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.