Open Access Research article

A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study

Ian J Norman1*, Samantha Coster1, Paul McCrone2, Andrew Sibley3 and Cate Whittlesea4

Author Affiliations

1 King's College London, Division of Health and Social Care Research, London SE1 8WA, UK

2 King's College London, Centre for the Economics of Mental Health, Health Services Research Department, Institute of Psychiatry, Box P024, De Crespigny Park, London SE5 8AF, UK

3 University of Southampton, School of Health Sciences, University Road, Southampton, SO17 1BJ, UK

4 King's College London, Pharmaceutical Science Division, Department of Pharmacy, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NN, UK

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BMC Health Services Research 2010, 10:4  doi:10.1186/1472-6963-10-4

Published: 5 January 2010



Supplementary prescribing for mental health nurses was first introduced in the UK in 2003. Since then, a number of studies have reported stakeholders' perceptions of the success of the initiative. However, there has been little experimental research conducted into its effectiveness. This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing.


A post-test control group experimental design was used to compare the treatment costs, clinical outcomes and satisfaction of patients in receipt of mental health nurse supplementary prescribing with a matched group of patients in receipt of independent prescribing from consultant psychiatrists. The sample comprised 45 patients in receipt of mental health nurse supplementary prescribing for a minimum of six months and a matched group (by age, gender, diagnosis, and chronicity) of patients prescribed for by psychiatrists.


There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care. Total costs per patient for service use were £803 higher for the nurse prescribers' group but this difference was not significant (95% confidence interval -£1341 to £3020).


No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers. The cost appraisal also showed that there was no significant difference in the costs of the two types of prescribing, although the pattern of resources used differed between patients in the two prescriber groups. The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.