Revision as of 13:28, 19 October 2011

Welcome to Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice project. This space was created by and for the students at Queen Margaret University in Edinburgh, UK. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

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Past[edit | edit source]

The History of Injection Therapy and Physiotherapy
[edit | edit source]

Present[edit | edit source]

Injection Therapy
[edit | edit source]

Current Prescribing Rights[edit | edit source]

Supplementary Prescribing[edit | edit source]

Future independent prescribing would be carried out by specialised Physiotherapists who had relevant experience and training recognised by the health professional council. Any prescribing would be governed and guided by patient group directions (PGD) or patient specific direction (PSD) which restricts the prescribing and administering medication to specific conditions and/or specific people.

Physiotherapists with relevant experience and training to a recognised standard by the health professional council have been allowed to supplementary prescribe (SP) since 2003. The big difference between SP and independent prescribing (IP) is there are no legal restrictions to the clinical conditions that Physio’s can be involved in. This is due to the fact that SP is managed and clinically governed by an IP who must be a Doctor, and care to the patient is given as a team management approach with a clear patient specific plan of care that the SP would work within. There are some stipulations to what the patient’s clinical management plan of care must include:

· Patients name

· The illness or condition of the patient that can be treated by the SP

· The date the treatment plan is to commence

· Which prescribed medicine can be given by the SP

· What restriction/limitations there are to the administered dose

· Situations identified that the SP must consult with the IP

Local amendment in 2003 to allow SP for AHP

The NHS (Pharmaceutical Services) (Scotland) Amendment Regulations 2003. SSI No. 296

The NHS (Charges for Drugs and Appliances) (Scotland) Amendment (No.2) Regulations 2003. SSI No. 295

NHS (General Medical Service) (Scotland) Amendment (No3) Regulations 2003. SSI No. 443

Definition[edit | edit source]

"Voluntary prescribing partnership between an independent prescriber (doctor) and supplementary prescriber (pharmacist, nurse, physiotherapist, etc) to implement an agreed patient-specific Clinical Management Plan with the patient's agreement" ^[1]

Medicine Act 1968[edit | edit source]

The legislation outlined in the Medicine Act 1968 governs health professionals in clinical practivce regarding the administrion, supply and prescription of medcines. The Medicine Act states that a prescription from an appropriate practitioner is required for the supply of medicinal prodcuts, a substance or combintation of substances used for the treatment or prevention of dieases in human beings or animals. Originally, an appropriate practitioner is defined by the Act as a doctor or dentist, but has since been extended to include certain members of the nursing and pharmaceutical professionals^[2].

Supplementary Prescribing within Current Scope of Practice[edit | edit source]

Classes Offered[edit | edit source]

In 2005, prescribing rights were extended to physiotherapists by the Department of Health (DoH) and the Medicines and Healthcare Products Regulatory Agency (MHRA), in addition to the implementation of training courses for Allied Health Professionals. Supplementary prescribing classes involve at least 26 days in the classroom, and 12 days in practice with a designated medical practitioner ^[1]

Limitations of Current Prescribing Rights
[edit | edit source]

"You have a responsibility to deliver care based on current evidence, best practice and, where applicable, validated research when it is available." ^[3]

It is clear that there must be close professional interactions between the independent prescriber (IP) and supplementary prescriber (SP) in addition to the requirement that the "patient is considered an equal partner in order to ensure informed consent and concordance" ^[1].

Concordance has been defined as: "a new approach to prescribing and taking medicines, based on partnership. The patient and the healthcare professional participate as partners to reach an agreement on the illness and treatment. Their agreement draws on the experiences, beliefs and wishes of the patient to decide when, how and why to use medicines..." ^[4]

The Prescribing Problem

Worlwide there is an issue of 'non-compliance', where patient's do not always take medications as prescribed, for several reasons. These can be due to:

receiving prescriptions, but medication is unavailable at pharmacies (primary non-compliance)
taking incorrect dosages
taking medication at wrong times
forgetting one or more doses of medication
stopping the treatment too soon, ceasing to take the medication sooner than the prescriber recommended, or failing to obtain a repeat prescription (secondary non-compliance) ^[1]

The reasons for 'non-compliance' are complex. Best clinical practice utilises available evidence and subsequent clinical decisions are based on these findings. Although evidence-base for practice in this area is incomplete, there are suggestions that interventions to address this should be both complex and multi-factoral. Additionally, a concordance approach by the prescriber is likely to be more effective, and therefore will influence and promote effective taking of medications ^[1].

Do current Prescribing Rights' allow for a Patient-Centred Approach to Physiotherapy Practice?

