Brickbats and bouquets for Medicines Bill

1 May 2012

Nursing organisations are giving a firm thumbs-down to the new delegated prescriber role proposed in the Medicines Amendment Bill.

Nursing organisations are giving a firm thumbs-down to the new delegated prescriber role proposed in the Medicines Amendment Bill.

Consultation on the bill, which includes the long-awaited and applauded move to give nurse practitioners the same prescribing status as dentists and midwives, closed in mid-April.

Submissions by the New Zealand Nurses Organisation, College of Nurses, and the joint submission by nurse educator groups NETS (National Association of Nurse Education in the Tertiary Sector) and Council of Deans of Nursing and Midwifery NZ (CDNM) are “warmly”, “strongly”, and “unreservedly” in favour of the bill’s move to shift NPs from the current designated prescriber status to the same authorised prescriber status as medical practitioners, dentists, and midwives.

The organisations are also united against the bill’s proposal to create a new, third prescribing category to be known as a delegated prescriber under which health practitioners, like registered nurses, could prescribe under a delegated prescribing order issued by an authorised prescriber.

The College of Nurses and Nurse Practitioners New Zealand submission says they see no place for delegated prescribing in New Zealand and the existing designated prescriber category is the appropriate mechanism for registered nurse prescribing in New Zealand.

The joint nurse educators’ submission says it does not see delegated prescribing being “relevant or appropriate for contemporary nursing practice”.

The NZNO submission agrees, saying it does not support the move for delegated prescribers with no rationale or evidence provided for the proposed category. NZNO also says there was a “high degree of uncertainty and confusion” about how it was intended to work in practice.

It says it had consulted not only the College of Nurses and nurse educator groups but also the District Health Board leader directors of nursing, the College of Mental Health Nurses, Family Planning New Zealand, the Nurse Practitioners Advisory Committee, Plunket, and the Nursing Council, and none of those nursing groups supported the delegated prescribing category.

“The nursing profession, which comprises half the health workforce and covers all health settings, believes that the delegated prescriber category is not required, and that the authorised and designated categories are sufficient to enable safe access to prescription medicines and meet future health need,” says the NZNO submission.

The submissions are also united against the bill introducing a further category to allow the Minister of Health the power to approve temporary prescribers for up to two years as a mechanism for demonstrations or pilots like the current diabetes nurse specialist prescribing demonstration.

NZNO says the temporary prescriber category would add “yet another layer of complexity” to the “somewhat crowded continuum” of prescribing types proposed by the bill with all categories requiring regulating, auditing, education and training.

“Such complexity is potentially confusing, unsafe, expensive and unnecessary,” it says.

The College submission also point out that the designated prescriber category had already been used to allow the diabetes nurse prescribing demonstration sites.

However, both the NZNO and College call for the current definition of designated prescriber to be revised to avoid current “cumbersome” issues around having individual prescribing regulations for each area of practice that can quickly become outdated.

The bill, currently being considered by the Health Select Committee, is due to be reported back to parliament by July 2.

Doctors not keen on more prescribers

The “continued push” for independent prescribing by “multiple health professional groups” could result in fragmented patient care, says the New Zealand Medical Association submission.

The NZMA says, in its view, more independent prescribing by other health professionals “may well lead to greater fragmentation of care” as it facilitated “independent practice” outside the “multidisciplinary team or medical home”.

“Where changes are introduced the quality of patient care should as a minimum be maintained but preferably improved,” it adds.

It goes on to say consideration must also be given to the pharmaceutical budget and issues like antibiotic resistance that could result from the introduction of additional professional groups with prescribing rights.

The NZMA submission says it “fully supports” delegated prescribing under the supervision of a registered medical practitioner but questions the training of other authorised prescribers, like the current midwives and dentists and proposed NPs and optometrists, to carry out the supervisory role.

“Their training, however, is not at the same level required of medical practitioners and we question whether or not they have the necessary skills and expertise to provide supervision in terms of delegated prescribing,” the submission says.

Medicines Amendment Bill 2011 main points

  • Gives nurse practitioners and optometrists the same authorised prescriber status as medical practitioners, dentists, and midwives, which has been fought for by nurses since the now-canned 2006 Therapeutic Products and Medicines Bill was first tabled.
  • Establishes a third prescribing category of delegated prescriber, which would allow RNs to prescribe under an order from an authorised prescriber.
  • Also provides mechanism for Minister of Health to approve temporary prescribers for up to two years to allow for demonstration sites and pilots.
  • Nursing organisations have given the thumbs down to delegated prescriber and temporary prescriber proposals and are calling instead for amendments to existing designated prescriber category to allow Nursing Council to approve and monitor RN prescribing in specialty areas.