Prescribing can be seen as an advanced area of practice, with associated professional, clinical governance, legal, and ethical considerations. When you are legally able to prescribe, there is an onus to be aware of these and to be able to demonstrate at all times that you have fulfilled your duty of care. This duty is professional in working within your scope of practice, legal in being able to clearly articulate the logical basis of informed decision-making, and ethical in weighing up the risks, benefits, and autonomy of the people in your care. 

This section provides: 

• links to the professional prescribing standards 

• a brief history of the laws underpinning prescribing;

• information about continuing professional development

• recommended reading

Prescribing for practitioners other than Doctors developed rapidly over the years. A series of changes in law were prompted by the Cumberlege review of community nursing services in 1986 (DHSS, 1986). The key legal developments to enable prescribing for nurses and midwives can be seen in the timeline illustrated in Figure 1. There are other dates of pertinence to Pharmacists and Allied Health Professionals and prescribing continues to expand. 

Some of the core legal imperatives as a professional apply to prescribers, such as confidentiality and consent. Key legal topics that are covered on most prescribing courses include:

• duty of care and negligence

• confidentiality

• consent and capacity

• Gillick competence and Fraser Guidelines

• prescribing laws and regulations

It is useful to stay attuned to new laws, as it is never a defence in court to claim you were unaware of a particular law. For example, it is important to sign up to the MHRA alerts and to note significant changes to medicines law, such as the Human Medicines Regulations. 

Seminal work by Beauchamp and Childress (2004) noted 4 principles of biomedical ethics that continue to underpin our clinical and prescribing decisions. A balance between acting in a way that is of benefit (beneficence), whilst avoiding harm (non-maleficence) and promoting informed decision-making (autonomy) requires examination. The final principle of justice, where we practice in a fair way, can be viewed through the lens of standardisation of care, for example, clinical guidelines and care protocols. Given the need for guidelines to include economic analysis, there can be conflict between the four principles which prompts the need for critical analysis.  

Resource links are provided to help you explore this topic further.

Professional requirements entail a set number of participatory and other continuing professional development experiences. However, as a prescribing who is accountable for decisions, it is likely that more time is needed to keep up to date with research, guidelines, pharmacology and in growing your scope of practice. Continued learning is needed to fulfil your professional and legal duty of care, with a requirement to be able to explain the process by which decisions have been made.

One way to identify CPD needs is to consider the "Pieces" of information needed for safe clinical decision-making

The PIECES model for improving clinical decision-making

Growing scope of practice involves confidence in decision-making and an ability to apply key principles to a wider set of circumstances or conditions. The PIECES model has been developed to illustrate the continual process of justifying sound decision-making while identifying ongoing development needs. Having the skills and confidence to diagnose is essential to prescribing, but it is likewise important to always question the basis of decisions, be open to alternatives and to be self-aware of the influence of personal views or knowledge limitations. This model aims to prompt practitioners to stop and think about their consultations. Each part includes questions to self-assess decision-making processes and development needs.