Although current prescribing mechanisms available to physiotherapists serve in providing some patients with increased access to medications, it is clear they are limited in their capacity to optimize patient-centred practice. The extent of which current measures fail to meet the needs of patients was illustrated by a recent scoping project undertaken by the Department of Health into the provision of medicines by allied health professionals (AHPs) ^[5].

Physiotherapists utilise Supplementary Prescribing, Patient Specific Directions (PSDs) and Patient Group Directions (PGDs) in order to provide patients with the medicines they need ^[5] . It is at present a legal requirement that physiotherapists only administer drugs detailed within the patients clinical management plan (CMP) which are determined by an independent prescriber- such as a doctor - when using any of the above pathways ^[5]. However, such professionals are often unavailable for consultation in many clinical working environments, such as outpatient departments. Therefore, ensuing delays' in communication within the multi-disciplinary team unfortunately result in the needs of many patients failing to be met. Interestingly, doctor availability has been previously identified as posing "the greatest challenge" for physiotherapists implementing such treatments ^[5]. Moreover, such arrangements make it increasingly difficult for clinicians to adhere to Standard 13 of the Core Standards of Physiotherapy Practice of The Chartered Society of Physiotherapists ^[6].

With specific reference to PGDs, physiotherapists are unable to modify the provision of medication - such as modifying a patient’s prescription in order to supply a more suitable drug ^[5]. Furthermore, many departments require different medications to be detailed on separate PGDs, with some clinical settings requiring numerous PGDs in order to manage a single pathology. It is clear that this pathway poses a significant barrier to patient-centred care for physiotherapy departments who do not possess the necessary PGDs to manage certain health condiions ^[5].

Physiotherapists are often unable to prescribe or administer drugs quickly enough in order to optimize the management of a patient's health condition under existing legislation, such as when patients respond to a treatment provided ^[5]. Despite the fact that AHPs such as Physiotherapists are able to asses and identify deterioration or improvement of a patient’s condition, they are currently unable to appropriately alter or reduce dosage without consulting an independent prescriber. Not only does this result in avoidable delays in the provision of appropriate treatments, but clinicians often take unnecessary preventative measures in order to minimise risk when a patient’s condition deteriorates, such as advising patients to contact their GP, or in some cases calling an ambulance ^[5].

It is clear that current prescribing mechanisms for physiotherapists do not meet the needs of patients. Furthermore, it is clear how delays in the cessation or commencement of drug administration, as well as dose modification could negatively influence the effectiveness of physiotherapy treatment.

'Do current mechanisms reflect the Autonomy of modern day Physiotherapists'?'

"The role of allied health professionals is not yet adequately reflected in medicines legislation" ^[5].

According to the 'Standards of Proficiency' of the Health Professions Council (HPC), under Standard 1a.6 Registrant Physiotherapists must:
“be able to practice as an autonomous professional, exercising their own professional judgment
– be able to assess a situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem
– be able to initiate resolution of problems and be able to exercise
personal initiative" ^[7]

Physiotherapists do not currently enjoy sufficient prescribing rights in order to practice with full professional autonomy and use their high levels of knowledge and expertise to act appropriately in the best interest of patients. Therefore, the extent of which current prescribing pathways allow for practitioners to adhere to professional standards is questionable.

The roles performed by physiotherapists have evolved substantially during recent years, with modern day practitioners performing initial assessments, treatments and subsequent referrals similar to the way in which doctors have traditionally done so. This is reflected by the increased number of patients who seek primary contact with physiotherapists instead of their GP through self-referral schemes, as well as the lead role performed by physiotherapists in outpatient review clinics ^[5].

What legal issues are involved?

Currently, there are no legal restrictions on clinical conditions treated via supplementary prescribing, however, it is expected that supplementary prescribing would be used for chronic medical conditions and other health needs^[1]. The only form of treatment that patients cannot currently receive exclusively from Physiotherapists is the prescription of drugs, and remains the single aspect of patient care which patients must access from an independent prescriber ^[5]

Consultation[edit | edit source]

The recommendation by the Allied Health Professionals Prescribing and Medicines Supply Mechanisms Scoping project in 2009 that further measures should be put in place to extend independent prescribing rights to adequately qualified Physiotherapists was subsequently accepted by the Department of Health Non Medical Prescribing Board ^[5]. Since then, a twelve week engagement exercise was undertaken in September 2010 in relation to independent prescribing rights for Physiotherapists ^[8].
The exercise found that 91% of the 388 respondents who were either individuals (83%) or organisations (17%) supported independent prescribing by Physiotherapists ^[8] These findings were used to support the conduction of a public consultation on the matter.

