Medicines Bill a “threat to patient safety"
Tuesday, 5 October 1999
For immediate release
Dr Ralph Wiles
Medicines Amendment Bill “potential threat to patient safety”
The Medicines Amendment Bill which was passed by Parliament today extending prescribing rights initially to nurses and potentially to other health sector groups in future could jeopardise patient safety, says the Royal NZ College of General Practitioners.
The Bill sets out the framework but not the detail for prescribing by groups other than doctors. However, the proposed regulations already drafted by the Ministry of Health cause the College great concern over potential threats to patient safety. These plans allow for the autonomous diagnosis and treatment of patients by nurses.
"We recognise the special training and expertise of nurses working in a specialised area of practice, such as diabetes care" said College Chairperson Dr Ralph Wiles. "We support the introduction of nurse prescribing in collaboration with doctors and other members of a team. This could be started quite quickly and safely, and there is demand and support for this within both the nursing and medical professions.
"Independent diagnosis and treatment by nurses is quite different," explained Dr Wiles. "We believe that the proponents of this approach seriously underestimate its difficulties and dangers. It is not possible to plan treatment for a patient without a proper diagnosis. The average GP spends 11 years in some sort of training, with repeated assessment, before the Medical Council certifies him or her as qualified to diagnose and prescribe without some type of supervision. If nurses are to do the same work, they need the same training and regulation as doctors."
In addition to quality and safety concerns, the College believes that encouraging independent nurse practitioners to operate separately from the existing primary health care system will only increase fragmentation and poor co-ordination of care.
“The demand for independent prescribing for nurses appears to us to come from a small number of enthusiasts, and is not supported by most of the nursing profession,” Dr Wiles said. "We support the proposed New Prescribers Advisory Committee established by the Bill, but have serious reservations about its composition and terms of reference," he added.
"There is potential for increased quality of patient care, enhanced teamwork, and advancement for nurses if a collaborative approach is followed. However, there is also the potential for the proposal to go seriously wrong. The RNZCGP and the New Zealand Nurses Organisation have both proposed a limited introduction of nurse prescribing in an area of specialised practice. It would be tragic for the New Zealand public to be casualties of another 'unfortunate experiment'".