key: cord-0920186-bp6w2as0 authors: Stiles, Clare title: Health visitor prescribing during the Covid-19 pandemic date: 2021-04-24 journal: Case Rep Womens Health DOI: 10.1016/j.crwh.2021.e00317 sha: 940297f74ef1dbb98c2b8e853b7c406e21a3050e doc_id: 920186 cord_uid: bp6w2as0 nan Health visitors are registered nurses or midwives who have completed further university training, usually at master's level, in community public health nursing. They provide a universal service by working with individuals, families and groups using a public health framework to reduce health inequalities, focusing on preschool children and their families. 'Health visitor' is a term used in the UK, Norway, Denmark and Finland, but similar models of nursing have other titles, such as Child Health Nurse in Sweden, Public Health Nurse in Ireland, the USA and Canada, Plunket Nurse in New Zealand and Social Nurse in Belgium [1] . The majority of health visitors have completed a prescribing qualification as part of their training, and this can be one of several different forms of prescribing qualification. In the UK, most health visitors will have the V100 qualification, also known as Community Practitioner Nurse Prescriber, which allows them to prescribe from only a small formulary of medications and medical appliances within the British National Formulary (BNF). These include medications for constipation, dry skin, anti-pyretics, anti-infestations and anti-fungals. Some health visitors have become qualified as independent prescribers, also known as V300, which allows them to prescribe from the whole BNF as long as it is within their sphere of competence, which is maternal and child health. Health visitors are ideally placed to prescribe for the common conditions in maternal and child health. However, a growing body of research suggests that health visitors are not using these qualifications and skills to prescribe for their clients, but are asking General Practitioners (GP) or Advanced Nurse Practitioners to prescribe for them. Coull et al. [2] discovered, in a review of nurse prescribing across Scotland, that a significant number of health visitor prescribers were not actively prescribing for clients, despite GPs supporting nurse prescribing, particularly in specialisms in which the nurse or health visitor was more knowledgeable than the GP. This would apply to conditions such as cow's milk protein allergy and ductal candida infection in breast-feeding mothers. Brooks [3] , Bishop and Gilroy [4] and Rippon and Massey [5] identified several barriers to health visitors' prescribing, such as lack of time, continuing professional development sessions which were not relevant to health visiting practice and the formulary for V100 being too limited. Courtenay et al. [6] conducted a Delphi consensus study which identified conditions which health visitors might need to prescribe for, some of which can be prescribed for using the V100 formulary but not all. In Scotland, a national job description for health visitors has been developed at band 7, which relates to an advanced level of practice which would include diagnosing and prescribing for their clients, thus increasing the professional status of health visitors in the view of colleagues and clients. Training and continuing professional development sessions need to be tailored to the needs of health visitors for them to be relevant to practice within this specialism, and recognition of previous experiences of barriers to prescribing could be overcome by the use of mentors to promote prescribing practice. Muncey [7] reported that clients who had received a prescription from their health visitor did not go on to consult a GP about the same condition. Health visitors are motivated to prescribe in order to enable children and their families to receive medication timeously and without necessitating an appointment with a GP, thus saving time and effort for all involved; however, not all clients are aware that health visitors can prescribe. As health visitors have continued to visit families in their own homes throughout the Covid-19 global pandemic, health visitor prescribing has prevented families from having to attend GP surgeries to seek medication, thus saving GP time, and reducing the risk of infection for GPs and families by reducing face-to-face contact. The V100 qualification is too limited for health visiting practice as it does not allow the health visitor to prescribe for conditions such as cow's milk protein allergy, ductal fungal infections in breast-feeding mothers, mastitis, gastro-oesophageal reflux disease in infants, etc. However, the V300 is too much for health visiting practice as it includes learning skills and knowledge suitable for treating adults with complex health needs, which a health visitor would never prescribe for. Continuous Professional Development (CPD) updates on prescribing practice centre on the acutely ill adult. This is a barrier to health visitors and inappropriate for their sphere of practice, so a prescribing qualification and formulary specifically for health visiting practice is required, as are refresher study days for prescribing within health visiting practice. It should be relatively easy to audit the conditions which health visitors need to prescribe for and a formulary of drugs and treatments could be agreed to extend prescribing beyond the V100 for health visitors. Education for health visitors, particularly in prescribing practice, should be fit for purpose and relevant to health visiting practice. The prescribing formulary should be targeted for health visiting practice, as should ongoing CPD. Institute Of Health Visiting, Health Visiting Across The World, online Institute of Health Visiting The expansion of nurse prescribing in Scotland: an evaluation Developing health visitor prescribing Maintaining and developing prescribing practice: non-medical prescribing by health visitors in 2015 Non-medical prescribing by HVs Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers: a modified Delphi consensus study The impact of health visitor prescribing and advice on parent/carer use of GP services