Prescribing nurses in care homes

An independent prescriber is someone whose role is to assess patients with previously diagnosed or undiagnosed conditions and is responsible for making decisions about the clinical management required, including prescribing medicine.[1] As other professions are mostly associated with prescribing rights, the term ‘non-medical prescribing’ (NMP) denotes any prescribing completed by a healthcare practitioner who is not a doctor, nor a dentist.

Nurse prescribing was firstly introduced in the UK in 1998.[2] An ‘independent prescriber’ is a nurse who is registered with the Nursing and Midwifery Council (NMC) and has successfully completed an Independent Nurse Prescribing Course (also known as a v200 or v300 course[3]) with the organisation. Only nurses who have passed the programme, and have the necessary competency, are able to prescribe medications.

Independent prescribing is particularly beneficial in a Nursing or Care home setting where service users often have more complex needs. Delivering responsive care at the right time can be crucial for their wellbeing. What’s more, employed prescribing nurses can provide person-centred care as they know their residents and can notice and act on changes in their health, making them a really important asset to any Nursing or Care home. However, as any other business, care homes need to be aware of some of the risks associated with having independent prescribers providing care and medicine to service users.

The importance of having appropriate cover

Care providers may either employ non-medical prescribers (NMPs) in-house or outsource such services to external contractors. Those nurses are expected to have some level of personal protection in place, such as the one that is provided by a Medical Defence Union (MDU), in the event of civil damage or claims of that nature.

However, from numerous discussions we’ve had with prospective clients over the years, we’ve discovered that many insurers do not provide any contingent liability that links to the services provided by a prescribing nurse employed by the business.

Unfortunately, this creates a gap in coverage and means that in the event of a malpractice claim allegation or a civil claim for damages, the business is exposed if the claimant or family include the employer in any litigation or legal correspondence. All this could potentially lead to significant costs. Therefore, it is critical to discuss the extent of your coverage with your broker to ensure you are adequately protected if this situation arises.

Solutions that provide peace of mind

Standard business insurance may not include specific protections against risks that exist in the care sector. This could leave your business, staff and service users exposed. Hence, areas to consider include:

• Medical Malpractice or Treatment risk insurance – It is important to recognise the difference between these two descriptions. Malpractice includes protection for diagnosis and prescription services, whereas Treatment Risk provides protection for ‘errors and omissions’ in the provision of medical services (with a specific exclusion around diagnosis and prescription services). Most providers will be fully protected with Treatment-type cover but if you employ or use prescription nurses you may need to consider your exposures and insurance protections further.

• Public Limits of Liability – Most commissioners will required you to carry a minimum of £10M Public Liability protection. This cover can extend to include the ‘treatment’ protection with inner limits often applying. Our recommendation would be to carry a minimum of £5M limit of protection for the ‘treatment’ covers.

Consider ahead of renewal

Finally, be aware of potential new limitations or exclusions within your renewal terms. Set time aside to review documents carefully with your broker. They will be able to carefully review the terms with you, pointing out any changes in cover and their potential consequences.

At Howden, we can arrange such protection, we do not operate a ‘one-size-fits-all’ approach. We know that care and nursing homes are different in terms of the support provided, the residents you look after and the way you deliver care. This can range from utilising the latest technology to providing more intense 1-2-1 services and care packages. What should also be recognised is that the required level of support needed can differ, as well as the environments in which care is provided.

We have a team of experienced account handlers who can help advise you at this difficult time. Contact Howden’s expert team on 0117 205 1850 or email [email protected] for more information.