Introduction
As a future non-medical prescriber, I am preparing for the complexities of clinical practice, where prescribing decisions carry significant legal, ethical, and accountability implications. This essay critically explores these dimensions through a specific patient scenario: being asked to prescribe medication on behalf of a colleague. This situation is relevant to my future role, as it raises questions about professional boundaries, patient safety, and adherence to regulatory frameworks. Using the first-person perspective, I will examine the legal requirements governing prescribing, the ethical dilemmas inherent in such a request, and the accountability mechanisms that ensure safe practice. Structured into three distinct sections for clarity, this discussion draws on prescribing and professional literature to analyse the challenges and demonstrate independent critical thinking. My aim is to highlight the importance of navigating these issues with caution and integrity in my future practice.
Legal Issues in Prescribing on Behalf of a Colleague
Legally, prescribing medication is a highly regulated activity in the UK, and as a non-medical prescriber, I must adhere to strict guidelines to ensure compliance. The Medicines Act 1968 and subsequent regulations, including the Human Medicines Regulations 2012, outline that prescribers are responsible for their decisions and must act within their scope of practice (Department of Health, 2012). In the scenario of prescribing on behalf of a colleague, I face the risk of breaching these laws if I have not personally assessed the patient. The Nursing and Midwifery Council (NMC) Code (2018) explicitly states that I must only prescribe based on my own clinical assessment and knowledge of the patient’s condition (NMC, 2018). If I were to prescribe without this, I could be held liable for any adverse outcomes, as I would be acting outside my legal authority.
Furthermore, guidance from the General Pharmaceutical Council (GPhC) reinforces that prescribing must be an autonomous decision, free from undue influence or delegation (GPhC, 2019). Therefore, agreeing to a colleague’s request without independent evaluation could result in professional misconduct charges or legal action if patient harm occurs. For instance, if the prescribed medication leads to an adverse reaction due to an unassessed allergy, I would bear responsibility for failing to uphold my legal duty of care. This scenario underscores the importance of understanding and adhering to legal boundaries in my future role, ensuring that I prioritise patient safety over collegial pressure.
Ethical Challenges in the Prescribing Scenario
Ethically, the request to prescribe on behalf of a colleague presents significant dilemmas, centring on principles such as beneficence, non-maleficence, and professional integrity. As a future prescriber, I am guided by the NMC Code (2018), which emphasises acting in the best interests of the patient and avoiding harm (NMC, 2018). In this scenario, prescribing without a personal assessment risks compromising patient safety, as I may lack critical information about their medical history or current condition. This directly conflicts with the principle of non-maleficence—doing no harm—which is a cornerstone of ethical practice.
Moreover, there is an ethical tension between maintaining collegial relationships and upholding professional standards. Refusing a colleague’s request might strain workplace dynamics, yet agreeing could undermine trust in my professional judgement if harm ensues. Indeed, Beauchamp and Childress (2019) argue that ethical decision-making in healthcare often involves balancing competing obligations, and in this case, patient welfare must take precedence over collegial harmony (Beauchamp and Childress, 2019). Reflecting on this, I recognise the need to develop assertiveness in declining inappropriate requests, while communicating respectfully to preserve working relationships. This dilemma highlights the complexity of ethical decision-making in prescribing and the importance of grounding my actions in patient-centred values.
Accountability in Prescribing Practice
Accountability is a critical aspect of non-medical prescribing, encompassing responsibility for clinical decisions and their outcomes. As a prescriber, I am accountable to patients, employers, and regulatory bodies such as the NMC, ensuring that my actions align with professional standards (NMC, 2018). In the context of prescribing on behalf of a colleague, accountability poses a significant challenge because I would be personally liable for the prescription, even if acting under instruction. The Royal Pharmaceutical Society (RPS) competency framework for prescribers stresses that accountability rests with the individual making the prescribing decision, requiring a thorough understanding of the patient’s needs and treatment rationale (RPS, 2016).
This scenario also raises questions about vicarious liability and the role of organisational policies. While employers may provide indemnity for actions within my scope of practice, prescribing without assessment falls outside this protection, leaving me vulnerable to disciplinary action or litigation (Griffith and Tengnah, 2020). To mitigate such risks, I must ensure robust documentation of any decision-making process and, if faced with such a request, clearly record my rationale for refusal or alternative actions taken. Additionally, engaging in reflective practice and seeking supervision will be essential in my future role to address accountability challenges. By critically evaluating similar scenarios during training, I can build confidence in maintaining accountability, even under pressure from colleagues.
Conclusion
In conclusion, prescribing on behalf of a colleague presents multifaceted challenges across legal, ethical, and accountability domains, each demanding careful consideration in my future role as a non-medical prescriber. Legally, I must adhere to regulations that prohibit prescribing without personal assessment, ensuring compliance with frameworks like the Human Medicines Regulations and the NMC Code. Ethically, the scenario tests my commitment to patient safety over collegial pressures, highlighting the need to prioritise beneficence and non-maleficence. Accountability further underscores my individual responsibility for prescribing decisions, necessitating robust documentation and reflective practice to safeguard patient welfare. Together, these insights reveal the complexity of prescribing in clinical settings and the importance of developing resilience and assertiveness to navigate such situations. Moving forward, I am committed to continuous professional development to strengthen my competence in managing these challenges, ensuring that my prescribing practice remains safe, ethical, and legally sound. This critical exploration not only prepares me for future scenarios but also reinforces the significance of patient-centred care in all aspects of my role.
References
- Beauchamp, T.L. and Childress, J.F. (2019) Principles of Biomedical Ethics. 8th ed. Oxford: Oxford University Press.
- Department of Health (2012) The Human Medicines Regulations 2012. London: The Stationery Office.
- General Pharmaceutical Council (GPhC) (2019) Standards for Pharmacy Professionals. London: GPhC.
- Griffith, R. and Tengnah, C. (2020) Law and Professional Issues in Nursing. 5th ed. London: Learning Matters.
- Nursing and Midwifery Council (NMC) (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: NMC.
- Royal Pharmaceutical Society (RPS) (2016) A Competency Framework for All Prescribers. London: RPS.
