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Minutes

15 March 2006 | 21 June 2005 | 17 June 2002 | 12 March 2002 | 30 October 2001 | 31 July 2001

Confirmed minutes of the Third Meeting of the New Prescribers Advisory Committee (NPAC)

Meeting held on 12 March 2002
Turnbull House, Bowen Street
9.30 am - 3.00 pm

Present:

Associate Professor Margaret Horsburgh (Chair)
Ms Beryl Anderson
Dr Patrick Ball
Mr Alister Brown
Dr Denise Dignam
Dr John Edwards
Mr Peter Glensor
Professor Keith Grimwood
Ms Marion Hunter
Dr Stewart Jessamine
Professor John Shaw
Dr Dennis Thorburn
Associate Professor Judy Kilpatrick

Apologies:

Dr Mark Adams
Ms Sue Driver
Ms Trish Compton

In Attendance:

Caroline Greaney (Secretary)
Helen Lockyer, for part of the meeting
Marion Clark, Nursing Council, for part of the meeting
Sue Scobie, Nursing Council, for part of the meeting
Kitty Flannery, Nursing Council, for part of the meeting

ITEM 1: Confirm minutes of previous meeting

  1. There were no amendments to the minutes of the previous meeting
  2. Confirmed: minutes of the second meeting, 30 October 2001.

ITEM 2: Correspondence out

  1. The Committee noted that a letter was sent to all relevant registering bodies advising them of meeting dates for 2002.

ITEM 3: Correspondence in

Standing orders
  1. The Committee noted that it received a reply to its letter to the Minister. The Committee will continue to keep an eye on the progress of the standing orders regulations.
Letter from Dietitians Board
  1. The Committee noted that the Dietitians Board appears to be confused about independent prescribing and the administration and supply of prescription medicines under standing orders. The Dietitians Board seems to believe that they already have the ability to prescribe, but a great deal of what they appear to 'prescribe' are not prescription medicines. The Committee understands that dietitians working in hospitals may initiate new therapy or treatment in some situations, and give advice, which medical practitioners will act upon.
  2. Agreed: the secretary will draft a reply to the Dietitians Board that acknowledges their letter, provides some information about NPAC, and points out the differences between independent prescribing rights and standing orders.
Letter from Pharmaceutical Society
  1. The Committee noted the very informative letter it has received from the Pharmaceutical Society.
Email from Nursing Council
  1. To be dealt with when the Nursing Council's Application is discussed.

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ITEM 4: Update on Standing Orders Regulations (Helen Lockyer, MoH)

  1. The proposed standing orders regulations will only initially allow Medical Practitioners and Dentists to prescribe medicines that are prescription only medicines. The regulations that enable standing orders can be amended in the future to enable midwives, nurses and veterinarians to delegate prescribing under standing orders if this is considered desirable in the future.
  2. The regulations will require standing orders to be specific about the competencies of staff working under the standing order, the types of drugs available to be administered in certain circumstances. Standing orders will need to be reviewed annually.
  3. Drafting Instructions have been issued to Parliamentary Counsel Office but drafting has not yet commenced. The best-case scenario is to have the regulations made by the middle of the year.

ITEM 5 - Consideration of Nursing Council Application for independent prescribing right for nurses practising in the sexual and reproductive health scope

