Stakeholders' views of the Use of Standing Orders in General Practice

Abstract

BACKGROUND : Standing orders are an integral part of general practice in New Zealand. They allow a practice nurse (PN) to assess a patient, diagnose an illness and administer a medication without needing intervention from a general practitioner (GP). Their use is usually in relation to common differentiated illness. There is a paucity of research on the use of standing orders in general practice, either in New Zealand or internationally. The aim of this study is to explore organisational stakeholders’ views of standing order use in general practice in New Zealand.

RESEARCH DESIGN AND METHODS : Inductive thematic analysis was used in this qualitative study to identify and report emerging themes from the data collected from eight semi-structured interviews with participants representing key stakeholder organisations from nursing, medicine and pharmacy.

RESULTS : There were three key themes. The first being a lack of understanding on the use of standing orders at organisational stakeholder level. The second was legal and professional concerns for those using standing orders. The third theme related to the potential impact of standing orders on nursing practice. However, all participants saw standing orders as a useful tool to enable patients access to medications in a timely, effective manner while also enhancing nursing practice.

CONCLUSION : The variability of understanding and use of standing orders and a lack of knowledge as to legal and professional requirements on the part of GPs and PNs may, in part, be related to a lack of resources to provide information, training and advice. National standardisation of standing order templates, appropriate training on assessment and diagnosis for PNs and education on the legal requirements for GPs and PNs may address these issues. Standing orders were perceived by stakeholders to be a useful tool in general practice to enable patients to be seen and treated by PNs in an effective, timely fashion without the need to involve a GP. They were also a potential mechanism to enhance nursing practice and a possible solution to the expected general practice workforce shortages in the future.