Non-medical prescribers

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 successfully completed a Nursing and Midwifery Council (NMC) Community Practitioner Nurse Prescribing course (also known as a v100 or v150 course) and are registered as a CPNP with the NMC. The majority of nurses who have done this course are district nurses and public health nurses (previously known as health visitors), community nurses and school nurses. They are qualified to prescribe only from the Nurse Prescribers Formulary (NPF) for Community Practitioners. This formulary contains appliances, dressings, pharmacy (P), general sales list (GSL) and thirteen prescription only medicines (POMs).

• Independent Prescribers (IP)

Independent prescribers are nurses who have successfully completed an NMC Independent Nurse Prescribing Course (also known as a v200 or v300 course) and are registered with the NMC as an IP. They are able to prescribe any medicine provided it is in their competency to do so. This includes medicines and products listed in the BNF, unlicensed medicines and all controlled drugs in schedules two - five.

Those who have successfully completed the supplementary part of the prescribing course are also able to prescribe against a clinical management plan. Supplementary prescribing is described by the Medicines and Healthcare products Regulatory Agency (MHRA) as:

"a voluntary partnership between an Independent Prescriber (IP-er) and a supplementary prescriber (SP-er)," (e.g. nurse, pharmacist) "to implement an agreed patient-specific clinical management plan (CMP) with the patient's agreement."

The RCN acknowledges that some nurse prescribers are registered midwives and therefore would prescribe in their own sphere of practice and competence according to the NMC code. 

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.

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.

In the event a nurse is asked to add medications electronically to a clinical system as a non-prescriber, the RCN states that this is not acceptable. It should be noted that the practice systems allow for messaging to a prescriber so the nurse can give a professional opinion and recommend prescribing to the prescriber, for example, a specific inhaler device or a change in diabetes medication. It is then the prescriber who considers the medication, taking into account other factors, such as medications, blood results and other clinical results. The prescriber can then add the medication if they agree with the request. Providing advice to a prescriber on what would be appropriate to prescribe is acceptable, however, documentation is key. Ultimately, it is then up to the prescriber to consider this advice to inform their 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’.

It is important that GPs are prescribing in line with GMC guidance, Good practice in prescribing and managing devices (2021), which states:

Prescribing at the recommendation of a professional colleague:

• 76 If you prescribe based on the recommendation of another doctor, nurse or other healthcare professional, you must be satisfied that the prescription is needed, appropriate for the patient and within the limits of your competence.
• 77 If you delegate the assessment of a patient’s suitability for a medicine, you must be satisfied that the person you delegate to has the qualifications, experience, knowledge and skills to make the assessment. You must give them enough information about the patient to carry out the assessment. You must also make sure that they follow our guidance on ‘Decision making and consent’ in paragraphs 42 to 47.
• 78 In both cases (paragraphs 76 – 77), you will be responsible for any prescription you sign.

The principles of accountability and delegation also apply here.

There are two types of prescribers:

• An independent prescriber is a practitioner who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and can make prescribing decisions to manage the clinical condition of the patient.
• A supplementary prescriber is a practitioner who prescribes within an agreed patient-specific clinical management plan (CMP), agreed in partnership by a supplementary prescriber with a doctor or dentist.

The table below is a brief summary of what IPs and SPs can prescribe (this does not include CPNP).

In general, an IP can prescribe any medicine for any condition within their clinical competence, whilst an SP may prescribe any medicine within their clinical competence that is included in the patient-specific CMP.

RCN resources

Medicines management support and guidance

Nurse prescribing: developing confidence, autonomy and collaboration

Patient Specific Directions and Patient Group Directions

Prescribing in pregnancy

Other resources 

The NMC Code

Royal Pharmaceutical Society’s Prescribing Competency Framework as their standards of competency for prescribing practice. All approved prescribing programmes must meet the new standards by 1 September 2022. 

Medicines and Healthcare products Regulatory Agency (MHRA) can provide information on legislation and medicines and medical devices.

NICE Medicines and Prescribing Centre provides support for medicines and prescribing.

Country-specific guidance is also available at the following websites by searching for ‘nurse prescribing':

England: Department of Health

Northern Ireland: Department of Health

Scotland: NHS Scotland

Wales: Welsh Government