Medicines optimisation, is a person-centered approach to the safe and effective use of medicines that ensures people obtain the best possible outcomes (NICE, 2015). This approach goes beyond traditional medicines management by focusing on shared decision making, evidence based prescribing, and supporting individuals to use their medicines in a way that maximises benefit and minimises harm.

Good medicines optimisation is a fundamental aspect of nursing and midwifery practice. It encompasses the safe administration of medicines, appropriate prescribing, and supporting people to use their medicines effectively. A medicines optimisation approach places the person at the centre of care, ensuring treatment is better targeted and individuals are better informed, ultimately helping them achieve the best possible outcomes from their medicines.

Good medicines management is an integral part of most nursing and midwifery practice and includes the administration of medicines, prescribing and supporting people to take their medicines correctly.

All medicines are classified according to three legal categories which are:

• Prescription-Only Medicines (POM): Must be sold or supplied according to a prescription prescribed by an appropriately qualified health practitioner, this can be a doctor, dentist, or other independent or supplementary prescriber. They can generally only be supplied at a registered pharmacy premises by or under the supervision of a pharmacist.
• Pharmacy (P) Medicines: Can generally only be sold or supplied at a registered pharmacy premises by or under the supervision of a pharmacist.
• General Sales List (GSL) medicines: Can be sold from a wider range of premises such as supermarkets as long as those premises can be closed to exclude the public (i.e. they are lockable) and the medicines are pre-packed.

The legislation on medicines regulation is clearly defined under the Human Medicines Regulations 2012. Prescription only medicines (POMs) cannot be administered or supplied unless one of four types of instruction is in place:

• a signed prescription
• a signed Patient Specific Direction (PSD)
• a Patient Group Direction (PGD)
• a Vaccine Group Direction (VGD).

There are some specific exemptions in medicines legislation which may apply in limited circumstances, for example:

• The administration of certain parenteral medicines such as adrenaline that can be administered in an emergency without the directions of a prescriber.
• In occupational health settings, the legislation allows for the supply and/or administration of medicines specified in a written instruction signed by a medical practitioner.

The Specialist Pharmacy Service website outlines the key legal frameworks that govern how medicines can be supplied and administered, along with guidance to help determine the most appropriate mechanism for different situations.

For medicines optimisation in social care settings, there are several resources that outline the standards, requirements, and good‑practice expectations for safe and effective medicines management.

NICE Guideline – Managing Medicines in Care Homes (SC1)

This guideline sets out the national evidence‑based standards for how medicines should be handled in care homes. It covers the full medicines pathway and is the primary reference for providers, managers, and staff.

CQC – Adult Social Care Medicines Resources

The Care Quality Commission provides practical guidance on what “good” looks like when they inspect medicines management in adult social care services.

Regulation 12 (Safe Care and Treatment): What providers must do to ensure medicines are handled safely, including risk assessments, storage, and administration.

Regulation 17 (Good Governance): Requirements for accurate records, audits, and oversight of medicines systems.

Inspection expectations: What inspectors look for during visits, including MAR chart quality, stock control, PRN protocols, and controlled drugs management.

This resource helps providers understand how CQC assesses medicines safety and what is required to meet regulatory standards.

RCN

• RCN advice guide. Non-medical prescribers.
• RCN. Medicines optimisation subject guide.
• RCN. Children and young people: Medicines optimisation subject guide.

Royal Pharmaceutical Society (RPS)

• RPS Designated Prescribing Practitioner Competency Framework. This new framework will help universities running independent prescribing programmes, NHS trusts and boards with independent prescribers, trainee independent prescribers and experienced independent prescribers to understand the expectations for a DPP through standardised competency descriptors.
• RPS. A Competency Framework for all Prescribers. This framework sets out what good prescribing looks like. It describes the demonstrable knowledge, skills, characteristics, qualities and behaviours for a safe and effective prescribing role.

NICE

• NICE. Medicines and Prescribing Centre provides support for medicines and prescribing.
• NICE. Patient Group Directions. Guidance providing good practice recommendations for individual people and organisations involved with PGDs.
• NICE. Medicines optimisation – quality standard (QS120).
• NICE. Controlled drugs: safe use and management (NG46).
• NICE. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes.
• NICE. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence.
• NICE. Register for Medicines and Prescribing News and Alerts via the NICE website.

Further resources

• British Medical Association. Guidance on prescribing and drug administration in general practice.
• Care Quality Commission. Medicine in health and adult social care: learning from risks and sharing good practice for better outcomes.
• General Pharmaceutical Council. High level principles for good practice in remote consultations and prescribing. This information is for all healthcare
• NHS Specialist Pharmacy Service. This website provides tools and resources to help with decision making around prescribing and the legal frameworks and associated processes in relation to medicines management.
• NHS England, Clinical Reference Group. Prison pain formulary, handling Tramadol in Health and Social Justice sites and management of drug dependence in adult prisons. These resources support clinicians prescribing pain medicines in prisons.
• NMC. Code of conduct. The NMC code presents the professional standards that nurses, midwives and nursing associates must uphold in order to be registered to practise in the UK.
• NMC. Standards of proficiency for nursing associates. These standards set out what nursing associates know and can do when they join our register.
• NMC. Standards for prescribing programmes. Part 3 of Realising professionalism: Standards for education and training.
• Scottish Government. Non Medical Prescribing in Scotland: Guidance for Nurse Independent Prescribers and for Community Practitioner Nurse Prescribers in Scotland: A Guide for Implementation.
• NHS Scotland. Effective prescribing and therapeutics. Polypharmacy. This provides guidance on preventing inappropriate polypharmacy at every stage of the patient journey. See also links to additional resources.

If you have any queries on this guidance or suggestions as to how the guidance can be further developed please contact kim.ball@rcn.org.uk, Professional Lead for Primary Care.