Skip to content

Minutes

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

Confirmed minutes of the
New Prescribers Advisory Committee (NPAC)

Meeting held on 17 June 2002
Pharmacy Seminar Room,
Auckland University
10.00 am - 3.35 pm

Present:

Associate Professor Margaret Horsburgh (Chair)

Ms Beryl Anderson
Dr Patrick Ball
Associate Professor Denise Dignam
Ms Sue Driver
Dr John Edwards
Mr Peter Glensor
Professor Keith Grimwood
Ms Marion Hunter
Associate Professor Judy Kilpatrick
Dr Shane Reti (joined meeting at 10.45)
Professor John Shaw
Dr Dennis Thorburn

Apologies:

Dr Mark Adams
Mr Alister Brown
Ms Trish Crompton
Dr Stewart Jessamine

In Attendance:

Anna Gribble (Secretary)
Leslie Frederikson, New Zealand Association of Optometrists, for part of the meeting
Peter Grimmer, Opticians Board, for part of the meeting
Rob Jacobs, Department of Optometry of Vision Science (University of Auckland), for part of the meeting

ITEM ONE - Welcome to Dr Shane Reti

  1. Dr Reti had advised that he would be late so the meeting began with discussion about the NPAC logo design and colour.
  2. Agreed: the NPAC logo will be green and purple and initials will be in bold type
  3. Agreed: the website will display the following information:
    • An application form
    • Application process details
    • Background information regarding the extension of prescribing authority
    • Background information regarding the NPAC
    • Details regarding the legislative process for the making of regulations extending prescribing authority
    • Minutes of the NPAC meetings
    • NPAC member profiles
    • The Terms of Reference for the NPAC
  4. The website will be available in 2-3 weeks at www.newhealth.govt.nz.

ITEM TWO - Confirm minutes of previous meeting

  1. There was one typographical amendment to paragraph 7 of the previous minutes.
  2. Confirmed: minutes of the third NPAC meeting, 12 March 2002

ITEM THREE - Correspondence out

  1. The Committee questioned whether statutory registration boards are aware that the NPAC will meet again this year.

ITEM FOUR - Correspondence in

  1. E-mail from Medical Radiation Technologists Board The Committee noted that the Medical Radiation Technologists Board was not going to make an application to the NPAC.
  2. Letter from the Council of Medical Colleges to the Ministry of Health (the Ministry) and a letter from the Antimicrobial Resistance Advisory Group (ARAG) The Committee clarified that these letters were for the NPAC's information. There was a brief discussion regarding:
    • the Council of Medical Colleges request to the Ministry in respect of a Memorandum of Understanding and the Heads of Agreement
    • advice to the Ministry from Dr Rod Ellis-Pegler regarding antimicrobial resistance and additional prescribers
    • Associate Professor Chambers comments.
  3. The Committee noted that the Minister of Health receives advice from several streams and that the NPAC provides advice only in respect of independent prescribing authority for groups of health professionals. Other groups, including the Ministry, PHARMAC and ARAG, can provide detailed advice on specific aspects of an application or, in the case of the Ministry, provide alternate advice to that given by the Committee. Issues requiring additional advice should be highlighted to the Minister.
  4. A flowchart outlining the process for assessing applications and providing advice was distributed to Committee members
  5. A discussion regarding who consultation should be with, how it should be conducted and the number of times consultation is required during the assessment process ensued. There was concern that the Committee does not necessarily know whether it is receiving appropriate expert advice because of the way consultation outcomes are being incorporated into and presented in applications. Issues around consultation processes, especially with Mäori and consumers were raised.
  6. The Committee noted that the onus for meeting criteria is on the applicant and that not meeting criteria could result in delays in assessment.
  7. Agreed: to discuss any potential changes to the application template later in the meeting
  8. Agreed: to inform the Minister of Health of these issues
  9. Agreed: to invite the Minister of Health to the next Committee meeting to discuss his/her expectations for extending independent prescribing authority and the role of the NPAC.

