The general practitioner, the psychiatrist and the burden of mental health care
Paper No.1
David Goldberg and Kevin Gourney
Institute of Psychiatry, King's College, London
In March of 2000, the Government announced that it would accept and take forward the main recommendations of the review of prescribing and the administration of medicines (Department of Health, 1999a). The NHS plan published in July of 2000 reinforced the Government's commitment to extend nurse prescribing to a wider range of nurses from an expanded nurse prescribers formulary (Department of Health, 2000a). In turn, the Queen's Speech in late 2000, set out proposals for making changes to the Medicines Act, thus paving the way for more radical changes in prescribing.
In October 2000, the Department of Health issued a consultation paper on
proposals to extend nurse prescribing, and in that suggested that mental health
might be an area where nurse prescribing should take place (Department of
Health, 2000b). The consultation period for this paper ended in January 2001.
The Secretary of State has already announced that an extra £10 million will be
provided to train nurse prescribers between 2001 and 2004. The consultation
paper points out that there are already 23,000 district nurses and health
visitors who have authority to prescribe from the Nurse Prescribers Formulary (NPF;
Department of Health, 2000b). However, this formulary is limited and
concentrates mainly on dressings and appliances, although it does include a
number of medicines, including some Prescription Only Medicines (POMs). At
present it is possible to add a POM to the NPF, but this involves an application
(for each individual POM) to the Medicine Control Agency (MCA), consideration by
the Committee of the Safety of Medicines (CSM) and a period of public
consultation prior to Ministers taking a decision on amending the order. This
process takes several months. Obviously if there were radical changes in nurse
prescribing, with a very large number, and wide range, of POMs added to the
list, this process would rapidly become unworkable and a new system would need
to be set in place.