Becoming an independent prescriber can be a way of investing in personal development
The focus of this article will be to consider the impact of independent prescribing on aesthetic practice. I would argue that it is fair to suggest that non-medical prescribing can be seen as an aspiration of many medical aesthetic practitioners. So, if this is the case, what makes non-medical prescribing such an attractive proposal to medical aesthetic practitioners? What can be seen as their motivation for doing such a challenging course? I suggest that one of the main reasons for this is that it allows the practitioner to work in a much more independent manner than they previously could (Swaminathan and Patel, 2020), and it reduces the practitioner's reliance on external support.
The benefits of being an independent prescriber
Being an independent prescriber has a positive effect on businesses: not only does it have a financial impact, as the practitioner is no longer paying someone to write their prescriptions, but treatments such as botulinum toxin can be provided from start to finish, which allows the practitioner to work in a more streamlined manner. Additionally, from a practical point of view, independent prescribers do not have to work around other peoples' schedules, so that they can fit in time to prescribe for you.
If considering these factors alone, it is understandable why medical practitioners would wish to become an independent prescriber. As a small business owner, it can be seen as an effective way of not only expanding a business, but also investing in yourself and your own professional development.
Prescribing is also now more attractive because it is more accessible than it used to be. Independent prescribing in nursing was initially introduced in 1999 as an area of specialist practice (Walls, 2019), and, in the past, it was quite difficult to get onto a prescribing course. It was usually only possible for those who practised in specific roles, such as in primary care or within specialist roles. This differs to our medical counterparts, where prescribing has long been a part of medical training (Eriksson, 2018).
It is now easier to get onto a prescribing course, as many institutions accept external candidates, which makes it more accessible. Furthermore, there are now options for online courses that can be done while working around current commitments. This makes it easier for the busy practitioner to have a work–life balance, as they can work around their studies, and it can be done at their own pace.
The challenges of prescribing
So, the aforementioned factors look positive, and it is understandable why medical practitioners would want to become independent prescribers. However, the ability to independently prescribe comes with its own problems, which will be considered in this article.
If considering non-medical prescribing from the perspective of a newly qualified prescriber in the field of aesthetics, it can be difficult to know where to start. Initially, the ability to prescribe provides the practitioner with a new level of practice, as they now have the ability to prescribe a vast number of medicines and devices that were previously unavailable to them. I would argue that this can be stressful, as, from my own experience as a newly qualified prescriber, this can be somewhat overwhelming and daunting initially, and it does take some consolidation time to get used to. This is supported by Pearson et al (2020), who argue that one of the major obstacles faced by newly qualified nurse prescribers is the time that it takes to move from newly qualified to prescribing with confidence. Additionally, there are other issues that the newly qualified prescriber may face that are not expected. One of these is the pressure to prescribe for people who are not professionally qualified.
» If the medical practitioner is not competent or experienced in prescribing a treatment, it can soon become a daunting experience that sits outside of both their professional practice and comfort zone «
While this article is not discussing who should and should not be practising medical aesthetics, from my own experience, I know that there is an expectation, and, in some cases, pressure from some individuals who feel that, as soon as someone has the prescribing qualification, they should be prescribing for them. There are many people who practice medical aesthetics who come from backgrounds that are not professionally registered. It is a debate within itself as to whether people should be practising medical aesthetics when they are not qualified, and it is beyond the scope of this article.
Problems arise when medical practitioners feel pressured to prescribe for non-qualified people. It can be assumed that this is for a variety of reasons; some practitioners may do it for the obvious financial motives, while others may be do it because they feel obliged to and cannot say no. However, by doing this, practitioners need to question whether they are working within their professional boundaries. Lim et al (2017) argue that many newly qualified prescribers are not familiar with the parameters of their practice, and it can be easy to be placed in a situation where they are prescribing for someone and acting outside of both their competency and professional boundaries.
