Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Prescribing Competency Framework

The National Prescribing Centre (NPC) has published a single competency framework for all prescribers (PDF) that provide a common set of competencies underpin prescribing regardless of professional background.

The NPC has previously published several similar documents that at specific professional groups but over time it has become clear that a common set of competencies apply to doctors, dentists and non-medical prescribers.

The competencies are split into three domains with each domain being further divided into dimensions. Each dimension contains several statements that describe activities or outcomes that would be demonstrated by a "good prescriber".

The domains and dimensions are as follows:

The Consultation
Shared decision making
Prescribing Effectively
Always improving
Prescribing in Context
The Healthcare System
Self and others

Action: Clinicians who can prescribe will find this document to be a useful resource for appraisal, revalidation and reflection.

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Non-oral contraception and VTE risks

The British Medical Journal has published the results of a cohort study that aimed to assess the risk of venous thrombosis in current users of non-oral hormonal contraception.

The study reviewed data from four national registries in Denmark containing information for 1,626,158 women aged 15 to 49. Individuals with a history of cancer or previous venous thrombosis were excluded.

The study included 9,429,128 women years of data between 2001 and 2010 with 5,287 first venous thrombosis events recorded of which 3,434 were confirmed. The incidence of venous thrombosis in non-users of hormonal contraception was 2.05 per 10,000 women years.

Compared to this baseline risk the relative risk of venous thrombosis for contraceptives was as follows:

  • Combined oral contraceptives containing levonorgestrel - 3.21 (95% CI 2.70 - 3.81)
  • Combined oral contraceptives containing norgestimate - 3.57 (95% CI 2.98 - 4.21)
  • Contraceptive Patch - 7.90 (95% CI 3.54 - 17.65)
  • Vaginal Ring - 6.48 (95% CI 4.69 - 8.94)
  • Implant - 1.40 (95% CI 0.58 - 3.38) non-significant
  • Levonorgestrel IUD - 0.57 (95% CI 0.41 - 0.81)

The increased relative risk observed with the patch is equivalent to 7.66 additional events of venous thrombosis per 10,000 women years.

The authors note that the data sources used are robust and allow of limitation or elimination of several potential sources of bias. However, they also note that the data did not allow for any correction for family history of venous thrombosis or body mass index.

Action: Clinicians should be aware of this study. The data in this study may be useful in communicating risk to aid individual patients in making contraceptive choices.

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Influenza immunisation plan 2012/13

The Chief Medical Officer at the Department of Health (DH) has written to colleagues within the NHS to provide details of the recommended influenza immunisation programme for 2012/13.

The letter notes that the last flu season saw low rates of flu. It also recognises that the virus is unpredictable and that we must avoid complacency and strive for even higher vaccination rates this year.

The letter also contains several Annexes that cover the following areas:

  • Groups recommended to receive flu vaccine
  • GP practice checklist
  • Pregnant women
  • Health and social care workers
  • Improving uptake and data collections
  • Vaccine virus strains and available vaccines
  • Vaccine supply and strategic reserve
  • Contractual arrangements, service reviews and funding

Vaccine uptake aspirations are also set as:

  • reaching or exceeding 75% uptake for people aged 65 years and over
  • reaching or exceeding 70% uptake for people under 65 years in clinical risk groups, including pregnant women

The DH has also published a Seasonal flu plan that contains greater detail and also a section on increasing vaccine uptake among clinical risk groups.

Action: Clinicians should be aware of the target vaccination groups and the uptake aspirations.

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CD regulations updated

The Department of Health has advised that the Misuse of Drugs Regulations have been updated to allow appropriately qualified nurses and pharmacists to prescribe controlled drugs. The changes came into effect on 23rd April 2012.

Nurses and pharmacists who are qualified Independent Prescribers can now prescribe any controlled drug listed in schedules 2-5 for any medical condition within the bounds of their clinical competence with the exception of diamorpine, cocaine and dipipanone for the treatment of addiction.

In addition, nurses and pharmacists can requisition controlled drugs that they are allowed to prescribe and are authorised to supply or administer these drugs. Persons acting under the direction of a nurse or pharmacist who has prescribed a controlled drug can legally administer that drug.

These changes have also clarified the legal aspects of authorising and administering a mixture of medicines that include controlled drugs, for example via syringe drivers.

Action: Nurses and pharmacists who are independent prescribers should be aware of these changes. Updates to computerised clinical systems may be required to enable prescription printing.

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