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NHS England sets out proposals for more efficient and responsive access to medicines for patients
Proposals allowing certain health professions to prescribe or supply and administer medicines for patients have been published today (Thursday) by NHS England.
The proposals would apply across the United Kingdom, and would enable four groups of registered allied health professions (AHPs) – radiographers, paramedics, dietitians and orthoptists – to prescribe or supply and administer medicines, giving patients responsive access to treatment.
For many patients an AHP is their lead clinician, yet they often do not have access to the appropriate prescribing or supply and administration of medicines mechanisms. This means the patient may have to make an additional appointment with their GP or doctor to get the medicines they need.
The proposals would enable new ways of working to make better use of AHPs’ skills, providing a more efficient and convenient service for patients while reducing demand on other services.
NHS England is consulting on these proposals, which cover:
- Independent prescribing by radiographers
- Independent prescribing by paramedics
- Supplementary prescribing by dietitians
- Use of exemptions within the Human Medicines Regulations (2012) by orthoptists
Suzanne Rastrick, Chief Allied Health Professions officer at NHS England said today: “Our proposals will allow patients to get the medicines they need without delay, instead of having to make separate appointments to see their doctor or GP.
“Breaking down barriers in how care is provided between different parts of the NHS is key to the vision set out in the NHS Five Year Forward View.
“Extension of prescribing and supply mechanisms for these four professions creates a more flexible workforce, able to innovate to provide services that are more responsive to the needs of patients, and reduce demand in other parts of the healthcare system.”
The four separate consultations have been launched today by NHS England in partnership with the devolved administrations, the Department of Health and the Medicines and Healthcare Products Regulatory Agency.
The consultations have been posted on NHS England’s consultation hub website.
The consultations on proposals to introduce independent prescribing for paramedics and radiographers will run for 12 weeks from 26 February. The consultations on proposals for dietitians and orthoptists will run for eight weeks from 26 February.
I support the society of Radiographers proposal that would permit appropriately trained radiographers to independently prescribe any medicine for any condition, within their professional scope of practice and competence. This option has no limitations and would mean the greatest number of patients could benefit from more timely and therefore improved care, first time and in the right place.
I am very unsure of this proposal. Having worked as a radiographer for nearly 20 years I have no doubt that we are capable of prescribing medications relelvant to our work area. However I am not convinced the main driver of this reform is to improve patient care, but if more about the erosion of clinicians role with the ultimate aim of saving money on expensive consultant wages. Why would a trust employ a consultant or staff grade clincian when they could spend half the money employing a radiographer who will be able to see patients in their stead?
This is another attack on the finances of the NHS.
I fully support the proposal that Radiographers should be permitted to independently prescribe any medicine for any condition, within their professional scope of practice and competence.This would support innovative service redesign to make best use of radiographers’ skills in both radiotherapy and imaging. Independent prescribing would also enhance the flexibility and expertise of the workforce, thereby improving care for patients both now and in the future.
ODPs should be given access to PGDs and perhaps prescribing as they would be well supported in the clinical environment and could greatly improve patient care. If given a small formulary of pain relief anti-emetics and fluids this would vastly improve care for patients in theatres and on the wards in a similar manner to the midwife and paramedic exemptions in the Human Medicines Regulations (2012).
AHPs work in very defined specialist areas and therefore I think allowing them to prescribe medication relevant to thier area of expertise is low risk.
As a therapuetic radiographer I have tried hard to make supplementary prescribing work and I also make use of PGDs in certain circumstances, but there are times when the limitations of these mechanisms result in patients having to wait for medication, as well as duplication of effort if a doctor has to assess a patient before prescribing medication which I have already decided is appropriate. I want to be able to offer the safest and most efficient service to the patients that I see and I think independent prescribing will help me to do this.
Independent prescribing for therapeutic radiographers particularly is the natural progression to a more appropriate and robust mechanism of medicines management and therefore we feel should be supported. For diagnostic radiographers it could bring service redesign opportunities which will streamline pathways for patients. Radiographers are aware of their scope of practice and would not be working outside of this.They would only be prescribing a small number of drugs relevant to their area of expertise.
Why not dispense medications automatically – the same technology, and the same precautions –as banks “dispense” money?
I fully support this move, as radiographers we often work specifically with certain medications and know these inside out and use more frequently then rotational registrars who when then have to call and the patient is left waiting hours before they can received medications. Cancer care uses lots of medications also that G.P’s are less familar with.
I would only use about 10 medications and as I review my patients weekly I am best placed to check the medications are working and have no interactions which is highly safe and effective use of time and money. Most the consultants give a medication and never that patient again.
I have serious reservations about this. I think there is a question of safety.
Dieticians and supplements? Fine, entirely appropriate.
But I’ve worked with a couple of former paramedics who had retrained as doctors – both excellent clinicians who were surprised by how much more there was to learn.
There are 4 year, graduate entry medicine courses. May that should be encouraged for allied health professionalswho want to take more responsibility and work as independent diagnosticians
This is a very Short sighted view as I recall similar comments were made about nurses being independent prescribers which has been an undoubted success. In primary and urgent care settings nurses see and treat and prescribe for hundreds of patients a day. The addition of Paramedics as independent prescribers will open up more services to patients and allow them to take full accountability for their actions and will allow patients to be treated at home rather than being taken to ED. I have 2 Paramedics who work alongside me in a Walk-in Centre and would have no issue with either of them prescribing. I myself have been an independent non medical prescriber since 2005 this has both enhanced my practice and benefited numerous patients. I also work in substance misuse and prescribe methadone and other opiate substitutes products on a regular basis. Opening up prescribing to other AHP will in my opinion benefit patients which can only be a positive change. I fully support the proposal.
Hi EM Registrar,
It’s not just about supplements for dietitians. I work with patients on parenteral nutrition. I calculate the requirements taking into account the nutritional assessment that I have completed, biochemistry, clinical condition, fluid balance, medications, assessment of their current oral diet and then I go to the junior doctor and ask them to sign the prescription for parenteral nutrition thereby asking them to take legal responsibility for the prescription and my assessment and decisions. This is a question of safety as I really feel for them having to do this with minimal training and they are not comfortable doing this but currently have no choice. They are put in a very vulnerable position.
I am not surprised but extremely dissapointed that ODP’s are not included in this group of registered proffesionals to be given this respnsibility! Once again we are the forgotten proffesion, who work just as hard and have just as much right and capability to be given this responsibility.
I agree totally. We could run our theatre dept on ODP’s alone. We do the same things as nurses and are well respected by the clinicians we work with. Yet the government still fails to recognise what we do. How is it I can do Advanced life support and other such courses, have individual responsibility for patients into care, yet still we can’t even use PGD’s / be considered for prescribing. Ludicrous. I urge all ODP’s to write a letter to NHS England to make them notice us!
Many ODPs as professionals would no doubt use PGD effectively and the service would be better for it, however as Chloe notes ODPs are a forgotten profession but because of that all ODPs must demand that the CODP explains why we are not part of the AHP federation, guess what? its financial ! they are the group that can make this happen and it is being ignored . Anonymous says that ODPs can run theatres alone and that is no doubt true as it happens in my local trusts, however aren’t we better together working in collaboration with others?
Do a little poll of ODPs in your workplace and you will be astonished just how many don’t have any idea that we are not actually AHPs which begs the question what are we and where is our professional affiliation? Want PGD rights? then lobby for inclusion in the federation and we can become part of a wider group of professionals that actually have a voice and are supportive of the individual professions.