Sir,

An editorial, contained with the British Medical Journal,1 suggested that the legislation passed by the Department of Health to extend prescribing rights to nurses and pharmacists, with adequate training, limited to specialist areas, could provide benefits to the patient by easing access to treatment. Current training programmes were deemed to be too short and unsatisfactory for subspeciality areas.

The perceptions of patients, regarding this legislation, have not yet been fully established. Four hundred patients in general and subspeciality clinics were interviewed by a doctor and invited to answer a questionnaire, in Ophthalmology departments in four hospitals. The questionnaire asked, whether patients felt confident in nurses and pharmacists prescribing medications to them, independently, if they were trained in a particular speciality, and if they were not trained in a particular speciality.

If they were not confident, they were asked to provide possible reasons why—whether they felt there was a lack of appropriate medical training for nurses or pharmacists or whether this was due to a lack of familiarity or a lack of supervision of the professionals involved.

Approximately 60% of patients were confident in trained specialist nurses (238/400) and pharmacists (241/400) prescribing medications independently to them. However, patients were mostly uncomfortable with the notion of untrained nurses (328/400, 82%) or pharmacists (340/400, 85%) prescribing medications to them. The reasons given by those patients answering negatively were as follows: 64% (249/400)—lack of appropriate medical training by nurses or pharmacists, 12% (46/400)—lack of familiarity with the prescriber, 6% (24/400)—lack of supervision and 18% (68/400)—all of the above reasons.

In addition, patients were asked whether they brought their medications or a list of medications with them, and were asked whether they understood their diagnosis, 77% correctly named their diagnosis. Only 19% of patients, however, brought a list of medications with them, which raises a concern that nurses or pharmacists may not be aware of other medications used, and hence not able to account for interactions.

In summary, a significant proportion of patients (40%) are not confident that nurses or pharmacists, with specialist training, can prescribe their medication. A larger proportion of patients (85%) do not appear to be confident with these professional groups prescribing, without additional training. This constitutes a major problem as the authority of specialist nurses or pharmacists will undoubtedly be in question.