The 'Consultation of Proposals to Introduce Independent Prescribing by Physiotherapists' is currently underway, taking place between the 15th September - 8th December 2011 ^[8]. The proposals detailed within the consultation not only include independent prescribing rights for physiotherapists, but also wither such professionals should be allowed to mix medicines as well as administer a selection of controlled drugs proposed by The Chartered Society of Physiotherapy ^[8]

Individuals completing the Consultation will have the opportunity to choose from five options relating to the introduction of independent prescribing by physiotherapists:
1) Independent prescribing for any condition from a full formulary
2) Independent Prescribing for specified conditions from a specified formulary
3) Independent Prescribing for any condition from a specified formulary
4) Independent prescribing for specified conditions from a full formulary
5) No change ^[8].

The consultation is available to complete at the following web address:
http://www.dh.gov.uk/health/2011/09/independent-prescribing/

Future[edit | edit source]

Autonomous Practice[edit | edit source]

Independent Prescribing[edit | edit source]

Definition[edit | edit source]

Independent prescribing is when " the prescriber takes responsibility for the clinical assessment of the patient, establishing a diagnosis and the clinical management required, as well as for prescribing where necessary and the appropriateness of any prescription" ^[9] At present, doctors, dentists and certain nurses in respect of a limited list of medicines are legally authorised prescribers who fulfil the requirements for independent prescribers and this should continue. Certain other health professionals may also become newly legally authorised independent prescribers.

Physiotherapists have been using medicines for injection therapy since the early 1990s via doctors’ directions and Patient Specific Directions (PSDs). PSDs is a written statement defining the management of a named patient which has been agreed by the clinician responsible for the patient, and by other appropriate health professionals. Since 2000, local anaesthetics and corticosteroids have been used extensively via Patient Group Directions (PGDs) by injection therapists. PGDs is a specific written instruction for the supply and administration, of a named medicine in an identified clinical situation. It applies to groups of patients who may not be individually identified before presenting for treatment. PGDs are now estimated to number around 3,000 in the UK. PSDs, PGDs and, increasingly, Supplementary Prescribing are used in a broad range of community and acute settings. Physiotherapists use these mechanisms with a range of relevant medicines in clinical areas spanning musculoskeletal, pain management, neurological, respiratory, emergency, women’s health, paediatric and elderly care.
Extended Scope Practitioners:
A few chartered physiotherapists are involved in administering and supplying to a PGD: typically, these are undertaking extended scope practitioners roles. Just to clarify the terminology, ‘Extended scope practitioners are clinical physiotherapy specialists with an extended scope of practice, who see patients referred for assessment, clinical diagnosis and management’ (CSP 2000).
A paper in "Physiotherapy" January 2001 (Gardiner & Wagstaff Physiotherapy 87 (1) 2-3) outlining the role undertaken by Extended Scope Practitioners in Stepping Hill Hospital, Stockport states that the ESPs who undertake injection therapy are working under a Patient Group Direction i.e. a written set of guidelines, which allows them to have a supply of local anaesthetic and steroids for the administration of intra- and extra-articular steroid injections.
Other ESPs whose role is of a therapeutic, rather than a diagnostic nature; those taking responsibility for the ongoing medical management of rheumatology patients for example, are also involved in monitoring medication and altering dosages as necessary under Patient Group Directions and Patient Specific Directions.

Specialist physiotherapists (also known as extended scope practitioners) now work independently in outpatient clinics assessing, diagnosing, and taking sole management responsibility for patients. They can already order investigations, and refer on to other specialists. Prescribing would entail the use of a small range of medicines including analgesics and non-steroidal anti-inflammatory medication, for both oral use and for injection.

Classes Offered[edit | edit source]

Similar to Supplementary prescribing, Independent prescribing classes involve at least 26 days in the classroom, and about 12 days in practice with a designated medical practitioner ^[1]

References[edit | edit source]

