Veronica James

Further challenges to medical dominance? The case of nurse and pharmacist supplementary prescribing

Doctors have traditionally been viewed as the dominant healthcare profession, with the authority to prescribe medicines, but recent non-medical prescribing initiatives have been viewed as possible challenges to such dominance. Using the example of the introduction of supplementary prescribing in the UK, this study sought to explore whether such initiatives represent a challenge to medical authority. Ten case study sites in England involving primary and secondary care and a range of clinical areas were used to undertake a total of 77 observations of supplementary prescribing consultations and interviews with 28 patients, 11 doctors and nurse and pharmacist prescribers at each site. Supplementary prescribing was viewed positively by all participants but several doctors and patients appeared to lack awareness and understanding of supplementary prescribing. Continued medical authority was supported empirically in five areas: patients’ and supplementary prescribers’ perception of doctors as being hierarchically superior; doctors legitimation of nurses’ and pharmacists’ prescribing initially; doctors’ belief that they could control (particularly nurses’) access to prescribing training; supplementary prescribers’ frequent recourse to use doctors’ advice, coupled with doctors’ encouragement of such ‘knock on door’ prescribing advice policies; doctors’ denigration of most routine prescribing but claims that diagnosis was more skilled and key to medicine. Supplementary prescribing appeared to be successfully accomplished in practice in a range of clinical settings and was acceptable to all involved but did not ultimately challenge medical dominance. However, more recent nurse and pharmacist independent prescribing (involving diagnosis) may represent a more significant threat.

Supplementary prescribing by community and primary care pharmacists: an analysis of PACT data, 2004–2006

Background and objective:  Pharmacist prescribing is a relatively new intiative in the extension of prescribing responsibilities to non‐medical healthcare professionals. Pharmacist supplementary prescribing was introduced in 2003 and allowed prescribing in accordance with a clinical management plan agreed with a medical practitioner and patient to improve patient access to medicines and better utilize the skills of healthcare professionals. The objective of this research was to examine the volume, cost and trends in pharmacist prescribing in community and primary care using Prescription Analysis and Cost (PACT) data and to suggest possible reasons for the trends.

A self-harm training needs assessment of school nurses.

Self-harm is acknowledged to be increasing and is especially prevalent in young people. School nurses are central to adolescent mental health, delivering initial and sustained intervention. However, few studies have considered their experiences and training needs in fulfilling this role. This training needs assessment explored the self-harm training needs of school nurses within one UK primary care trust by utilizing questionnaires and interviews developed specifically for the study. School nurses felt frustrated and inadequate when working with young people who self-harm. The majority had attended self-harm training, yet felt that it only helped a little. Nurses desired training, particularly in practical approaches when working with young people who self-harm, however, analysis suggested that they also needed underpinning theoretical knowledge. Therefore, this study highlights the need for self-harm training for school nurses, incorporating both practical approaches and theoretical knowledge, to ensure that young people who self-harm receive an effective, high-standard service.

Professional attitudes to Changing Childbirth in Nottingham,UK

Changing Childbirth has been a central focus of maternity care policy in England. The objective of this study was to determine whether different professional groups involved in maternity care-hospital and community midwives, general practitioners and obstetricians-had different professional attitudes to a local implementation scheme. Data were obtained using a postal questionnaire, based on an agenda developed from focus groups. Whilst general practitioners appeared to be somewhat less optimistic than were midwives, there existed clear differences of opinion within the midwifery profession itself, depending upon whether the midwife worked in the community or in hospital. All professionals appeared conscious of the gap between the service ideals and the limited resources available to achieve them, and expressed uncertainty over future directions and ways of working.