Prescribing Update for Community Clinicians

This one-day prescribing update is designed specifically for community clinicians, with a strong focus on the prescribing decisions, medication risks and clinical challenges encountered in patients’ homes, virtual wards, urgent community response services and wider community practice.

The programme is suitable for a mixed workforce of independent prescribers, supplementary prescribers and clinicians working under Patient Group Directions (PGDs). The day will use practical case discussions and prescribing scenarios to explore safe, evidence-based decision-making in the community.

Rather than taking a traditional GP-focused approach, the programme has been developed around the needs of clinicians working across Primary Care Networks, district nursing, urgent community response, virtual wards, night nursing, palliative care, tissue viability, care-home support, at-home services, pharmacy and MSK services.

Who should attend?

This update is suitable for:

• Community nurses, including V100 and V150 prescribers
• District Nurse Team Leaders and V300 independent prescribers
• Urgent Community Response and Virtual Ward clinicians
• Advanced Clinical Practitioners
• Night nursing teams
• Palliative care nurses
• Tissue Viability Nurses
• Care Home Support and At Home teams
• Pharmacists working with Virtual Ward and community services
• Physiotherapists and MSK clinicians, including V300 prescribers
• Other nurses and AHPs who prescribe, administer medicines under PGDs or contribute to medicines optimisation and monitoring

Course aims

The course aims to strengthen confidence in safe prescribing, medicines optimisation, clinical monitoring and escalation within community settings.

The emphasis will be on recognising when medicines may be contributing to deterioration, adapting prescribing to frailty and comorbidity, identifying high-risk medicines, applying current prescribing guidance and knowing when treatment should be reviewed, withheld, changed or escalated.

Learning outcomes

By the end of the day, participants will be able to:

1. Apply current prescribing guidance to common presentations encountered in community practice, including respiratory disease, diabetes, dermatological conditions, women’s health and infection.
2. Identify high-risk medicines and prescribing situations that require additional monitoring, caution or escalation, particularly in older people, people with frailty and those receiving multiple medicines.
3. Recognise the impact of renal impairment on prescribing, including when dose adjustment, additional monitoring or review of potentially nephrotoxic medicines may be required.
4. Assess medication-related deterioration in the community, including adverse drug reactions, interactions, treatment failure and medicines contributing to falls, confusion, dehydration or acute kidney injury.
5. Apply antimicrobial stewardship principles when managing common infections, including when antibiotics are indicated, when they should be avoided and when microbiological investigation or escalation is required.
6. Review prescribing during transfer of care, identifying medication discrepancies following hospital discharge and improving medicines reconciliation across hospital, GP, pharmacy and community services.
7. Optimise respiratory prescribing by reviewing inhaler therapy, adherence, technique, corticosteroid use, exacerbation management and current asthma and COPD recommendations.
8. Recognise key prescribing considerations in diabetes, including sick-day management, insulin safety, hypoglycaemia, SGLT2 inhibitors, GLP-1 therapies and diabetes management in frailty and palliative care.
9. Apply safe dermatology prescribing principles, including topical corticosteroid use, emollient prescribing, antimicrobial stewardship and assessment across different skin tones.
10. Apply safe prescribing principles in women’s health, including menopause, HRT, vaginal and urinary symptoms and recognising presentations that require investigation or referral.
11. Consider pain, neurological and cardiovascular medicines within the wider context of frailty, polypharmacy, renal impairment and community monitoring.
12. Work safely within individual scope of practice, recognising the differing responsibilities of V100/V150/V300 prescribers, clinicians using PGDs and members of the wider multidisciplinary team.

Programme

Community-focused case discussions

Throughout the day, delegates will work through practical cases drawn from community settings, including:

• A frail older patient recently discharged from hospital with medication discrepancies
• A patient taking high-risk medicines who develops dehydration and possible acute kidney injury
• An older person with confusion and suspected UTI
• A virtual ward patient with poorly controlled diabetes during acute illness
• A patient with worsening asthma who is overusing their reliever inhaler
• A district nursing patient with possible cellulitis or an infected wound
• A patient with eczema requiring review of topical corticosteroid prescribing
• A woman seeking advice about HRT and menopausal symptoms
• A patient taking anticoagulants who has also started an OTC NSAID
• A patient whose prescribing needs change because of frailty, renal impairment or palliative care

Teaching approach

The day will be interactive and case based, using prescribing scenarios to encourage delegates to consider:

• What is the clinical problem?
  Is medication contributing?
  Should I prescribe, review, withhold or escalate?
  What monitoring is required?
  Is this within my scope of practice?
  Who else in the multidisciplinary team needs to be involved?