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Courtenay M, Griffiths M, editors. 'Independent and Supplementary Prescribing: An Essential Guide'. New York: Cambridge University Press; 2010.
↑ The Chartered Society of Physiotherapy. (2004) Prescribing rights of physiotherapists - an update. [Online] Available at: http://www.somed.org/members/ITstudentinfo/ITinfo10.pdf
↑ Nursing and Midwifery Council. 'Code of Professional Conduct'. London: NMC Publications; 2002
↑ Medicines Partnership. 'Project Evaluation Toolkit'. London: Medicines Partnership; 2003
↑ ^5.00 ^5.01 ^5.02 ^5.03 ^5.04 ^5.05 ^5.06 ^5.07 ^5.08 ^5.09 ^5.10 ^5.11 Department of Health (2009),'Allied health professions prescribing and medicines supply mechanisms scoping project report.', London, HMSO.
↑ Chartered Society of Physiotherapy (2005) ‘Core Standards of Physiotherapy Practice’ [online] Available at: http://www.csp.org.uk/uploads/documents/csp_core_standards_2005.pdf. [Accessed December 12, 2010].
↑ Health Professions Council (2007) ‘Standards of Proficiency -Physiotherapists’ [online] Available at: http://www.hpc uk.org/assets/documents/10000DBCStandards_of_Proficiency_Physiotherapists.pdf [Accessed December 12, 2010].
↑ ^8.0 ^8.1 ^8.2 ^8.3 ^8.4 Department of Health (2011) 'Consultation on Proposals to Introduce Independent Prescribing by Physiotherapists.' London, HMSO.
↑ Department of Health. 'Supplementary Prescribing by Nurses and Pharmacists within the NHS in England: A guide for Implementation'. London: DoH; 2003.

[Courtenay_and_Griffiths-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Courtenay M, Griffiths M, editors. 'Independent and Supplementary Prescribing: An Essential Guide'. New York: Cambridge University Press; 2010.

[2] The Chartered Society of Physiotherapy. (2004) Prescribing rights of physiotherapists - an update. [Online] Available at: http://www.somed.org/members/ITstudentinfo/ITinfo10.pdf

[NMC_2002-3] Nursing and Midwifery Council. 'Code of Professional Conduct'. London: NMC Publications; 2002

[Medicines_Partnership-4] Medicines Partnership. 'Project Evaluation Toolkit'. London: Medicines Partnership; 2003

[DH_2009-5] 5.00 ^5.01 ^5.02 ^5.03 ^5.04 ^5.05 ^5.06 ^5.07 ^5.08 ^5.09 ^5.10 ^5.11 Department of Health (2009),'Allied health professions prescribing and medicines supply mechanisms scoping project report.', London, HMSO.

[CSP_2005-6] Chartered Society of Physiotherapy (2005) ‘Core Standards of Physiotherapy Practice’ [online] Available at: http://www.csp.org.uk/uploads/documents/csp_core_standards_2005.pdf. [Accessed December 12, 2010].

[HPC_2007-7] Health Professions Council (2007) ‘Standards of Proficiency -Physiotherapists’ [online] Available at: http://www.hpc uk.org/assets/documents/10000DBCStandards_of_Proficiency_Physiotherapists.pdf [Accessed December 12, 2010].

[DH_2011-8] 8.0 ^8.1 ^8.2 ^8.3 ^8.4 Department of Health (2011) 'Consultation on Proposals to Introduce Independent Prescribing by Physiotherapists.' London, HMSO.

[DoH_2003-9] Department of Health. 'Supplementary Prescribing by Nurses and Pharmacists within the NHS in England: A guide for Implementation'. London: DoH; 2003.

