The role of the nurse is evolving and the clinical nurse specialist is now a central figure in most rheumatology departments. Initially, the duties of nurse specialists centred on patient education and monitoring of disease modifying anti-rheumatic drugs, but increasingly they have assumed a wider remit encompassing clinical assessment and the administration and monitoring of biologic therapies. With opportunities to expand knowledge and practice, many are now looking to acquire prescribing powers and gain additional practical treatment skills.
Nurse prescribing was advocated by the Cumberlege Report in 1986 and in 1989 the first Crown Report recommended that suitably qualified registered nurses, notably district nurses and health visitors, should be authorized to prescribe from a limited list, the Nurse Prescribers Formulary for District Nurses and Health Visitors (Department of Health, 1989). Legislation allowing independent prescribing by nurses was passed in 1992 (The Medicinal Products Act) and, following a successful pilot scheme, nurse prescribing for district nurses and health visitors became more widespread from 1998. The second Crown Report in 1999 recommended that prescribing rights be extended to other groups of nurses and other health professionals including physiotherapists, radiographers, podiatrists, chiropodists and optometrists (Department of Health, 1999). Following legislation (Department of Health, 2001) and amendments to the Prescriptions Only Medicines Order, supplementary prescribing was introduced for nurses and pharmacists on 4th April 2003. Approval for supplementary prescribing to be rolled out to other allied health professionals (AHPs) was passed in April 2005.
Independent nurse prescribers can prescribe from the Nurse Prescribers Extended Formulary which includes all general sale lists (GSL) and pharmacy medicines plus a list of prescription only medicines (POMs) for the management of a range of specified medical conditions and situations, including minor ailments, minor injuries, health promotion and palliative care. Independent prescribing is thus particularly suited to primary care. The list of medicines that can be prescribed by an