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Is this ‘Goodbye’ to the NHS?

Posted by shutah on August 23, 2007

Taking from article by Richard Hoey of Pulse

According to an article in Pulse magazine, it would appear that there are now 10,000 independent or supplementary nurse prescribers in the UK, three-quarters of them in primary care!  However, training courses to become a ‘nurse prescriber’ consist of only 26 days of theory and 12 days of mentored practice! 

Professor Hugh McGavock, a former member of the Committee on Safety of Medicines, said he had ‘serious concerns’ over the issue, stating,  “nurses’ knowledge of diagnosis is pathetically poor. It takes medical students five years to be competent at differential diagnoses. Only a country with not enough doctors would go down this cheapy line.”

Apparently, the use of medicines requiring complex clinical judgment, including antibiotics and antidepressants, has increased far more rapidly. Use of ciprofloxacin (an antibiotic) is up 218%, paroxetine (aka Seroxat) by 262% and rosiglitazone (aka Avandia) by 245%, according to the latest data, for May this year.

Professor Tony Avery, an author of the BMJ editorial who is conducting a review of nurse prescribing for the Department of Health, said the data raised some concerns, particularly over use of antibiotics.

Professor Avery, head of primary care at the University of Nottingham and a GP in the city, said: ‘We also found large increases in antibiotic prescribing and if they’re not offset by decreases elsewhere, that’s worrying. But it’s still less than 1% of community prescribing.’

Dr George Rae, a member of the GPC prescribing subcommittee and a GP in Whitley Bay, Tyneside, expressed concerns over antidepressant prescribing and called for a full audit.

Perhaps this should be linked to an article in the Mirror newspaper yesterday about Mail Order MedicinesIt seems to me that we are copying the ‘American Way’ and I doubt it will be too much longer before we have to contribute part of our earnings to an ‘Insurance Provider’ such as Blue Cross, Altius or Medicare to get our health care!   Is it goodbye to the NHS?

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3 Responses to “Is this ‘Goodbye’ to the NHS?”

  1. The important question isn’t how many prescriptions nurse-practitioners are writing, but the circumstances in which they do so. Is there adequate supervision? Would these prescriptions have been written anyway? I’m certain that not all of these are ‘extra’ prescriptions – a proportion of them would have been made anyway and only the signature on the form has changed. So yes, there’s concerns, and looking into them is appropriate, but whether it’s something that impacts patient care hasn’t been answered yet.

    As to the Mirror’s report: What they fail to mention is that the online pharmacies are outside of the UK and importing many of the medicines they mention would be a criminal offense. Clenbuterol, Valium and most other sleeping pills are class C, while Ritalin is a class B drug. Anyone importing these without a proper license would be breaking the Misuse of Drugs Act and could potentially be fined and/or jailed. Reputable online pharmacies won’t ship these kinds of medicines to the UK. Disreputable online pharmacies might, but whether what they deliver will actually contain any of the drug in question is another matter entirely.

  2. shutah said

    Chimp,

    I admire your ability to ‘see the grey’, rather than like myself, just the black or white!

    In the Guardian newspaper report a Department of Health spokesman states that “Patient safety is our priority. That’s why nurse prescribers are senior, experienced nurses who have undergone rigorous training before being able to prescribe – they have to successfully complete the relevant courses, be accredited by their respective regulatory bodies and had their qualifications noted on the professional register.

    “Once trained, they are required to keep their skills up to date. This ensures that patient safety is protected and that patients can be confident that they are receiving the highest standards of care.”

    But can they? Surely a patient needs to be attended by a doctor, and in some cases on a regular basis, in order that these drugs can be prescribed safely. Perhaps the prescriptions in the article are merely ‘repeat prescriptions’ for a patient and, as you suggest, the doctor himself signs them. However, the implication, by their very title is that, ‘nurse prescribers’ actually prescribe the drugs! Which is what the Guardian reported, ie “…nurses who have undergone rigorous training before being able to prescribe.”

  3. I’ve been following the debate on Nurse Practitioners for a while and there are definitely significant concerns about the roles they are sometimes used in. Where they’re used as a cost-cutting measure because nurses are cheaper than doctors, and damn the patients, it’s obviously a bad thing. I’m sure there’s plenty of cases where this has happened.

    But that’s not the only role they’re used for. And I’m fairly sure that there’s plenty who are used in situations where they improve patient care in roles that complement those of doctors. A diabetes nurse, working with a dietician and a doctor is likely to provide a better for patients than the GP alone, for example.

    It’s all to do with using their skills appropriately. Figures for numbers of prescriptions don’t tell us much about this, because what actually counts are the figures for appropriate prescriptions and that’s highly contextual information.

    The figure that interested me in the original report (and which probably interested you as well) were the ones for paroxetine. It would be interesting to know whether these are new prescriptions or not. The worst-case scenario would be that nurse practitioners in areas other than mental health are randomly diagnosing depression and writing new prescriptions for SSRIs. The corresponding rise in amitripyline prescriptions suggests that this isn’t the case, but it’s an important question.

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