This is the third and final part in a series of short articles on my experiences of becoming a paramedic prescriber. Previously, I have discussed my experience in getting onto a course, then my experiences during the course itself. In this final part, I will examine how becoming a prescriber has changed my day-to-day clinical practice.
The final hand-in for the non-medical prescribing (NMP) course was early May 2019, with results coming mid-June; then within 10 days, my professional registration had been amended and I was registered as a paramedic independent prescriber. As a profession new to prescribing, I had expected to come across issues with getting registered with the clinical commissioning group (CCG) and then getting set up appropriately as an authorised prescriber within EMIS, the clinical management software we use as a practice.
It was a pleasant surprise to email the CCG on a Friday and be given the approval to start prescribing at the end of the following week. It did take a little more work and some trial and error with my practice management but we did, after a few days, manage to get me set up as a prescriber in a system that currently does not allow paramedics to be prescribers. This will not be representative of every experience of newly qualified paramedic prescribers from what I have seen in online forums. However, in time, as more paramedics become prescribers, these issues are likely to settle, making the transition to prescribing in practice a smoother one.
Despite the issues I encountered, I was able to sign my first prescription within 2 weeks of having the register amended. While this was a daunting experience, it felt like a revolution, as I was able to take responsibility for an entire episode of patient care. I was able to independently assess a patient, decide on any appropriate treatment taking into consideration their renal and liver functions, other medication, comorbid illness, and antimicrobial stewardship among other factors, and then take responsibility for the prescribing decision. My consultations felt more streamlined and complete, and the time saved by not having to wait for a GP to be free to issue a prescription for me reduced the time pressure notably. I even had a regular patient congratulate me the first time I signed my own prescription for her, having explained why I now could.
While on the face of it, all that has changed is my ability to sign a prescription and, in practical terms, this is somewhat true, the gravity of this change has not been lost on me. I would never have said I was under-cautious previously; but now, almost without fail, every prescribing choice I make is double-checked with the British National Formulary, as well as relevant local and national guidance.
Thus far, I have not had any issues thankfully, and long may it continue. Being one of the first paramedic prescribers of hopefully many to come, has instilled me with a sense of additional caution. I would not want anything I did to reflect badly on a profession that is still growing and learning, but whose potential I believe is yet to be fully realised.
In conclusion, the training to become a paramedic prescriber was a lot of work, but enjoyable, and I gained more out of it than I expected. Having completed this, I have found that it has changed my clinical practice for the better; my patients get a more complete service from me, and a more streamlined consultation, and I get to be part of the advancement of the profession. Taking this new responsibility entirely on my shoulders is a daunting exercise, but I have a better understanding of my limitations and am grateful to be working with a supportive team of doctors who will always offer their advice if I find myself unsure or out of my depth.
It has been a busy year but well worth it and I can see that myself, my employer and the health economy at large will reap the benefits for years to come. For anyone in a position to consider the NMP course, I would say take the plunge and enjoy every moment of it.