Spoonful of medicine for prescribing bill

1 September 2012

Nursing opposition to the proposed delegated prescriber role has been tempered by amendments proposed by the Health Select Committee to the Medicines Amendment Bill.

Nursing organisations made strong submissions to the committee that they saw no need for creating a third prescribing category and registered nurse prescribing would be better served under the existing designated prescriber role.

The new category will still go ahead, but the committee recommends delegated prescribing be implemented through regulations to control the new role. Applications for delegated prescribing rights would also now require the support of the relevant responsible authority, like the Nursing Council.

Marilyn Head, policy analyst for the New Zealand Nurses Organisation, says even though the role remains, the amendments show that the nursing profession has been listened to.

Jenny Carryer, executive director of the College of Nurses, agreed, saying the amendments meant the profession’s regulatory body could avoid delegated prescribing if they chose to.

The bill, yet to have a date set for its return to Parliament for its second reading, also brings in the long-awaited and applauded move to give nurse practitioners the same authorised prescribing status as medical practitioners, midwives, and dentists.

The Health Select Committee reported back last month on the bill after considering 43 submissions and hearing additional submissions in person from 19 of them.

The committee has recommended the bill be passed with minor amendments.

These include scrapping proposed provisions for temporary prescribing rights – a move called for by the nursing sector – as they were seen as superfluous as designated and delegated prescribing regulations could already specify a time limit.

A further amendment aims to ensure more “flexible” and “efficient” ways of updating the lists of medicines that designated prescribers can prescribe by allowing updates to be done by the Director-General of Health by notice in the Gazette. The nursing sector had called in its submission for the current nursing ‘cumbersome’ process to be revised to prevent medicine lists from quickly becoming outdated.

Carryer said moving to a gazetted list would shorten the process of adding new drugs as they became available.

The committee has also recommended that introducing delegated prescribing rights for a group of health professionals “would require the support of the relevant responsible authority” and would be done under regulation. The proposed delegated prescribing category enables limited prescribing for registered health professionals under the sanction of an authorised prescriber.

The nursing sector had called for the delegated prescribing category to be scrapped as unnecessary, as mechanisms already existed for broadening and regulating registered nurse prescribing, but Head said the amendments had allayed NZNO concerns.

She said even though the committee had recommended going ahead with the delegated prescriber role, they had made very clear, support was required from the responsible authority.

“And the Nursing Council has already indicated that they won’t be pursuing delegated prescribing,” said Head.

Carryer said the amendments did allow the Nursing Council to “not necessarily buy-in to delegated prescribing for RNs” and it could pursue the designated prescribing category.

Head believed the designated prescribing category – already used to allow the diabetes nurse specialist prescribing demonstration sites – was the right mechanism to pursue new prescribing roles for registered nurses and the amended bill “absolutely” allowed for this to continue.

She said other health professional groups might pursue delegated prescribing.

The committee said the intention of delegated prescribing was to give patients “more convenient, efficient access to medicines by broadening the range of practitioners who may prescribe, while ensuring patients’ safety”.

Associate health minister Peter Dunne’s office has said the Government’s intention is for the bill to be passed by the end of the year. by FIONA CASSIE