Table 4 Barriers and Facilitators to non-medical prescribing

Justifying need (n = 14)

❖ Trust strategy & commitment to promote and fund NMP

❖ Expectations of course and intended NMP role are discussed with interested candidates and their DMPs. Having a defined set of patients/conditions e.g. role as specialist nurse

❖ Lack of strategic approach in organisations

❖ Lack of support from managers & clinicians

❖ Overly restrictive trust strategy to expanding the number of NMPs

❖ Lack of vision and/or evidence of benefits of commissioning services in new and developing areas e.g. community based pharmacists

Finding a practice supervisor (n = 18)

❖ Having an established relationship with potential DMP

❖ NMP lead support for inexperienced DMPs

❖ DMPs who have already been a mentor and have positive experience of NMP

❖ Lack of support when developing NMP in new areas of practice

❖ Lack of financial incentive to act as DMP

❖ NMP candidates who have to find and secure DMP support in different setting to their usual area of practice, e.g. those working across a number of GP practices

Preparation for prescribing role (n = 23)

❖ Systematic and structured approach to selecting students for NMP training, e.g. use of national criteria

❖ Trusts who provide additional training to ensure students have pre-requisites for NMP training e.g. numeracy training, assessment and diagnostic training, mental health pharmacology module

❖ Students are prepared for the prescribing programme with respect to course content & amount of learning that is required

❖ Having a well defined prescribing role that is agreed between NMP and their manager

❖ Inconsistent approach to selection process ❖ Lack of awareness (amongst candidates and managers) of NMP course academic content and requirement

❖ Inappropriate expectations (amongst candidates, manager or clinicians) with respect to remuneration and how prescribing qualification will be used in practice

❖ Relevance of NMP programme to non-community based nurses

❖ Inconsistent methods of academic assessment of NMP between different education providers

Confidence & ongoing support (n = 19)

❖ Trust provision of NMP support groups, meetings and networks

❖ NMPs receive support (from NMP lead, DMP or Peers) during initial implementation and role transition

❖ NMPs receive ongoing support from other NMPs and their own clinical team (including clinical supervision)

❖ Supplementary prescribing used as means to build confidence

❖ A lack of support approach within trust

❖ Lack of understanding about, and access to appropriate CPD for prescribing role

❖ Providing support for community & mental health based NMPs

❖ A lack of confidence to negotiate prescribing responsibility within mental health settings or problems defining individual scope of practice

❖ Restrictions imposed by enforced use of supplementary prescribing

Practicalities & legalities (n = 11)

❖ Procedures for registering and governing NMP up-and-running in organisation

❖ Confidence reduced by the time lag between course completion, registration with professional body as NMP, and implementation of role

❖ Implementing NMP across range of providers in primary & secondary care