2016 P.58

STATES OF JERSEY

r DRAFT HEALTH INSURANCE

(AMENDMENT No. 15) (JERSEY)

LAW 201-

Lodged au Greffe on 31st May 2016

by the Minister for Social Security

STATES GREFFE

Page - 3 P.58/2016

DRAFT HEALTH INSURANCE (AMENDMENT

No. 15) (JERSEY) LAW 201-

European Convention on Human Rights

In accordance with the provisions of Article 16 of the Human Rights (Jersey) Law

2000, the Minister for Social Security has made the following statement

In the view of the Minister for Social Security, the provisions of the Draft Health

Insurance (Amendment No. 15) (Jersey) Law 201- are compatible with the

Convention Rights.

Signed: Deputy S.J. Pinel of St. Clement

Minister for Social Security

Dated: 26th May 2016

Page - 4 P.58/2016

REPORT

Introduction

This report presents amendments to the Health Insurance (Jersey) Law 1967 which

seek to establish a mechanism by which specialist nurses and other health care

professionals can issue community prescriptions for prescription-only medicines.

These amendments will also equalise current provisions by expanding the existing

proper and necessary test to community prescribing. The constitution of the Health

Services Disciplinary Tribunal and Pharmaceutical Benefit Advisory Committee are

moved into Ministerial Orders, and further minor amendments have been made to

clarify and align provisions within the Law.

Prescribing practitioners

Medicines issued on a community prescription can be obtained in community

pharmacies, and the cost of the medicine and dispensing fees are paid for by the

Health Insurance Fund. This is established in the Health Insurance (Jersey) Law 1967

which describes these community prescriptions as pharmaceutical benefit. The Law

currently states that only 2 classes of practitioner may issue pharmaceutical benefit:

these being G.P.s and dentists.

P.82/2012: Health and Social Services: A New Way Forward noted that the demand

for health services is set to increase in Jersey as the population ages. At the same time,

our current workforce is under-utilised, with many working below the competencies

associated with their role. P.82/2012 identified the need for a new health and social

care system, and recommended development towards multi-disciplinary teams formed

around the patient care pathway. The vision suggested these teams would include

specialist nurses who are authorised to prescribe medicines within their scope of

practice, that they might support patient care at home and in the community, reducing

our reliance on institutionalised care models. (These specialist nurses are known as

non-medical prescribers.)

P.82/2012 also noted that

Roles [in Jersey] have not developed in line with international best practice,

as there are only a limited number of expanded role practitioners.

Nonmedical prescribing is only now being developed, and the skill mix needs

to change within teams in order to secure service sustainability and offer

more attractive career options.1

Health and Social Services has successfully implemented non-medical prescribing,

following amendments to the Medicines (Jersey) Law 1995 which enabled the

Minister for Health and Social Services to specify a wider range of practitioners who

may prescribe prescription-only medicines. Three additional pieces of secondary

legislation were subsequently enacted, providing legislation around the individual

registration and regulation of non-medical prescribers

Health Care (Registration) (No. 4) (Jersey) Regulations 2012;

Medicines (Prescription Only) (Amendment No. 8) (Jersey) Order 2013; and

Misuse of Drugs (Miscellaneous Amendments) (No. 4) (Jersey) Order 2013.

Thirty-two nurses have completed a bespoke accredited education programme, and

additional non-medical prescribers have been successfully recruited from the UK.

