Intended for healthcare professionals

Feature Health Policy

Handing over the prescription pad

BMJ 2009; 339 doi: (Published 27 November 2009) Cite this as: BMJ 2009;339:b4835
  1. Nigel Hawkes, freelance journalist
  1. 1London
  1. nigel.hawkes1{at}

    Despite doctors’ objections, other health professions are getting increasing rights to prescribe. Nigel Hawkes investigates

    The entitlement to write prescriptions was once the doctor’s prerogative. It signified knowledge, authority, and the exercise of a power sanctioned by social and professional consent.

    Today, nearly 10 years after the NHS Plan promised to expand the role of nurses, prescribing has been dragged from the grasp of a reluctant medical profession. Nurses and pharmacists who are appropriately qualified now have access to the whole of the British National Formulary. Later this year, they will also be permitted to prescribe unlicensed medicines for the first time. Physiotherapists, podiatrists, and radiographers already have some prescribing rights and could soon have more.

    This change has happened piecemeal and, in the eyes of many doctors, without adequate safeguards. The profession has opposed every step in the process, many doctors claiming that it is unsafe to allow unqualified people to prescribe powerful medicines on the basis of a few weeks’ training. In consultations, the profession has voted solidly for the slowest possible progress, given that no progress at all was not an option. The British Medical Association reacted with horror when in 2005 plans were published to extend nurse prescribing, demanding a meeting with Patricia Hewitt, then health secretary. One doctor launched a petition (now closed) on the No 10 Downing Street website against nurse prescribing: he attracted 147 signatures.

    Unfounded fear

    What followed these protests has, however, been an anticlimax. Nurses have assumed their new powers cautiously; pharmacists already knew more about medicines than most doctors. The rush of patients damaged by poor prescribing or by unexpected drug interactions has not occurred. Only a single case of inappropriate prescribing has found its way to the fitness to practise panel of the Nursing and Midwifery Council.

    “It’s gone smoothly,” …

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