Prescribing Rights in the UK
This page has been created as part of the Queen Margaret University project on current and emerging roles in contemporary physiotherapy practice
Past[edit | edit source]
The History of Injection Therapy and Physiotherapy
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Present[edit | edit source]
Injection Therapy
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Current Prescribing Rights[edit | edit source]
Supplementary Prescribing[edit | edit source]
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.
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]
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) [2].
Physiotherapists utilise Supplementary Prescribing, Patient Specific Directions (PSDs) and Patient Group Directions (PGDs) in order to provide patients with the medicines they need [2] . It is at present a legal requirement that physiotherapists only administer drugs detailed within the patients clinical management plan (CPM) which are determined by an independent prescriber- such as a doctor - when using any of the above pathways [2]. 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 [2]. 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 [3].
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 [2]. 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 [2].
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 [2]. 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 [2].
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" [2].
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" [4]
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 [2].
What legal issues are involved?
Currently, there are no legal restrictions on clinical conditions treated via supplementary prescribing[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 [2]
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 [2]. Since then, a twelve week engagement exercise was undertaken in September 2010 in relation to independent prescribing rights for Physiotherapists [5].
The exercise found that 91% of the 388 respondents who were either individuals (83%) or organisations (17%) supported independent prescribing by Physiotherapists [5] 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 [5]. 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 [5]
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 [5].
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" [6]
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 Courtenay M, Griffiths M, editors. Independent and Supplementary Prescribing: An Essential Guide. New York: Cambridge University Press; 2010.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 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].
- ↑ 5.0 5.1 5.2 5.3 5.4 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.