ITEM FIVE - the Nursing Council's application for prescribing rights in a sexual and reproductive health scope of practice

Dr Shane Reti joined the meeting at this point (10.45 am). There was a round table of introductions

An additional document from the Nursing Council, title "Community Needs for Nurses in Sexual and Reproductive Health" was distributed

  1. The Chair of the Subcommittee considering this application briefed the full Committee on its recommendations and outlined areas that continued to raise concern (indicative medicines list, justification, consultation).
  2. Discussion covered:
    • whether consultation and advice was adequate, focussing on the indicative medicines list and the apparent lack of consultation with specialists working in some areas where sexual and reproductive health nurse practitioners seek independent prescribing authority
    • that the indicative list of medicines requires additional work and whether the Ministry would provide specialist advice on this list of medicines
    • whether the link between the list of indicative medicines and societal need was satisfactorily justified for all compounds within the scope of practice
    • that the evidence surrounding consultation does not state which groups provided what comment
    • that there needed to be stronger societal justification for independent prescribing for erectile dysfunction and hormone replacement therapy (HRT). It is noted that the tabled document does address this issue although five Committee members still have significant concerns about including such conditions in the scope of practice due to their complexity and because the case for independent prescribing in these areas was not well made
    • that there were several errors of a technical nature in the indicative list of medicines
    • that it would be useful to include figures regarding the number of nurse practitioners and registered nurses working in this scope of practice
    • that Mäori consultation is well covered but consultation with consumer groups is not.
    • There was some discussion regarding the regulatory and legislative changes required in order to amend a schedule of medicines to ensure that it remained current. A more practical approach would be similar to the midwives and dentists. Rather than a prescribed formulary, designated prescribers should have access to the open Pharmaceutical Schedule and prescribe within their identified scope of practice, which would include generic disease groupings.
    • Agreed: Groups of health professionals prescribe within their defined scope of practice, are limited by the scope of practice and disease groupings but are not restricted by a prescribed formulary
    • The Committee noted that under the Health Practitioners Competence Assurance Bill 2002 (the HPCA), all health professionals will have to operate under a defined scope of practice.
  3. There was a brief discussion regarding prescribers, in particular dental prescribers and midwives, who have prescribed outside of what is permitted.
  4. Agreed: to provide advice to the Minister although there are weaknesses in the application. This decision was not unanimous. The Minister should note areas of concern.
  5. The NPAC recommends that nurse practitioners working in the scope of sexual and reproductive health be granted limited independent prescribing authority
  6. The NPAC recommends that all groups of health professionals develop clear and definitive scopes of practice and that the prescription of medicines is enabled by the identification of best clinical practice and development of clinical guidelines and is limited by the boundaries identifying the scope of practice
  7. The NPAC notes that there has been considerable work on the scope of practice, regulatory framework, required competencies and disciplinary action
  8. The NPAC notes that there is a demonstrated public health need for limited independent prescribing authority for nurse practitioners working in family planning and with clients who have sexually transmitted infections
  9. The NPAC notes that the justification for limited independent prescribing authority for erectile dysfunction, HRT and menopause-related conditions is not well supported
  10. The NPAC requests that the Ministry of Health provide comment on indicative medicines list
  11. The NPAC recommends that nurse practitioners working in a sexual and reproductive health scope of practice have access to a generic list of medicines rather than a formulary
  12. That Dr Reti and Professor Grimwood asked that their concerns relating to clinical safety be noted.
  13. A fax from the Health and Disability Commissioner regarding the responsibility for follow-up prescribing was tabled
  14. The Committee noted that a designated prescriber may have responsibility to provide follow up care but that a doctor could not reasonably decline an urgent request.

Lunch

ITEM SIX - the New Zealand Association of Optometrists (NZAO) and the Department of Optometry and Vision Science application for extended prescribing rights for optometrists

