What are the practices and experiences of prescribing practitioners in the United Kingdom? A mixed-methods study

Background Pharmacological treatment is the most common form of healthcare intervention; 1.1billion items were dispensed in the community in England alone in one year. With increasing numbers of prescribers being educated, and a growing number of professions being eligible to undertake the course, it is imperative to understand the reasons why some prescribers do not use their qualification, or why severe constraints are restricting practice for some. The restricted or nonuse of the qualification is wasteful of the expense of education and invested time. Prescribing rights, for healthcare professionals other than doctors, began in the United Kingdom (UK) with nurses and health visitors in 1992. Currently, the UK has more professions eligible to prescribe than any other country: nurses, midwives, podiatrists, pharmacists, physiotherapists, radiographers, dietitians and advanced practice paramedics. Although they all undergo identical education and assessments in the V300 course as all other professions, dietitians and diagnostic radiographers are restricted to supplementary prescribing where everyone else have independent prescribing rights. Study Design This is a mixed methods investigation of the practice and experience of prescribing practitioners in the United Kingdom. An integrative literature review was undertaken and Role Theory, encompassing identity theory, social theory and organisational theory, was used as the theoretical framework. Phase 1 is a quantitative survey with an original questionnaire. There were n409 valid responses. Descriptive statistics were analysed with the use of SPSS. Phase 2 consisted of n11 qualitative semi-structured interviews. Reflexive thematic analysis was used to analyse the data. Findings from both phases were discussed together. Findings The key findings show that the use of supplementary prescribing is increasingly restrictive in the rising use of advanced clinical practice roles. Newly qualified prescribers are in a vulnerable position as confidence is low at this point, and almost half declared they do not have the level of support they need. There are healthcare practitioners who have qualified and never prescribed; lack of support, lack of confidence, lack of need to prescribe in their clinical area are cited as reasons. Colleague support and supervision, along with CPD, are recognised as highly influential to a prescriber flourishing or failing to prescribe. There are still prescribers who experience significant delays due to IT systems that are unable to accommodate their profession. The Competency Framework for All Prescribers became a mandatory part of prescriber education in 2018 and there is currently a wide variation of prescriber awareness of or experience using the Framework. Underpinning all these aspects is how they affect, or are affected by, prescriber confidence. These findings have implications for Higher Education Institutes, practice and further research.