Pain Relief Made Easier - Consultation On Prescribing Of Controlled Drugs By Nurses And Pharmacists, UK
The Government is today launching two consultations that aim to make it easier for patients to get the medicines they need by allowing:

- the prescribing of controlled drugs, including for pain relief, by nurse independent prescribers and pharmacist independent prescribers.
- the supply and/or administration of morphine and diamorphine under Patient Group Directions by nurses and pharmacists for the immediate necessary treatment of sick or injured persons

A 12-week Home Office consultation will look at whether the Misuse of Drugs Regulations should be updated to enable the prescribing of controlled drugs such as morphine for pain relief, by specially trained nurses and pharmacists.

The Medicines & Healthcare Products Regulatory Agency (MHRA) will simultaneously launch a consultation on proposals for changes to the legislation governing the supply and/or administration of pain relief through morphine and diamorphine by nurses and pharmacists working under Patient Group Directions.

In recent years, nurses and pharmacists have taken on increased responsibility for patient care by treating patients on a one-off basis, or by managing specialist clinics. These enhanced roles have improved access to and quality of patient care. However, limited access to appropriately qualified prescribers can result in a delay in a patient receiving medication and may inhibit a patient's recovery.

Allowing Nurse and Pharmacist Independent Prescribers' to prescribe Controlled Drugs will increase access to medicines for patients, improving care in areas such as palliative care, substance misuse, post-operative care and pain relief.

Health Minister Lord Hunt said

"These proposals will make it easier for patients to get the medicines they need without compromising safety. Enabling nurse and pharmacist prescribers to prescribe those controlled drugs they are competent to use, completes the changes we made last year and allows these highly trained professionals to use their full range of skills to help their patients.

"As the NHS continues to reform and adapt to meet patient needs, patients are increasingly being treated by a broader range of health professionals and sometimes outside traditional healthcare settings. The proposed changes to medicines legislation will allow nurses and pharmacists to give pain relief quickly and safely to patients who need it. "

Dr Peter Carter, General Secretary of the Royal College of Nursing (RCN), said

"The RCN has been calling for these changes which will improve the care and service for patients, so this is a welcome move. It shows that the Department of Health has listened to the views of the RCN and its members on this issue."

"Nurses are highly trained and skilled. Last year 12,000 prescriptions for controlled drugs were written by nurses. Allowing appropriately trained and qualified prescribing nurses to prescribe more controlled drugs within their competency and speciality, and allowing nurses to supply and administer more controlled drugs under patient group direction will ensure that nurses can take a more active role in ensuring that patients' symptoms are well managed. This is good news for nurses and good news for patients."

Both consultations, if accepted, would make better use of the skills of healthcare professionals and contribute to the introduction of more flexible team working across the NHS.

The Advisory Council on the Misuse of Drugs (ACMD) will consider the responses to both consultations, before making recommendations to Home Office Ministers. The Commission on Human Medicines (CHM) will also consider the responses to the consultation on Patient Group Directions before making recommendations to Department of Health Ministers. Any changes arising from the ACMD and CHM's recommendations would be introduced by Statutory Instrument, no earlier than late summer 2007.

1. The consultation on prescribing of controlled drugs is available on the Home Office website at

2. The consultation on Patient Group Directions is available at

3. Patient Group Directions (PGDs) allow the supply and/or administration of named medicines by specified health professionals, in an identified clinical situation.

4. The Government is committed to increased flexibility and responsiveness in health and social services. In enabling health professionals to take on prescribing responsibilities, the key principles are to

- improve the quality of service to patients without compromising patient safety;
- make it easier for patients to get the medicines they need;
- increase patient choice in accessing medicines;
- make better use of the skills of healthcare professionals; and
- contribute to the introduction of more flexible team working across the NHS.

5. The Commission on Human Medicines (CHM) made recommendations to Ministers in 2005 that Nurse Independent Prescribers and Pharmacist Independent Prescribers should be able to prescribe any licensed medicine for any medical condition within their competence. Department of Health Ministers accepted these recommendations and they were enacted in NHS and Medicines legislation in 2006. Restrictions around controlled drugs still apply.

6. A Patient Group Direction (PGD) is a written instruction, signed by a senior doctor and pharmacist, and authorised by the organisation in which it will be used. It allows the supply and/or administration of named medicines by specified health professionals, in an identified clinical situation.

PGDs apply to groups of patients who may, or may not, be individually identified before presenting for treatment. They are not a form of prescribing. Healthcare professionals supplying and/or administering medicines under a PGD do not need to be qualified prescribers, but the organisation in which they are working must be satisfied that they are fully competent to do so.

7. The MHRA consultation also covers proposals to expand the use of PGDs in the Independent healthcare sector in NI and correction of a technical error on sales of medicines supplied under PGDs in the independent sector.

The consultation could result in changes to the Prescription Only Medicines Order to update the provisions on PGDs.

8. Controlled Drugs are subject to special legislative controls provided by the misuse of drugs legislation as they are considered sufficiently "dangerous or otherwise harmful", with the potential for diversion and misuse. However, this legislation, which is the responsibility of the Home Office, is not intended to impede the legitimate use of Controlled Drugs where clinically appropriate, but rather to regulate and govern it for reasons of patient and public safety. Both the CHM and the Advisory Council on the Misuse of Drugs (ACMD) have advised Government that there is no evidence that expanding the prescribing of Controlled Drugs to nurse and pharmacist independent prescribers or enabling nurses and pharmacists to supply and/or administer morphine and diamorphine under Patient Group Directions will lead to increased diversion or misuse.

9. Legal controls as well as governance arrangements for Controlled Drugs will apply to any changes. These continue to be strengthened with the implementation of the Government Response - Safer management of Controlled Drugs - to The Fourth Report of The Shipman Inquiry. Everyone with responsibilities for prescribing, dispensing or supplying Controlled Drugs will operate within these tighter arrangements across both the public and independent sectors in health and social care.

For media queries on the consultation process please contact Andrew Bell at the Home Office Media Centre on 0207 035 3835

For enquiries on Nurse and Pharmacist indepedent prescribing and the wider policy issue, please call the News Desk at the DH Media Centre on 0207 210 5221