It is easy to forget—or not even be aware of the fact—that, by prescribing for someone else, the prescriber is not only accountable for the prescription, but also for the safe administration of the medication. Therefore, if prescribing a medicine for another practitioner, the prescriber would need to be present to supervise the administration of the medication. In other words, they should be present when the treatment is carried out. However, realistically, how often does this actually happen? I would argue that, if you are going to be present while someone else provides a treatment, then why not just do it yourself? Surely it is not worth taking the risk and putting your professional registration at risk to make a little money.
The effect on one's practice and the implications if anything went wrong need to be considered. It is my view that the Nursing and Midwifery Council (NMC) would take a rather dim view on this, even if something did not go wrong. Graham-Clarke et al (2018) suggest that nurse prescribers should resist the pressure to prescribe not only outside of their specific fields of competence, but also outside of the NMC competencies for prescribing practice.
Issues to bear in mind
As stated earlier, it is fair to say that the majority of medical aesthetic practitioners are undergoing a non-medical prescribing course for two main reasons. Firstly, to work in a more independent manner, and, secondly, so that they can prescribe medicines such as botulinum toxin. At face value, this may seem obvious. However, one factor is that many aesthetic prescriptions (for example, botulinum toxin) are prescribed off licence. Kendrew (2017) suggests that the medical practitioner needs to weigh up the risks and benefits. The patient should be made fully aware of this and involved in the process of whether or not to prescribe.
Other problems can arise when the prescriber is put into a situation that they are not ready for. For example, having a patient who has repeated cold sores (herpes simplex virus) and requires prophylactic acyclovir before treatment. Initially, this can seem quite simple. However, if the medical practitioner is not competent or experienced in prescribing a treatment, it can soon become a daunting experience that sits outside of both their professional practice and comfort zone. Summers and East (2021) support this and argue that newly qualified prescribers need time to acquire the skills to practice in a competent and confident manner. For those who are only used to—or think they will only be—prescribing aesthetic treatments, this can be surprising.
Another example of a possible issue is the prescribing of antibiotics in aesthetic practice. Kalaria et al (2019) suggest that antibiotics overuse can lead to multi-resistant organisms. This is not news for registered nurses and something that we are very aware of. However, sometimes in aesthetic practice, medical practitioners may be in a situation where they have to prescribe antibacterial products for their patients. This can be a dilemma in many ways. Firstly, although a full history has been taken, how can the medical practitioner be sure that the information given is accurate? Unfortunately, the practitioner cannot access to the patient's full medical records and past medical history, so they must be trusted and encouraged to be truthful. While it may sound slightly derogatory, there are some patients who would embellish the truth to have their requested treatment. Therefore, this can be a difficult decision. Secondly, for those who are solely working in medical aesthetics, it is reasonable to suggest that practitioners may not be familiar with antibiotics and current guidelines. Therefore, keeping up to date with and aware of National Institute for Health and Care Excellence (NICE) guidelines is vitally important, as suggested by Thornhill et al (2016). However, when busy and there are demands on one's time, it is not always as simple as it seems.
While the new aesthetic prescriber may now be able to prescribe, they may not be used to the parameters either of the sector, as suggested by Lim et at (2017). This is a difficult situation for the prescriber, and it is possible that they may feel isolated and suffer from a lack of support (or no support if they are the only member of the business), so it can be difficult for them to build up the confidence that they need to prescribe effectively. This is further highlighted by Mchugh et al (2020), who state that the isolation of being a new prescriber can be difficult to overcome. However, one way of addressing it is to have another prescriber to discuss any prescribing issues with. While this sounds like an effective plan, it may also be unrealistic, as many medical aesthetics companies are often operated by a sole proprietor, so there is no support in making prescribing decisions. This is further compounded by the fact that many aesthetic prescribers are not aware of or do not have clear and concise policies or procedures to follow in relation to prescribing.
Conclusion
There are many benefits to prescribing in aesthetics, and it is clear to see why many practitioners would be keen to complete the training to do this, as it provides an increased level of independence and less reliance on external people for prescribing. However, along with this come many factors that can be concerning for practitioners and include pressure from people to prescribe, which may be outside of one's competence as a new prescriber. This needs to be kept in mind when prescribing, and a good understanding of practitioner limitations and the NMC prescribing guidelines is essential in this field of practice.