Competency assurance standards for non-medical prescribers in Wales (WHC/2024/02)

Status:

Action.

Category:

Health professional letter.

Title:

Standards for competency assurance of non-medical prescribers in Wales.

Date of expiry / review:

1 April 2026.

Action by:

30 September 2024.

Required by:

• Chief executives.
• Nurse directors.
• Directors of therapies and healthcare science.
• Chief pharmacists.
• Local health boards.
• Velindre University NHS Trust.
• Welsh Ambulance Services NHS Trust.
• Public Health Wales NHS Trust.

Sender:

Andrew Evans,
Chief Pharmaceutical Officer,
Welsh Government.

Welsh Government contacts:

Darren Ormond,
Pharmacy and Prescribing,
Welsh Government,
Cathays Park,
Cardiff.
Contact Tel: 03000 255621.

Enclosures:

Chief professional officers’ letter to NHS Wales.

Background

Nurses, pharmacists, optometrists, physiotherapists, paramedics, radiographers and dietitians are subject to completing additional training, able to prescribe medicines for patients as either independent or supplementary prescribers, these healthcare professionals are collectively referred to as non-medical prescribers.

Non-medical prescribing has demonstrable benefits for patient care and investing in and supporting an increasing non-medical prescriber workforce is a key enabler in the planning and delivery of new care models and transforming care.

There are many non-medical prescribers working in health boards and NHS trusts and in primary care in Wales and non-medical prescribing training can support role and career development by enabling practitioners to take on greater responsibilities for managing patient care. 

Non-medical prescribing enhances patient care by supporting patients’ timely access to treatment with medicines, enabling choice whilst helping to reduce waiting times, reduce hospital admissions and maximising the wider skills of the healthcare team.

Responsibility of non-medical prescribing practitioners

Non-medical prescribers are accountable for all their prescribing decisions and any consequences arising from them. They should therefore only prescribe medicines they know are safe and effective for the patient and the condition being treated. They must be able to recognise and deal with pressures and conflicts of interest that could lead to inappropriate prescribing.

All non-medical prescribers are individually professionally accountable to their respective professional regulatory bodies and must act in accordance with the relevant professional standards and code of ethics and conduct.

Responsibility of employers

Where an appropriately trained and qualified non-medical prescriber prescribes as part of their professional duties with the consent of their employer, the employer is vicariously liable for the actions of the prescriber. Employers must therefore have in place robust arrangements for ensuring the initial and continued competence of non-medical prescribers working within their organisations.  
All health boards and NHS trusts in Wales will have existing policies regarding the employment, supervision and review of non-medical prescribers.

Implementing a consistent approach to competency assurance

In 2019, Health Education and Improvement Wales (HEIW) conducted scoping work which identified a need to produce guidance to more consistently support non-medical prescribers in appropriately evidencing their continued competence to prescribe.

The Standards for Competency Assurance of Non-Medical Prescribers (annex one) in Wales were developed by HEIW following a review of the non-medical prescribing policies currently in place within NHS organisations in collaboration with key internal and external stakeholders.

The standards support a “once for Wales” approach to the quality assurance of the non-medical prescriber workforce in Wales. They set the minimum requirements for evidencing and review of ongoing competence to prescribe for non-medical prescribers and employers of non-medical prescribers in four key areas:

• annual self-assessment of prescribing competence
• annual declaration of scope of prescribing practice and of continued competence to prescribe
• regular prescribing appraisal with a suitably qualified individual
• use of portfolios to evidence competence

The standards are aimed at all non-medical prescribers who provide NHS services to patients in Wales, and their employers in all sectors of practice and apply to all independent prescribers, community practitioner nurse prescribers and supplementary prescribers practicing in Wales.
These standards complement and do not replace or supersede standards set by professional regulatory or leadership bodies either relating to prescribing or revalidation more generally.

Required actions

All health boards, Velindre NHS Trust, the Welsh Ambulance Services NHS Trust, and Public Health Wales NHS Trust are required to implement the standards for competency assurance of non-medical prescribers within their organisation by 31 March 2026 at the latest.

To support implementation, these organisations are required to develop an implementation plan with the support of HEIW by 30 September 2024.

All health boards, Velindre NHS Trust, the Welsh Ambulance Services NHS Trust, and Public Health Wales NHS Trust should identify an appropriate senior manager within their organisation to be responsible for developing the implementation plan and whose details should be shared with HEIW by emailing Karen.Brambles@wales.nhs.uk by 28 March 2024.

Andrew Evans,
Prif Swyddog Fferyllol,
Chief Pharmaceutical Officer.

Sue Tranka,
Prif Swyddog Nyrsio / Cyfarwyddwr Nyrs GIG Cymru,
Chief Nursing Officer/Nurse Director NHS Wales.

Ruth Crowder,
Prif Gynghorydd Proffesiynau Perthynol i Iechyd,
Chief Allied Health Professions Advisor.

David O’Sullivan, OBE,
Prif Gynghorydd Optometrig Cymru,
Chief Optometric Advisor for Wales.

Delia Riply,
Dirprwy Prif Gynghorydd Gwyddonol (Iechyd),
Deputy Chief Scientific Adviser (Health).

To:

Health board and NHS Trust:

• chief executives         
• directors of nursing    
• directors of therapies and health sciences
• chief pharmacists

March 2024

Dear Colleagues,

Standards for Competency Assurance of Non-Medical Prescribers in Wales.

NHS organisations employing non-medical prescribers are required to have in place robust arrangements for ensuring the initial and continued competence of non-medical practitioners who prescribe as part of their professional duties within the organisation.

All NHS organisations in Wales have policies and procedures in place to support good governance in relation to non-medical prescribing. However, a scoping exercise undertaken by Health Education and Improvement Wales (HEIW) in 2019 identified opportunities to develop a more consistent “one for Wales” approach to the quality assurance of the non-medical prescriber workforce in Wales.

The scoping exercise which included the review of the existing non-medical prescribing policies in place across Wales, resulted in the production of the Standards for Competency Assurance of Non-Medical Prescribers in Wales.

This letter sets out a requirement for all health boards, Velindre NHS Trust, the Welsh Ambulance Services NHS Trust, and Public Health Wales NHS Trust to ensure arrangements for employing, supervising and reviewing the practice of non-medical prescribers comply with the standards for competency assurance of non-medical prescribers in Wales no later than 31 March 2026.

To support the implementation of standards organisations should identify an appropriate senior manager within the organisation to be responsible for developing an implementation plan by 30 September 2024.

We would be grateful if the details of your organisation’s nominated lead can be shared with HEIW by emailing Karen.Brambles@wales.nhs.uk by 28 March 2024.

HEIW will be responsible for providing oversight of each NHS organisation compliance with the requirements in this Welsh Health Circular and in due course against the standards.

Yours sincerely,

Sue Tranka.
Ruth Crowder.
David O'Sullivan.
Andrew Evans.
Delia Ripley.