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+<span lang="EN-GB">Physiotherapists
+at present can only supplementary prescribe, although it is an exciting time as
+there is currently a public consultation open until the 8<sup>th</sup> of
+December 2011.<span style="mso-spacerun:yes">&nbsp; </span>This consultation is looking to move towards giving Physiotherapists the right to independently supply and administer and prescribe medicines. In order for this to be included as an extended scope of practice the Medicine Act 1968 and Misuse of Drugs Regulations 2001 would have to be amended to ensure there were no legal implications for independently prescribing Physio’s, <span style="mso-spacerun:yes">&nbsp;</span>thus the reason for the public consultation.<span style="mso-spacerun:yes">&nbsp; </span></span>
+<span lang="EN-GB">Future
+independent prescribing would be carried out by specialised Physiotherapists
+who had relevant experience and training recognised by the health professional
+council. Any prescribing would be governed and guided by patient group
+directions (PGD) or patient specific direction (PSD) which restricts the
+prescribing and administering medication to specific conditions and/or specific
+people.</span>
+<span lang="EN-GB">Physiotherapists
+with relevant experience and training to a recognised standard by the health
+professional council have been allowed to supplementary prescribe (SP) since
+. The big difference between SP and independent prescribing (IP) is there
+are no legal restrictions to the clinical conditions that Physio’s can be
+involved in. This is due to the fact that SP is managed and clinically governed
+by an IP who must be a Doctor, and care to the patient is given as a team
+management approach with a clear patient specific plan of care that the SP
+would work within. <span style="mso-spacerun:yes">&nbsp;</span>There are some stipulations to what the patient’s clinical management plan of care must include:</span>
+<span lang="EN-GB" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
+Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt &quot;Times New Roman"">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
+</span></span></span><span lang="EN-GB">Patients name</span>
+<span lang="EN-GB" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
+Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt &quot;Times New Roman"">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
+</span></span></span><span lang="EN-GB">The illness or condition of the
+patient that can be treated by the SP</span>
+<span lang="EN-GB" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
+Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt &quot;Times New Roman"">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
+</span></span></span><span lang="EN-GB">The date the treatment plan is
+to commence</span>
+<span lang="EN-GB" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
+Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt &quot;Times New Roman"">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
+</span></span></span><span lang="EN-GB">Which prescribed medicine can
+be given by the SP</span>
+<span lang="EN-GB" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
+Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt &quot;Times New Roman"">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
+</span></span></span><span lang="EN-GB">What restriction/limitations
+there are to the administered dose</span>
+<span lang="EN-GB" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
+Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt &quot;Times New Roman"">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
+</span></span></span><span lang="EN-GB">Situations identified that the
+SP must consult with the IP</span>
+<span lang="EN-GB">&nbsp;</span>
+<span lang="EN-GB"><span style="mso-spacerun:yes">&nbsp; </span>Local amendment in 2003 to allow SP for AHP</span>
+<span lang="EN-GB" style="font-size:10.0pt;line-height:115%">The NHS (Pharmaceutical Services)
+(Scotland) Amendment Regulations 2003. SSI No. 296</span>
+<span lang="EN-GB" style="font-size:10.0pt;line-height:115%">The NHS (Charges for Drugs and
+Appliances) (Scotland) Amendment (No.2) Regulations 2003. SSI No. 295</span>
+<span lang="EN-GB" style="font-size:10.0pt;line-height:115%">NHS (General Medical Service)
+(Scotland) Amendment (No3) Regulations 2003. SSI No. 443</span>
 ==== Definition  ====
@@ Line 24: / Line 91: @@
 The legislation outlined in the Medicine Act 1968 governs health professionals in clinical practivce regarding the administrion, supply and prescription of medcines. The Medicine Act states that a prescription from an appropriate practitioner is required for the supply of medicinal prodcuts, a substance or combintation of substances used for the treatment or prevention of dieases in human beings or animals. &nbsp;Originally, an appropriate practitioner is defined by the Act as a doctor or dentist, but has since been extended to include certain members of the nursing and pharmaceutical professionals<ref>The Chartered Society of Physiotherapy. (2004) Prescribing rights of physiotherapists - an update. [Online] Available at: http://www.somed.org/members/ITstudentinfo/ITinfo10.pdf</ref>.
-==== Supplementary Prescribing within Current Scope of Practice ====
+==== Supplementary Prescribing within Current Scope of Practice  ====
 ==== Classes Offered  ====

Prescribing Rights in the UK: Difference between revisions

Revision as of 13:28, 19 October 2011

Contents

Past[edit | edit source]

The History of Injection Therapy and Physiotherapy
[edit | edit source]

Present[edit | edit source]

Injection Therapy
[edit | edit source]

Current Prescribing Rights[edit | edit source]

Supplementary Prescribing[edit | edit source]

Definition[edit | edit source]

Medicine Act 1968[edit | edit source]

Supplementary Prescribing within Current Scope of Practice[edit | edit source]

Classes Offered[edit | edit source]

Limitations of Current Prescribing Rights
[edit | edit source]

Consultation[edit | edit source]

Future[edit | edit source]

Autonomous Practice[edit | edit source]

Independent Prescribing[edit | edit source]

Definition[edit | edit source]

Classes Offered[edit | edit source]

References[edit | edit source]

Physiopedia

Content

Legal

Prescribing Rights in the UK: Difference between revisions

Revision as of 13:28, 19 October 2011

Past[edit | edit source]

The History of Injection Therapy and Physiotherapy[edit | edit source]

Present[edit | edit source]

Injection Therapy[edit | edit source]

Current Prescribing Rights[edit | edit source]

Supplementary Prescribing[edit | edit source]

Definition[edit | edit source]

Medicine Act 1968[edit | edit source]

Supplementary Prescribing within Current Scope of Practice[edit | edit source]

Classes Offered[edit | edit source]

Limitations of Current Prescribing Rights[edit | edit source]

Consultation[edit | edit source]

Future[edit | edit source]

Autonomous Practice[edit | edit source]

Independent Prescribing[edit | edit source]

Definition[edit | edit source]

Classes Offered[edit | edit source]

References[edit | edit source]

Our Partners

Physiopedia

Content

Legal

The History of Injection Therapy and Physiotherapy
[edit | edit source]

Injection Therapy
[edit | edit source]

Limitations of Current Prescribing Rights
[edit | edit source]