Chapter 10: Pain Medicine 2026

Published: 24/04/2026

10.10 Non-medical prescribing for pain management

 Professor RD Knaggs, Ms Felicia Cox

Why do this Quality improvement project?

Prescribing by non-medical healthcare professionals was initially developed to improve access to treatments, improve patient care and use resources more effectively. Non-medical prescribers (NMPs) are an ever-expanding workforce who play an increasing role in the modern NHS.  This quality improvement project should be approached with an MDT approach in order to evaluate and promote safe prescribing by NMPs with the overall aim of improving choice and convenience for patients. 

Background

Prescribing by non-medical healthcare professionals has increased over the last two decades. Since 2006, Nurse Independent Prescribers have been able to prescribe any medicine for any medical condition within their competence, and this now includes most controlled drugs.6 Pharmacist Independent Prescribers have similar prescribing authority. Independent prescribing has since been extended to other healthcare professionals, including physiotherapists, although restrictions remain around the prescribing of controlled drugs. From September 2026, all newly qualified UK pharmacists will be independent prescribers on the day of registration.

As an alternative to independent prescribing, nurses, pharmacists, physiotherapists and other allied health professionals authorised to prescribe may use supplementary prescribing, which requires a voluntary prescribing partnership between an independent prescriber (doctor or dentist) and a non-medical prescriber to implement an agreed patient-specific Clinical Management Plan (CMP) with the agreement of the patient.

Use of NMPs allows greater choice and convenience for patients.1. Working with NMPs can improve teamwork and either reduce doctors’ workloads or free up time to spend on more complex patient cases.2 NMPs report that the authority to prescribe increases their job satisfaction and self-confidence, makes them more independent, and enables better use of their skills.3 They also reported feeling that it enhances their relationships with patients. 4 Patients' perception of non-medical prescribing is positive, reporting positive experience and high satisfaction with accessibility and length of consultation.5

Best practice

Best practice for non-medical prescribing is dictated by the legal framework under which it was developed and the prescribing competency framework.6,7 All NMPs must prescribe only within their own area of competence.

Standards for NMP Prescribing

Prescribing activity 

  1. Indicator: Total number of items prescribed, and number of prescriptions written over a predetermined period
  2. Indicator: Proportion of medicines prescribed by non-medical prescribers within their own personal formulary during a predetermined period. Standard: 100%

Prescribing competence

  1. Indicator: Adherence to local policies and personal formulary (independent prescribing scope of practice). Standard: 100%
  2. Indicator: Adherence to the relevant regulatory body’s requirements (RPS, RCN, HCPC) for CPD supporting ongoing registration and prescribing competence. Standard: 100% 

Supplementary prescribing

  1. Indicator: Is a CMP available for each patient? Standard: 100% of a sample of patients
  2. Indicator: Is the CMP specific for each patient? Standard: 100% of a sample of patients
  3. Indicator: Is each CMP completed fully? Standard: 100% of a sample of patients
  4. Indicator: Is each CMP legible? Standard: 100% of a sample of patients
  5. Indicator: Proportion of patients reviewed by a medical practitioner within the last 12 months. Standard: 100% of a sample of patients

Suggested data to collect 

  • Utilisation of NMPs in MDT
    • Total number of items prescribed, and number of prescriptions written over a predetermined period
  • Adherence rates to standards described in best practice standards
    • Proportion of appropriate prescriptions
  • Patient access to prescriptions (waiting time)
  • Patient satisfaction with access to prescriptions

QI methodology

Where prescribing practice or patient-focussed care indicators are not met, a qualitative analysis and review of cases as a multidisciplinary team would be beneficial to thematically identify areas for improvement and consider how they can be addressed in a QI project. Examples could include:

  1. Prescribing practice
  • Undertake a baseline service evaluation to review the appropriateness of prescriptions in sequential patients.  The number of patients included in this sample would depend on the size of the service.
  • Identified cases where prescription is found to be inappropriate could be then analysed by a team, identifying themes for non-adherence to policy or formulary. Tools such as SEIPS (Systems Engineering for Patient Safety) can help structure analysis to ensure all areas that may be impacting on a systems outcomes are considered.
  • A Pareto chart could then be formed to order the most commonly occurring themes, allowing prioritisation of issues to be addressed.
  1. Patient-focussed care
  • Develop a way to gain feedback from patients regarding their care under non-medical prescribers.
  • Thematically analyse this to identify areas for improvement, and areas of excellence, and look to see if can be embedded more commonly in the system. Tools such as ‘five-whys’ can be used to structure team analysis.
  • Good QI practice would include patients in co-design of any system changes.

References

1.Latter S, Blenkinsopp A, Smith A, Chapman S, Tinelli M, Gerrard K, et al. Evaluation of nurse and pharmacist independent prescribing. Department of Health: London. 2010. 

2.Graham-Clarke E, Rushton A, Noblet T, Marriott J. Facilitators and barriers to non-medical prescribing - A systematic review and thematic synthesis. PLoS One. 2018 Apr 30;13(4):e0196471. 

3.Cope LC, Abuzour AS, Tully MP. Nonmedical prescribing: where are we now? Ther Adv Drug Saf. 2016 Aug;7(4):165-72. 

4.Tinelli M, Blenkinsopp A, Latter S, Smith A, Chapman SR. Survey of patients' experiences and perceptions of care provided by nurse and pharmacist independent prescribers in primary care. Health Expect. 2015 Oct;18(5):1241-55. 

5.Hindi AMK, Seston EM, Bell D, Steinke D, Willis S, Schafheutle EI. Independent prescribing in primary care: A survey of patients’, prescribers’ and colleagues’ perceptions and experiences. Health Soc Care Community. 2019;27(4):e459-e470.

6.https://doi.org/10.1111/hsc.12746. Department of Health. Nurse and pharmacist prescribing powers extended. Department of Health: London 2005.

7.Royal Pharmaceutical Society. A Competency framework for all prescribers. Royal Pharmaceutical Society: London. 2021. https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Prescribing%20Competency%20Framework/RPS%20English%20Competency%20Framework%203.pdf?ver=mctnrKo4YaJDh2nA8N5G3A%3d%3d