A new army of nurses with additional training may soon be allowed to prescribe medicines. The ministry of health and family welfare has introduced an amendment in the National Medical Commission (NMC) Bill, a wide-ranging legislation for reform in medicine, to allow nurse practitioners to able to prescribe drugs.

The government has moved quietly to create a new cadre of non-MBBS medical professionals with rights to practice and prescribe medicine in specified areas and under specified conditions. The move comes after the Parliamentary Standing Committee on Health rejected the National Medical Commission Bill provision enabling Ayush practitioners to prescribe a listed set of medicines after taking a bridge course.

Taking a cue from the committee’s recommendations to consider giving limited drug-prescription rights to nursing practitioners or pharmacists instead of Ayush experts, the Ministry of Health drafted a new provision in the Bill to grant a limited license to practice medicine to non-MBBS medical practitioners. The amended provision recently cleared the Cabinet hurdle and will now be part of the official amendments the government will move to the NMC Bill in the next session of Parliament. The new provision coins a new term, “mid-level medical practitioners”.

“Mid-level medical practitioners will get a limited license to practice specified medicines in primary and preventive healthcare settings and in other settings under the supervision of a medical doctor,” says the new section in the Bill. The Bill also provides for a separate register to list such mid-level medical practitioners with limited drug prescription rights. This register will be maintained by the Board of Ethics under the NMC, which will replace the Medical Council of India once the law is passed by Parliament and assented to by the President. So far under the Indian laws, only MCI-licensed and registered medical doctors can practice medicine and prescribe them. So now under the amended NMC Bill there’s a provision to maintain two registers — one of the licensed MBBS doctors and the other of specified mid-level medical practitioners with limited medicine prescription and practicing license. According to the bill, the nurse practitioners may also be allowed to perform some surgical or critical procedures under the supervision of senior doctors, and in certain circumstances.

Once through, the new cadre of mid-level medical practitioners will get to prescribe specified medicines independently in settings specified by the NMC and in hospital settings such as ICUs under medical doctors’ supervision. Those who qualify as mid-level medical practitioners include non-MBBS medical professionals such as a nursing practitioner who has done a specific nursing course like tertiary nursing care; pharmacists, physician assistants, optometrists, among others, ministry sources said. These practitioners will be specifically listed by the NMC.

The idea is to tide over the crisis of dearth of doctors in rural areas. India’s doctor-patient ratio is a dismal 1:1600 as against the WHO mandated 1:1000.

 

Nurse practitioners, a key part of hospital staff in several developed countries, are nurses with additional educational qualification and the permission to function in an extended medical role. The government has been trying to raise a cadre of non-MBBS medical professionals in certain fields to address the lack of medical attention arising from the shortage of doctors, especially in rural areas.

The amendment has been cleared by the Union Cabinet. A senior official in the ministry said the amended bill will be presented in the next session of Parliament.

“To fulfil the delivery of healthcare services in rural areas and share the workload of senior doctors, we have decided to allow nursing practitioners to prescribe and practise modern medicine,” Jayshree Mehta, president of the Medical Council of India, Said.

The move comes a month after the government junked a controversial amendment seeking to introduce a bridge course that would have allowed Ayush (Ayurveda, Yoga, Unani, Siddha, and Homoeopathy) practitioners to practice allopathic medicine to a “limited extent”.

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