Currently, there are small specialist teams of nurse prescribers who provide symptom

management to stabilise vulnerable patients within their own homes and prevent

hospital admission. These nurses work in the Rapid Response team. Additionally,

https://www.jerseylaw.je/laws/revised/Pages/26.500.aspxhttp://www.statesassembly.gov.je/AssemblyPropositions/2012/P.082-2012.pdfhttps://www.jerseylaw.je/laws/revised/Pages/20.625.aspxhttps://www.jerseylaw.je/laws/enacted/Pages/RO-118-2012.aspxhttps://www.jerseylaw.je/laws/enacted/Pages/RO-082-2013.aspxhttps://www.jerseylaw.je/laws/enacted/Pages/RO-166-2013.aspx

Page - 5 P.58/2016

there are qualified prescribing practitioner nurses working within the specialist

palliative care team who will be able to offer advanced symptom control, and thus

provide choice for terminally-ill patients who wish to die in their own homes. Further

prescribing practitioners (such as practice nurses, district nurses and community-based

pharmacists) could similarly provide improved medicines management across the

Island to patients in a primary care context. The development of such roles enables

service redevelopment to be optimised, and improvements to patient care. In addition,

specific medical roles within the Hospital may also be identified as prescribing

practitioners under the Health Insurance Law to allow new care pathways to be

developed, straddling secondary and primary settings. For example, the introduction

of a specialist palliative care consultant could offer care for patients irrespective of

their care setting, in the General Hospital, in the Hospice, and in their own homes.

Approval to prescribe in the community from the Health Insurance Fund

Non-medical prescribers in other jurisdictions have proven to be highly successful in

providing safe and cost-effective care. Their impact locally can be enhanced by

approving them to issue pharmaceutical benefit within the Health Insurance Law. This

will enable patients (or their carers) to collect medicines from community pharmacies

rather than the General Hospital pharmacy.

To this end, these amendments to the Health Insurance Law expand the class of

practitioner who may issue pharmaceutical benefit to include prescribing

practitioners identified under Article 57(1) of the Medicines (Jersey) Law 1995. The

primary Law is amended to enable an approval process to be established by

Ministerial Orders, whereby individual prescribing practitioners can be approved

according to the service they are providing and the environment (primary care and

community) in which they are working.

The Health Insurance Law already provides an approval process for General

Practitioners (established within the G.P. performers list). The Law has offered some

provision to approve dentists to issue pharmaceutical benefit, but this has not been

enacted. To equalise the treatment of all prescribers under the Health Insurance Law,

these amendments also seek to establish an approval process for dentists. As with non-

medical prescribers, approval will be a simple administrative process established

under Ministerial Orders.

The implementation of an approval process will enable the Minister to maintain a

nominal roll of community prescribers as has been envisaged by Article 26 of the

Law, and will improve the operational procedures for monitoring community

prescriptions.

It can be stressed that in no part does the Health Insurance Law determine which

health professionals may or may not prescribe within the qualification of their

profession. The ability of practitioners to prescribe prescription-only medicines is

established under the Medicines (Jersey) Law 1995, which registers health care

professionals.

Proper and necessary

Medical Benefit is paid from the Health Insurance Law in respect of G.P.

consultations, and the Law requires that the benefit may only be claimed in respect of

G.P. medical services which are proper and necessary. This amendment seeks to

echo this test and apply it to all prescribing funded by the Health insurance Fund, thus

equalising the provisions of the Law to each benefit created under the Law.

Page - 6 P.58/2016

Health Services Disciplinary Tribunal

The Health Insurance Law establishes a Health Services Disciplinary Tribunal which

may rule on the activity of G.P.s and dentists with respect to medical benefit and

pharmaceutical benefit. The Tribunal thus enables the Minister to challenge

practitioner activity and take recommendations on the use of the Fund, when it is

deemed there is cause to do so. This amendment increases the scope of the Tribunal to

include any approved practitioner who may issue Health Insurance Law benefits, thus

capturing the newly-created non-medical prescribers.

The Law currently restricts the issues which the Tribunal may consider to activities

which may be prejudicial to the efficient administration of the Health Insurance Law

or cause an unreasonable cost to the Health Insurance Fund. This is maintained, but

will capture the ability to consider whether prescribing has been proper and

necessary as discussed above. Currently, the Tribunal may only recommend that a

practitioner repay money to the Fund or that their approval is removed. This