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The number of mental health professionals able to prescribe has, for a number of years, reached beyond medics, but UK clinical psychologists are not yet permitted to train to prescribe. The purpose of this paper is to ask if prescribing could be part of the clinical psychologist's role.

This article lays out three core areas of discussion: what was the drive for non‐medical prescribing? Could psychologists be trained to prescribe? Could prescribing be another tool for psychologists? Currently, UK clinical psychologists are not able to prescribe unless they have an additional qualification as a medic, pharmacist or nurse. This paper ends by considering the position of a clinical psychologist who is also a registered nurse and wonders about the pros and cons of training to prescribe.

It was argued that clinical clinical psychologists who are also registered nurses are best placed and currently perhaps the only clinical psychologists able to train to prescribe. The author questioned his motives for considering training to prescribe and looked at the risks in prescribing.

The author is unsure if he wants to pursue prescribing privileges but makes no objection to clinical psychologists prescribing.

An enormous amount of change has occurred in the last six years for the mental health system in England and the workforce within it. We have seen the 10‐year National Service Framework for Mental Health (Department of Health, 1999) gradually make its impact felt in the form, in particular, of new community mental health teams and structures for delivering care in the community. We have also, most recently, experienced the passing of the Mental Health Act 2007 (HM Government, 2007), after many turbulent years of controversy and argument, extending to nurses and non‐medical practitioners who have been given statutory powers to act as approved mental health practitioners and approved clinicians.Alongside these important developments has been a gradual revolution in traditional ways of working, in the form of the New Ways of Working initiative. This article considers the impact of New Ways of Working on mental health nursing ‐ the single largest professional group within the mental health workforce ‐ and the continuing implications for the profession. The development of nurse prescribing is used as an illustration of the challenges and opportunities that have commonly arisen when new roles and skill sets have been introduced in mental health settings.

The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic medication, the route of administration, and the extent of service users' involvement.

A total of 26 psychiatrists and 12 nurses agreed to be interviewed in phase one of this study, concerning general aspects of prescribing. In phase two, 11 of the psychiatrists and five nurses from the first cohort took part in follow‐up interviews that focused specifically on their most recent prescribing experiences. In phase 3 of the study, 18 service users (14 male and 4 female) were recruited, during which their experiences of having medication prescribed was explored.

This interview‐based survey found that though there was some agreement between the attitudes and perceptions of prescribers and service users, there were also some important differences including differences with respect to the purposes of prescribed medication, when to prescribe, and under what conditions depot medication produces optimal results. It is not always clear to service users as to why certain medicines were prescribed nor is the information provided always understood. A considerable amount of prescribing practice is based on assumptions.

Even though medication (both oral and depot) has been shown to be useful in certain situations, nevertheless, the type of medication, dose and mode of administration continues to be idiosyncratic and inconsistent. This paper seeks to contribute to the debate by identifying in which pharmacological interventions for people with severe mental health problems could be improved.

The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.

Cross-sectional analyses of staff and resident’s record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).

In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants’ assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).

Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.

The purpose of this paper is to lay out how advanced practitioner development occurs in New Zealand primary health care settings. The paper specifically focuses on mechanisms occurring across policy creation and in practice leading to successful role development.

The authors applied a realist approach involving interviews, document review and field log observations to create refined theories explaining how successful development occurs.

Three final mechanisms were found to influence successful advanced practitioner role development: engagement in planning and integrating roles; establishing opportunities as part of a well-defined career pathway; and championing role uptake and work to full scopes of practice.

This research focuses on one snapshot in time only; it illustrates the importance of actively managing health workforce change. Future investigations should involve the continued and systematic evaluation of advanced practitioner development.

The successful development of advanced practitioner roles in a complex system necessitates recognising how to trigger mechanisms occurring at times well beyond their introduction.

Potential candidates for new roles should expect roadblocks in their development journey. Successfully situating these roles into practice through having a sustainable and stable workforce supply provides patients with access to a wider range of services.

This is the first time a realist evaluation has been undertaken, in New Zealand, of similar programmes operating across multiple sites. The paper brings insights into the process of developing new health programmes within an already established system.

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

The Ministry of Health (MOH) is the major healthcare provider in Malaysia, although the service is also being complemented by the private sector which constitutes about 35% of overall healthcare services. Public hospitals in the country are organised into national level, state level and district level. The national level hospital is Hospital Kuala Lumpur, which serves as the National Referral Centre. It is the largest hospital in the country with 2500 beds, providing a comprehensive range of tertiary care services. The state level hospitals provide a comprehensive range of secondary care services and are located in the state capital of each of the thirteen federal states in the country. These are also large hospitals with bed capacity ranging from 800‐1200. The district level hospitals on the other hand, provide basic impatient care services. For those with resident specialist, some secondary level speciality services are also provided. District hospitals without specialities are generally smaller with beds ranging from 30 to 150, while those with specialists may have beds ranging from 200 to 500.