Prescribing - Scotland
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 & Care 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.
There are no related resources for this policy.
- 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 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, these forms of prescribing may sometimes be preferable – for example, when prescribing for patients who are already taking medication for other conditions.
- 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.
News & Comment
The Scottish government is a strong proponent of extended prescribing. It states that "it is government policy to extend prescribing responsibilities to non-medical professions", and adds: "Independent prescribing aims to provide patients with quicker and more efficient access to medicines, and to make the best use of their skills, knowledge and expertise. Independent prescribing by other health care professionals will also allow doctors to make better use of their expertise."(4)
Nurses and pharmacists were the first healthcare practitioners to gain extended prescribing powers. In Scotland, they gained the right to become supplementary prescribers in 2003, and in 2006 gained the power to carry out direct prescribing.
Physiotherapists had already been using medicines for injection therapy since the early 1990s, through patient-specific directions (PSDs). Since 2001, they have been able to supply and administer medicines through patient group directions (PGDs), and in 2005, physiotherapists, podiatrists and radiographers were approved as supplementary prescribers, subject to the necessary training. There are currently 135 physiotherapists registered with the Health Professionals Council in the UK as supplementary prescribers.
It is hoped that independent prescribing will be the next step for physiotherapy in Scotland. 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.
- Take some time to understand the government drivers in this field and how they impact on physiotherapy in your area:
- Allied Health Professions Prescribing and Medicines Supply Medicines Scoping Project Report. If you are interested in prescribing, think about the clinical setting you work in, look at your current service models, and pick the medicines and prescribing framework that will best complement your work and meet your patients' needs.
- Consider which prescribing 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. A range of courses (mostly part time) are available at universities across Scotland.