Non-medical prescribers

This guide explains the different types of non‑medical prescribers and outlines the qualifications required for nurses, midwives, pharmacists and allied health professionals to prescribe safely and legally. It describes Community Practitioner Nurse Prescribers, Independent Prescribers, and supplementary prescribing. It highlights key legislative changes, such as the Misuse of Drugs Regulations update.

Types of nurse prescriber

Nurses, midwives, pharmacists and other allied healthcare professionals (AHPs) who have completed an accredited prescribing course and registered their qualification with their regulatory body, are able to prescribe.

The two main types are:

Community Practitioner Nurse Prescribers (CPNP)

These are nurses who have completed a Nursing and Midwifery Council (NMC) approved Community Practitioner Nurse Prescribing qualification (previously known as a v100 or v150) and are registered as a CPNP with the NMC. They are permitted to prescribe from the Nurse Prescribers’ Formulary for Community Practitioners, which includes selected appliances, dressings, general sales list (GSL) and pharmacy (P) medicines, and a limited number of prescription‑only medicines. This qualification is commonly held by district nurses, community nurses, health visitors/public health nurses, school nurses and other community‑based nurses.

Independent and Supplementary Prescribers (IPs/SPs)

Independent prescribers are nurses or midwives who have completed an NMC‑approved prescribing programme (formerly referred to as V300). They may prescribe any medicine, including controlled drugs (Schedules 2–5) and unlicensed medicines provided this is within their scope of competence.

Those who have also completed the supplementary prescribing component may prescribe in partnership with an independent prescriber under an agreed patient‑specific Clinical Management Plan (CMP). Supplementary prescribing is a voluntary partnership between the independent prescriber, the supplementary prescriber and the patient.

The Royal College of Nursing (RCN) notes that some prescribers are registered midwives, who must prescribe within their own professional scope of practice and in accordance with the NMC Code.

Standards for prescribers - The Nursing and Midwifery Council (2023)

Nurse independent prescribers and controlled drugs: changes to the Misuse of Drugs Regulations

The Misuse of Drugs Regulations covers all of the UK except Northern Ireland. This legislation divides controlled drugs (CDs) into five schedules corresponding to their therapeutic usefulness and misuse potential.

On 23 April 2012 changes to these regulations allowed nurses and midwives who are qualified as nurse independent prescribers to prescribe all controlled drugs listed in schedules two-five where it is clinically appropriate and within their professional competence (except for cocaine, diamorphine and dipipanone for the treatment of addiction). Changes also allowed nurse independent prescribers to mix any controlled drugs listed in schedules two-five prior to administration with another medicine for patients who need drugs intravenously.

Amendments to the Misuse of Drugs Regulations (Northern Ireland) 2002 were introduced on 10 May 2012 to allow a nurse independent prescriber and a pharmacist independent prescriber to prescribe controlled drugs as described.

Non-prescribers generating prescriptions for the GP (or other prescriber) to sign

This is a situation that often occurs in a triage situation, and it is sometimes difficult to see where the lines of accountability are.

Essentially, the responsibility for the decision to prescribe any medicine rests with the person signing the prescription, whether this is a medical practitioner or independent prescriber.

The Royal College of Nursing do not deem it to be acceptable for nurses who are not qualified as independent prescribers to add medicines to a patient’s electronic record for the purpose of automatically directing them to a prescriber for signing. Any such entry requires clear, direct communication between the nurse and the prescriber to ensure that the medicine has been clinically assessed, reviewed, and is intentionally prescribed by the appropriate professional.

Clinical systems provide secure messaging functions that allow nurses to offer a professional opinion or make a recommendation to a prescriber, for example, suggesting a particular inhaler device or proposing a change in diabetes medication. The prescriber must then consider the request in the context of the patient’s wider clinical picture, including current medicines, blood results, and other relevant information, and add the medication themselves if they judge it appropriate. If within scope of practice, providing clinical advice or recommendations to a prescriber is acceptable, but accurate documentation of the discussion and decision-making process is essential. The responsibility for prescribing rests with the authorised prescriber, who must make an independent, informed prescribing decision.

The registrant must ensure they are compliant to the NMC code when offering advice and guidance to the patient and to a colleague (the GP/prescriber). See section 8 ‘working collaboratively’ and section 18 ‘prescribing’.

GPs must prescribe in accordance with the GMC’s Good practice in prescribing and managing medicines and devices (2021, updated 2022 and 2024). The guidance states:

76 — When prescribing based on the recommendation of another doctor, nurse, or healthcare professional, the prescriber must be satisfied that the prescription is needed, appropriate, and within their own competence.
77 — If the prescriber delegates the assessment of a patient’s suitability for a medicine, they must be satisfied that the colleague has the qualifications, experience, knowledge, and skills to make that assessment. The prescriber must also ensure the colleague has sufficient information about the patient and that they follow the GMC’s guidance on decision making and consent.
78 — In both circumstances, the prescriber remains personally accountable for any prescription they sign.

These principles reinforce the GMC’s wider expectations around accountability, delegation, and safe prescribing, including the need for adequate information, appropriate mode of consultation, and clear clinical justification.