Prescribing

Key Points Background Implications News Resources Action Points References

Key Points

For the past few years there has been a growing move to increase prescribing powers of non-medical staff.

Spreading the responsibility for prescribing across a wider range of practitioners can offer patients quicker and more direct access to medication and treatment, as well as boosting efficiency and service improvement.

So far, some physiotherapists are qualified to offer prescribing with support from qualified prescribing colleagues, but there is now a growing momentum for full prescribing autonomy to be extended to those who choose to develop these skills.

Prescribing often goes hand in hand with physiotherapy. Many physiotherapy patients will benefit from prescriptions such as analgesics, non-steroidal anti-inflammatories and painkillers alongside their physiotherapy treatment.
There are currently three legal mechanisms by which a physiotherapist can supply, administer or prescribe medicines. Each of these has an increasing degree of autonomy and responsibility for the therapist:
- Patient-specific directions (PSDs) require direct written instruction from an independent prescriber (for example, a doctor or an independent nurse prescriber).
- Patient group directions (PGDs) are formal legal tools written by a doctor and a pharmacist that enable a practitioner to administer any licensed medication to one or more specific groups – for example, those who need local anaesthetics or corticosteroid injections.
- Supplementary prescribing (SP) allows a practitioner to prescribe certain medicines, providing they are approved by an independent prescriber.
Legislation around these forms of medicine use varies across the UK. Members must work to the law of the country in which they practise – which may not be where they live.
In order to prescribe, a physiotherapist must have completed a prescribing course approved with the state regulator for the country in which they work. When they have completed the course, they must amend their entry on the Health Professions Council register to show that they are a qualified prescriber.
Independent prescribing is not yet available to physiotherapists. However, in recent years it has become available to nurses and pharmacists across Great Britain, and is on the horizon for allied health professionals too. In England, independent prescribing is anticipated for allied health professions within a few years following the announcement in 2009 of ministerial and Department of Health support for the move.

Resources

Publication

Medicines, prescribing and physiotherapy (2nd edition)

1 year ago

Implications

Greater autonomy in prescribing results in increased professional flexibility. It does not mean that physiotherapists are obliged to prescribe: they can choose whether to prescribe or not, and which level of prescribing best suits their particular mode of practice.
Independent prescribing offers a range of benefits – particularly when used in models such as self-referral – as it enables the physiotherapist to provide the patient with a 'one-stop-shop', offering all the care they need in one place without multiple appointments. This can be especially advantageous in certain clinical areas such as community-based asthma management services or cardiac rehabilitation clinics, as well as for those in private practice, enabling them to provide a complete range of treatment.
Supplementary prescribers need an independent prescriber to approve a written clinical management plan for individual patients. They can prescribe medicines, but the system can cause delays for patients, duplication of tasks for professionals, and inefficiencies.
In the case of patient group directions, for a condition such as back pain as many as 10 separate directions may be required. Nevertheless, this form of supply mechanism may still be appropriate for patient care.
If training for independent prescribing follows the model now in place for other non-medical prescribers, such as nurses, it may be very similar to existing training for supplementary prescribing, with a few additional elements.
Take some time to understand the government drivers in this field and how they impact on physiotherapy in your area: see discrete country details within this section.
If you are interested in offering prescribing services, think about the clinical setting you work in, look at your current service models, and develop a medicines and prescribing framework that will best complement your work and meet your patients' needs.
Consider which medicines model will suit you best. For example, you may find that a patient group direction is more appropriate for your context than supplementary prescribing.
If you want to qualify as a prescriber, visit the list of approved courses on the Health Professions Council website.

News & Comment

Press Release

Independent prescribing rights under consideration for physiotherapists

34 weeks ago
Frontline article

Independent prescribing by physios inches closer

1 year ago
News item

Independent prescribing for physios inches closer

1 year ago
Frontline article

Independent prescribing streamlines patient care

1 year ago
News item

Physiotherapists recommended to be given independent prescribing rights

2 years ago
News item

CSP welcomes Department of Health recommendation for physiotherapists Independent Prescribing rights

2 years ago

Background

Until the late 1960s, there was no regulation governing medicines and prescribing. In 1968 the Medicines Act came into being. This act defined medicines and controlled the way they were used and distributed. It applies equally across Great Britain.

In the 1990s, as part of the wider move to improve efficiency and remove the traditional hierarchies within healthcare, limited prescribing powers began to be given to non-medical health professionals. Prescribing rights were first granted to nurses. Subsequently, Section 63 of the Health and Social Care Act 2001 allowed certain health professionals, including physiotherapists, to act as supplementary prescribers. The highest level of prescribing is independent prescribing, which provides full autonomy in decision-making and responsibility for medicines use. Independent prescribing has already been granted to nurses and pharmacists.

The CSP is carrying out research among physiotherapists who are already registered with the Health Professions Council as supplementary prescribers, to find out about the clinical areas in which they work, the medicines they are using and their development needs. This will inform a programme of work to support members who wish to go on to prescribe independently.

Action Points

Take some time to understand the government drivers in this field and how they impact on physiotherapy in your area. For details, see the section for your own country.
If you are interested in offering prescribing services, think about the clinical setting you work in, look at your current service models, and develop a medicines and prescribing framework that will best complement your work and meet your patients' needs.
Consider which medicines model will suit you best. For example, you may find that a patient group direction is more appropriate for your context than supplementary prescribing.
If you want to qualify as a prescriber, visit the list of approved courses on the Health Professions Council website.