Róisín Shortall (Dublin North West, Labour)

I thank the Senator for raising this issue and for her good wishes.

The introduction of nurse and midwife prescribing is a significant change in nursing and midwifery practice. There is strong international experience that supports such prescribing as being effective and safe and as improving services to patients. Regulations specifying the legislative requirements and conditions for prescribing of medicinal products by nurses and midwives were signed into law in May 2007. The legislation allows registered nurses or midwives to prescribe a range of medications within their scope of practice provided that they have completed an approved education programme, appropriate clinical experience, been registered with An Bord Altranais as a registered nurse prescriber and authority from the health service provider employing them.

I welcome the initiative shown by the nurses and midwives who have undertaken training as part of the nurse prescribing education programmes. Since the legislation came into effect in May 2007, 662 nurses and midwives have been funded by the HSE to undertake these programmes. Some 322 RNPs are in practice and prescribing in 106 health service providers. The remainder are in training or are preparing to register as nurse and midwife prescribers with An Bord Altranais.

The implementation of nurse prescribing in the community is progressing. Of the 322 RNPs, 211 are from acute hospitals, 97 are from primary and continuing care and 14 are from private organisations.

The HSE issued a circular in July 2011 outlining that GMS prescription pads will be made available to nurse prescribers employed by the HSE who are approved at local level and work in collaboration with GPs who are contracted under the GMS. The HSE considers it appropriate to restrict access to GMS prescription pads to this group of nurses at this time. In this regard, it should be noted that there are other restrictions on access to GMS prescription pads. For example, medical practitioners who do not hold GMS contracts with the HSE do not have access to GMS prescription pads, nor do hospital prescribers.

Turning to the position of patients in private nursing homes, general practitioners are contracted by the HSE under the GMS scheme to provide services to medical card and GP-visit cardholders. Such a patient is registered with his or her chosen GP, who acts as a gatekeeper for prescribing choices for his or her panel of patients. Medical cardholders are entitled to retain their medical cards when they move into private nursing homes. They also have the right to retain the GPs of their choice in the same way as if they were living in the community.

GPs receive a significantly enhanced capitation rate for medical card patients in private nursing homes in view of the additional medical care required by such patients. This includes the prescribing of drugs and medicines for such patients. It is clear, therefore, that the restriction on access to GMS pads does not serve to prevent patients in private nursing homes having appropriate access to drugs and medicines.

Any proposal to provide GMS prescription pads to private nursing home employees would require a very significant policy evaluation, involving a full assessment of clinical, patient safety, contractual and financial implications. I regret to inform the Senator there are no plans to make those changes.