| Analytical theme 1: Preparation—organisational readiness for implementation |
Theme 1.1: Clarifying need and advantage of independent prescribing |
Clarifying clinical/service need for independent prescribing |
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| Establishing service pathway gaps |
| Role clarity |
| Theme 1.2: Managerial leadership and support |
Role of managers |
| Recognising value |
| Culture |
| Theme 1.3: Interprofessional environment |
Inter-professional relationships |
| Communication & collaboration |
| Analytical theme 2: Training—optimising practitioner readiness for independent prescribing |
Theme 2.1: Selecting the right practitioners |
Selection |
Adoption was impeded by inconsistent candidate selection policies and lack of workforce planning.141 143 Individual practitioner expectation of professional/personal benefit remained a key driver for IP adoption.128 130 131 136 137 139 Skills requisite to IP (eg, physical assessment and communication skills) were important factors influencing service user and team acceptance of IP.133 134 138 142 144 146 148–150 Motivational barriers (eg, lack of remuneration, fear of litigation and competing professional or personal commitments) disincentivised training uptake.136 141 143
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| Skills and aptitudes |
| Motivation and commitment |
| Theme 2.2: Preparing and supporting practitioners during training |
Expectations of training |
Lack of information on NMP training and support for managing competing work, personal/ academic commitments negatively influenced student learning experiences.127–129 143 146 Standardised allocation of study leave/backfill/protected time and prepared practice mentors were essential to support learning.127–129 132 Additional training buddying schemes helped students better manage the competing demands of training while working.129.
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| Study leave |
| Designated Medical Practitioners |
Analytical theme 3:
Transition—ensuring early prescribing support |
Theme 3.1: Transition as a point of vulnerability |
Self-confidence |
Transition was a point of high vulnerability for new prescribers with an initial lack of confidence often under-recognised by teams.135 137 139 140 146 147 Delineating a minimum scope of practice by restricting formulary and/or using guidelines/protocols facilitated early growth of competence and confidence.136 137 139 140 147 149 Early exposure to prescribing opportunity, time and structured support systems with medical supervision were essential in transition.127 130–132 134–137 139 146 147
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| Theme 3.2: Nurturing confidence and competence |
Minimum competence |
| Experience and exposure |
| Theme 3.3: Transition support needs |
Informal and formal support systems |
| Analytical theme 4: Sustainment—maximising and developing independent prescribing |
Theme 4.1: Service delivery |
Impact on workload |
IP could increase workload and imposed time constraints.130 135–137 139 140 146 150 Role underuse was a risk in community settings if infrastructural requisites (eg, electronic prescribing/IT clinical record access) failed to be implemented.130 132 139 140 146 147 IP for service redesign and sustainability was facilitated by competence development, CPD opportunity and medical/managerial leadership.130 131 134 137 139 140 142 144 146 147 149 150 CPD provision and formal evaluation of IP implementation was inconsistent and lacked standardisation in primary care.130 136 140 147 150 ‘Enhancement’, ‘substitution’ and ‘role specific’ implementation models based on the maintenance or change in prescribing competence, service reconfiguration and/or substitution of services were identified.130 137 139 140 142 144 146 147 149
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| Theme 4.2: Supporting role development |
Role/service expansion |
| Continued professional development |
| Evaluation and reflection |
