations. It was always intended that the group would only continue if there were benefits for the attendees and their organisations. This has proven to be the case. Both in terms of the individual Leads finding time to attend, and their organisations backing their attendance.

We are grateful to NHS South West for providing the venue at no charge

Our evaluation of the Non-medical Prescribing [NMP] Leads Group:

Features and benefits include:

• Saving time for NMP Leads
• Policies and procedures are shared
• Governance arrangements shared
• Cross-organisational policies and Service level agreements shared
• Job descriptions shared
• Problem solving together
• Access to the latest information on ‘hot topics’

Specific benefits of this include:

NMP Leads say this group has saved them ‘days’ of work, allowed them to clarify difficult issues for their organisations with authority, and work to the same standards across the region.

Comments:

‘At every meeting at least one person will come away with information that will immediately benefit their organisation.’

‘I find the email link invaluable, I always check the NMP Leads emails and if I have a query, I get a quick and thorough answer from my peers’.

In summary the group:

• Saves senior management time
• Has helped unify policies and procedures across the region
• Has helped unify prescribing governance arrangements across the region
• Helps managers select the most suitable candidates for the NMP course
• Helps promote approaches to the development of non-medical prescribing which improve recruitment and retention (audit in progress)
• Has helped share and generate enthusiasm in prescribing developments

 Sharing information on Guidelines and linking this to local audits:

We enable implementation of Guidelines and trusted clinical information to be shared, including presentations on guidelines and NICE Key Therapeutic Topics. These are then fed back to prescribers locally.

Members are involved in NICE consultations and share this with the group.

Members link with the NICE Medicines and Prescribing Team as Associates and as Affiliates. This has helped shape local audits, policies and guidance.

Sharing information with partners and academic institutions:     

The group receives and responds to requests for information from organisations, which helps with service development across boundaries.

Academic institutions attend the group regularly and find this a very helpful way to share and disseminate information and seek the views of other employers.

Key Learning included:

• Facilitated group meetings, which allow time for sharing and discussion, are popular and can be shown to deliver benefits.
• Peer support forums and groups work well if they have clear terms of reference, which are regularly reviewed.
• External funding is not required for such a group providing a venue is available, and time release is possible.
• Email group links can be highly valuable.
• Inter-disciplinary and cross-organisational peer support groups are valuable.

For the future we plan to do more work on quantifying benefits to patients and for organisations of specific areas of practice; invite patients feedback and presentations; collate more information on and continue to share related audit work; support and promote action learning projects.

The group now has expertise on related policies; contracts; service level agreements; general data protection matters; effective audit methods and governance arrangements.

Implementation tips:

• It is beneficial for these type of groups to sit outside any formal structures.
• We tried setting up structured discussion groups and found that the simple email group link was more effective.
• The meeting agendas need to allow time to share and discuss key issues, too many agenda items or speakers detracts from the value of the group.
• If we were setting up the group now it would be good to think about a Prescribing Leads Group as opposed to a Non-medical Prescribing Leads Group, as the governance and accountability for prescribing are no different between professions.