Common ground

Pharma marketers are facing a unique challenge; how should they interact with the developing and expanding new target market of nurse prescribers? There are few people who would disagree that one of the cornerstones of marketing theory is that different audiences react in different ways to communications.

A company cannot expect to communicate effectively with two different target markets by speaking to them in the same way. The marketing community has developed a range of sophisticated communication techniques to speak to doctors but should not assume that communication techniques used for doctors will work for nurses.

Why should the industry be concerned about this new market? In understanding more about the background and latest developments in nurse prescribing, the answer to this question becomes abundantly clear.

Why is it relevant?
Recommendations for nurses to take onthe role of prescriber were first made in 1986. Fast forward to 2005 and there are now approximately 28,000 district nurses and health visitors qualified to prescribe from a list of appliances, dressings, pharmacy (P), general sales list (GSL) items and prescription-only medicines included in the Nurse Prescribers' Formulary (NPF).

This growth in the number of nurse prescribers, and the range of their prescriptive autonomy, has come about through a process of gradual steps. The key changes, however, have occurredover the last five years.

In 2001, funding was made available for all first level registered nurses, who met the agreed criteria to undergo the necessary training to enable them to prescribe from an extended formulary. Training for independent extended prescribingby nurses began in Spring 2002.

In 2003, proposals to expand the Nurse Prescribers' Extended Formulary (NPEF) were accepted, and the NPEF was expanded to include a number of additional conditions and medicines.

Later that year, legislation was passed by the Home Office allowing nurses to prescribe six controlled drugs.

Further controlled drugs, included in the proposals set out by the Medicines and Healthcare products Regulatory Agency (MHRA), are expected to be added in the future, following Home Office approval. Additional proposals to extend the NPEF to include medicines and conditions in emergency and first contact care are also expected.

Extended independent nurse prescribers, which include nurses in both primary and secondary care settings, are now able to prescribe from a list of over 250 prescription-only medicines (including controlled drugs), GSL and P medicines for a range of over 100 medical conditions.

While we are still waiting for a decision on recent proposals to extend the NPEF, one option on the table would be to include the whole British National Formulary.

Adding value
The step-by-step growth in the number of nurse prescribers, and the range of their prescriptive autonomy, has been on the back of clear evidence of the value of nurse prescribing.

Evidence shows that nurses, doctors and members of the public are quite positive about independent nurse prescribing, with continuity of care, time-savings, convenience and medicines information provision being some of the benefits identified for patients.

Benefits for nurses include the ability to deliver complete episodes of care, increased job satisfaction and autonomy, while the benefits for doctors include improved professional relationships and reduced workload.

Strength of SPs
A further area of autonomy is supplementary prescribing. Training for this was introduced in 2003 for nurses and pharmacists, and legislative changes enabling the extension of supplementary prescribing to some allied health professionals and optometrists are now in place.

With supplementary prescribing, unlike independent prescribing, there are no legal restrictions on the clinical conditions for which supplementary prescribers (SPs) are able to prescribe; they can access from the whole British National Formulary.

It will be patients with long-term medical conditions such as asthma, diabetes or coronary heart disease, or those with long-term health needs such as anti-coagulation therapy that are most likely to benefit from this type of prescribing.

A close partnership between the doctor and SP, along with access to patients' medical records and a prescribing budget, is essential for the successful roll out of supplementary prescribing.

Early indications show that it is specialist nurses, such as asthma or diabetic nurse specialists and pharmacists who are the most likely candidates to take on the role of SP. They tend to be the ones who work closely with doctors in GP practices and in secondary care.

Supplementary prescribing offers a number of benefits including, improved inter-professional relationships, more effective use of SPs' skills, reduction in drug errors, and the standardisation of treatment across groups of patients.

In England, there are nearly 5,000 extended/supplementary nurse prescribers and over 450 supplementary pharmacist prescribers. The intention is to roll out extended independent/supplementary nurse prescribing, reaching a target of 10,000 trained extended/supplementary nurse prescribers by the end of 2006.

The trend towards nurse prescribing has support across the board from healthcare professionals and government alike. This is no flash in the pan but rather a long-term commitment. With the number and autonomy of nurse prescribers set to increase, this is an issue pharmaceutical marketers cannot afford to ignore.

There are already relationships between the pharmaceutical industry and the nursing community. However, these tend to be on the basis of the nurse as care giver, patient adviser and user/delivererof a medicine or device, not on the basis of the nurse as the prescriber. The opportunity now open to the industry is a totally different proposition.

The challenge
The industry must learn to engage with nurses in the way that they want to be engaged with, it must understand the different pressures and constraints that nurses face.

It must develop a profile and networks within the nursing community through working in partnership with organisations such as The Royal College of Nursing.

However, it is not all one sided: the nursing community also faces a challenge. Nurses will need to develop their understanding of the pharmaceutical industry and develop a framework in which they can comfortably build an appropriate relationship with the industry.

The development of effective and appropriate channels of communication between the industry and nurses will take time to establish and there will be the need for appropriate investment. But this investment can open up a whole new range of possibilities.

The Authors
Dr Molly Courtenay, Royal College of Nursing, prescribing adviser & reader, Reading University, and Joel Rose, RCN, corporate sponsorship manager