  1. The Chair of the Subcommittee considering this application briefed the full Committee on its recommendations and the letters of endorsement received from the Opticians Board and the Pharmaceutical Society. The Chair also outlined areas that raise concern (the role of the Opticians Board, educational requirements for practising optometrists, the inclusion of glaucoma). There was discussion regarding these concerns.
  2. Agreed: to ask the applicants to clarify the following areas:
    • the role of the Opticians Board
    • registration of current optometrists seeking independent prescribing authority and educational requirements for this group during the transition period including arrangements for a register of optometrists with prescribing authority
    • the relationship between optometrists and ophthalmologists
    • processes for referring glaucoma cases
    • the treatment of chlamydia in the New Zealand context
    • reciprocity agreements with the United Kingdom.
  3. The Committee noted that there will be a transitional education phase from 2003 to 2006. From 2006 the proposal is that all graduating registered optometrists will be able to prescribe. The NZAO and the University of Auckland are presenting the application jointly. The University of Auckland has the only School of Optometry in New Zealand at present and 95% of optometrists are members of the NZAO.
  4. Leslie Frederikson (NZAO), Peter Grimmer (Opticians Board) and Rob Jacobs (Department of Optometry) join the meeting at this point (1.35)
  5. The Committee stated that all applications need a statutory registering body to accept responsibility for it. The Opticians Board is happy to do this and will accept all correspondence associated with the application. This correspondence will be shared with the NZAO, the Department of Optometry and the University of Auckland. It was also noted that under the HPCA there would be a two-tier regulation system for those with prescribing authority and those without.
  6. The Committee noted that current practising optometrists will need to complete a Certificate in Ocular Pharmacology (a 240 hour, three phase course consisting of background study, therapeutics and clinical aspects of optometry and pharmacology) in order to be competent to prescribe. This course offers 60 places by distance learning and will begin in 2003. Undergraduate courses will be progressively phased in and include greater emphasis on anatomy, therapeutics pharmacology and disease management, totalling five years of study.
  7. Discussion on the referral process and in particular referral processes for glaucoma focussed on patient need, access to care and the cost of treating glaucoma. The Committee noted that optometrists must be aware that they may need to seek a second opinion from an ophthalmologist. The relationship between optometrists and ophthalmologists is cordial and the two professions frequently work together. It is noted that optometrists and ophthalmologists operate in a multidisciplinary environment where communication is important. Ophthalmologists will provide advice on clinical components of ocular pharmacology courses. It was suggested that the Ministry of Health collect information regarding the occurrence of glaucoma.
  8. There was a brief discussion about the inclusion of doxycycline and ciprofloxacin in the indicative medicines list and the treatment of trachoma.
  9. There is reciprocal registering with the United Kingdom although UK optometrists will not be considered competent to prescribe in New Zealand.
  10. The Committee considered consultation with Mäori to be weak or absent although consultation with consumer groups was good.
  11. Leslie Frederikson, Peter Grimmer and Rob Jacobs leave the meeting at this point (2.30)
  12. The Committee discussed remaining concerns about the difficulty in accessing ophthalmologists, whether apparent internal disputes within the Opticians Board would be significant and the brokering role of pharmacists. There was also a discussion about the narrowness of a limited formulary and the regulatory delays that amending such a list would create. Errors in the application undermine some points.
  13. Agreed: to provide the Minister of Health formal advice. The Minister of Health should note areas of concern.
    • The NPAC recommends that optometrists be granted limited independent prescribing authority
    • The NPAC notes that the scope of practice for optometrists requires additional clarification regarding who can prescribe where and for whom
    • The NPAC notes that there are some concerns regarding the indicative medicines list particularly the inclusion of specialist-only medicines
    • The NPAC notes that consultation has not been inclusive of Mäori
    • The NPAC requests that the Ministry of Health provide comment on indicative medicines list
    • The NPAC recommends that optometrists have access to a generic list of medicines rather than a formulary
    • The NPAC requests that the Ministry of Health takes a leadership role and ensures that all available evidence is considered in the development of clinical guidelines and clinical pathway development within the scope of practice
    • That Dr Reti and Professor Grimwood asked that their concerns relating to clinical safety be noted.
  14. Agreed: that applicants would be provided with formal advice at the same time as the Minister
  15. Agreed: that the Ministry give a presentation regarding the HPCA

ITEM SEVEN - Scopes of Practice Paper

  1. Agreed: to include scope of practice paper prepared by the Ministry of Health as an appendix for future applicants
  2. Discussion continued regarding the inclusion of specific diseases under a scope of practice and that it may be more appropriate to include disease groupings. The importance of consultation with relevant profession groups was also raised.
  3. Agreed: not to change the template but to encourage improved analysis of consultation responses and rationales
  4. Agreed: to contact the Podiatrists Board to confirm when they expect to present an application for prescribing authority to the Committee

Item Eight - General Business

  1. Agreed: the next NPAC meeting will be held on 10 September 2002. This will be held in Wellington if the Minister of Health is able to be present. It will be held in Auckland if the Minister cannot be present.
  2. An update on the development of the Standing Order Regulations was given.

Meeting closed 3.35

top of page