Objective: Within the UK, after successful completion of a formally recognised programme Parkinson’s Nurse Specialists (PNS) can act as independent prescribers, and as part of their role initiate and/or titrate medication. This paper will explore the impact of PNS prescribing on people with Parkinson’s (PwP) and services.

Background: Parkinson’s medication is complicated and rarely taken in isolation. NMC guidance [1] states nurses who prescribe or advise on medication must only do so if they are suitably qualified and that they must ensure any treatment advised or prescribed is compatible with any other care or treatment [1]. Nurse prescribing has been demonstrated to provide a positive effect on patients, practitioners, and services, albeit the practice can create internal professional and cultural tensions [2]. 

Method: The USP research project, funded by Parkinson’s UK, has explored the role and the scope of the PNS within the UK. Realist approaches [3] were employed to understand what works, for whom and in what circumstances. As part of this project, we examined the role of PNS prescribing and the impact this has on PwP.

Results: 1232 participants (180 PNS/ 791 PwP/ 261 carers) contributed to the survey stage and 45 participants (17 PNS/19 PwP/9 carers) were recruited through a stratified random sample to the in-depth interview stage. 47% of PNS were qualified as independent prescribers, 94% of PNS felt they were expected to prescribe. The medication needs of PwP can be extensive; PNS shared they often prescribed Parkinson’s medications and treated multiple non-motor symptoms. PNS worked in partnership with PwP and provided a personalised and holistic approach to care. Due to the trust established in the relationship, alongside extensive specialist knowledge, medication is a central component of the PNS role. The PNS input also enabled fast and attuned medication changes that was linked to increased concordance. PNS also provide advice and liaised with GPs to improve adherence.

Conclusion: PNS prescribers can significantly improve speed of treatment, reducing long chains of prescription which added time and opportunity for fragmentation. Concordance was improved because of high levels of information sharing, similarly adherence was improved through trust and respect. PNS were highly involved in medication change and decision making, the data overwhelmingly demonstrated the value of the PNS as an independent prescriber.

References: [1] NMC. (2018). The Code Professional standards of practice and behaviour for nurses, midwives and nursing associates. The nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
[2] Nuttall D. (2018). Nurse prescribing in primary care: a metasynthesis of the literature. Primary health care research & development, 19(1), 7–22. https://doi.org/10.1017/S1463423617000500
[3] Brown, S., Dalkin, S., Bate, A., Bradford, R., Allen, C., Brittain, K., Clarke, A., & Hand, A. (2020). Exploring and understanding the scope and value of the Parkinson’s nurse in the UK (The USP Project): a realist economic evaluation protocol. BMJ Open, 10(10), [e037224]. https://doi.org/10.1136/bmjopen-2020-037224

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MDS Abstracts - https://www.mdsabstracts.org/abstract/to-prescribe-or-not-to-prescribe-assessing-the-impact-of-parkinsons-nurse-prescribers/