  1. The Minutes of the subcommittee were circulated prior to the meeting. The Chair explained the reasoning behind having subcommittees assessing applications prior to the meeting.
  2. The Committee then discussed the issues in the applications that they wanted clarified. These included:
  3. the detail of the application does not reiterate the whole nurse practitioner and nurse prescribing framework model. It assumes that the Committee is already aware of this framework;
  4. statements should be cross-referenced to the documents and to the other work on which they're based and are referring to;
  5. the applicant needs to provide greater evidence, background and each document must be justifiable and defensible in its own right;
  6. an explanation of the scopes is needed. In particular an explanation of the relationship between the 'primary health care' scope and the 'sexual and reproductive health' scope;
  7. there needs to be some justifications for the list of medicines. The application has listed indications for the medicines, not justifications.
  8. Representatives of the Nursing Council, Marion Clark, Sue Scobie and Kitty Flannery, joined the meeting at this point (11.05 am)
  9. The Chair explained that while the Committee is aware of the framework the Council has in place, but that it would have been useful to remind the Committee of it and supply a summary, rather than assume that the Committee would remember.
  10. The Nursing Council (NC) representatives were asked to describe the relationship between the primary health care scope and the sexual and reproductive health scope. The NC representatives pointed out that the Committee had missed a piece of documentation around the primary health care scope (this was photocopied and provided to the members of NPAC). The NC representatives explained that the sexual and reproductive health scope fits within the broader scope of primary health care for nurses. The idea is to have one set of regulations for primary health care, but separate sets of drugs for each sub-scope or sub-group. It was explained that it is unlikely that there will ever be a 'primary health nurse', but there may be a 'rural health nurse'. The Committee queried whether there are access issues in this scope; whether there was already current capacity to cover the prescribing in this scope; and what the boundaries of the scope are since it seems to cover HIV/AIDS and erectile dysfunction. The Committee asked whether the scope was drawn up to cover all possible prescribing of nurses currently working in the area rather than defining boundaries within the scope. The NC representatives replied that it was based on tasks performed by people who work in that area, and that a professional nurse would know what the knowledge and competence qualified them to do.
  11. The Committee pointed out to the NC representatives that there seems to have been an assumption that the NPAC know what sexual and reproductive health nurses do. There needs to be a description of their role, diseases they deal with, reference to epidemiology and international literature. The NC representatives agreed that previous work was used as a model and that they could provide the background information that was underlying the application.
  12. The NC representatives described how within the scope of sexual and reproductive health there are sub-limits, i.e. the management of sexually transmitted infections and hormone replacement therapy. It would a professional decision that the nurse made and to which drugs within the scope that he or she could prescribe.
  13. The Committee indicated that they might decide to seek independent advice regarding the list of medicines unless they were confident that the NC's consultation process has covered this off. The NC representative indicated that consumers and medical specialists in the area as well as the College of Venerologists had been consulted and that the list was formally drawn up by NC in consultation with other groups.
  14. The Committee sought justification of the uses of HRT and erectile dysfunction medicines within the scope. The Committee also pointed out that there appeared to be a number of errors in the list of medicines, including the prescribing of doxycycline for chlamydia in pregnancy.
  15. The Committee raised an issue about the preamble of the application, which includes arguments about improving access to services and improved services to Mäori. There was concern that considering the length of time taken to become a prescriber that the NC's approach will raise expectations in the community about there being a new group of prescribers.
  16. The Committee queried the consultation process and raised the point that it was not clear who was consulted and what they were consulted on.
  17. The NC representatives explained that there is review and assessment of the curriculum for education. All Masters programmes are assessed by NZQA or CUAP as well as by Nursing Council. Currently only Auckland University has a prescribing programme that is approved by the Nursing Council. The Nursing Council included medical specialists in its assessment team, has an audit tool and visit the site. Nursing Council come back to the University with requirements that must be met.

LUNCH - the Nursing Council representatives exited the meeting.

  1. The Committee discussed how it would proceed with the Nursing Council's applications.
  2. Agreed:
  • That further information is required from the Nursing Council. This includes:
    • an explanation of the scope of practice including a description of the clientele, age group, and the settings; references to existing documentation and processes;
    • a list of who was consulted and a copy of the consultation document;
    • a re-submission of the part of the applications that deal with justification so that it refers to international evidence;
    • clarification and justification for a number of medicines listed;
  • That NPAC will need to form a subcommittee to proceed with the Nursing Council's application. The Committee will consist of Dr Denise Dignam, Dr Patrick Ball, Dr Keith Grimwood, and Marion Hunter. Dr Denise Dignam will chair.
  • The subcommittee will make a formal recommendation to NPAC via email or at its next meeting;
  • The subcommittee is able to communicate directly with the Nursing Council;

ITEM 6 - Application from Optometrist Association and Auckland University

  1. The Committee discussed issues about the joint application from the Optometrist Association and Auckland University, and whether discussion about this application should proceed or not since the application has not come from the appropriate registering body.
  2. Agreed:
    • That the application is not an appropriate application in its current form and NPAC will not review it as it stands;
    • The Chair will meet with the applicant and the Optitians Board if possible, to discuss the concerns that NPAC has about the application in its current form;
    • That a process will be set up to deal with the application on an on-going basis should the application be resubmitted by the Board.

The Meeting ended at 3.00 pm

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