Over to you

News that some advanced practice physios will be able to prescribe drugs without a doctor overseeing their decision is a major advance for the profession. Lynn Eaton finds out more


David Baker, who at London's St Leonard's Hospital, has been a supplementary prescriber since 2008

A huge sigh of relief went up as - after years of hard work and behind-the-scenes negotiation - ministers finally gave the green light this week to independent prescribing.

The decision not only marks a major step forward for the status of the profession, it could mean the transformation of the patient's experience of care.

David Baker, who works in a chronic pain clinic at London's St Leonard's Hospital in Hackney, is delighted at the news. He already has supplementary prescribing rights and knows which drugs will help his patients. But he still needs a doctor to sign the prescription. The situation is frustrating for him - and can mean his patients suffer unnecessarily.

'Just the other week, we had a patient come in with severe back pain. He'd been sent for an MRI scan, but was on completely inadequate analgesia - just a low dose codamine that wasn't even touching his pain.'

Mr Baker wanted to give his patient something more appropriate, but the pain clinic only has a consultant present one day a week and the doctor wasn't in that day. So he tried to call the patient's GP. It took him ages to get through to the surgery, only to establish that the GP wouldn't be available until the following week and that, because no other GP knew the patient, no-one else could approve the treatment Mr Baker proposed.

'It would have been so much better if I could have just made the decision, given the patient the drugs, then have told the GP afterwards what I'd done,' he says.

Mr Baker became a supplementary prescriber in 2008. 'Working in a chronic pain unit, it was an obvious string to our bow,' he says. 'It struck me how little most physios know about medication, yet virtually everybody we see is in pain.'

Quick facts on independent prescribing

  • Can all physios potentially become independent prescribers? No. They will mainly be working in advanced practitioner roles - especially in respiratory, neuro, women's health and chronic pain. They'll need to show they have appropriate clinical governance in place and that there is a specific need for this service.
  • What will the training be? It's likely to be similar to that already available for people training for supplementary medicine prescribing. Several universities offer courses that tend to be about six months in length, part-time. Those already trained as a supplementary prescriber will need to do a conversion course before they become an independent prescriber.
  • When will the courses start? The HCPC will need to approve any new course. Realistically this process means it is unlikely any independent prescribing course will be available before September 2013, with the first independent prescribers coming through in 2014.
  • How much will they cost? Those who are self-funding can expect to pay at least £2,000. However, many physios in the NHS would be funded through their employer, who would be likely to receive a preferential rate for a block booking.
See more information from the Department of Health: Summary of public consultation on proposals

Now 60 per cent of GP referrals come direct to his clinic rather than going to the consultant first - a sign of the confidence doctors have in the service. But independent prescribing will make things even better he believes.

'The advantage will be that it is much more flexible. It will make things a lot easier, which will mean a quicker and more efficient service. Where a patient is in a lot of pain, it may be difficult for them to get to their GP. We could offer a one stop shop. With independent prescribing we could even do home visits.'

Some 200 physios currently have supplementary prescribing status like Mr Baker. They will have undertaken a 26-week part-time university course first and need to have registered their status with the Health and Care Professions Council (HCPC). On the whole they are physios working in NHS settings at advanced practitioner level.

Andrew McEwan is course leader and senior lecturer on one of the existing supplementary prescribing courses, at Leeds Metropolitan University. A nurse by background, he's been working on the non-medical prescribing courses since 2001, when the government first announced that nurses would get some limited independent prescribing, leading up to full independent prescribing rights for any drug in the formulary in 2007.

Safe prescribing and defendable decisions will be essential, he argues. The CSP has argued for access to the full formulary not just drugs related to the conditions physios are most likely to treat. Mr McEwan is delighted the government has given the go ahead for this.

'The biggest change [to come about from independent prescribing] will be improved patient outcomes,' he says. 'But the physios who become independent prescribers will feel a real sense of professional achievement. They will be able to offer a complete package of care to patients.'

Julie Read is only too happy to endorse that sentiment. She works as the lead in a community based respiratory care team in Hounslow and Richmond, south west London.

As a supplementary prescriber she helps advise on inhaled medications for patients with chronic obstructive pulmonary disease patients, in particular steroids and antibiotics.

'It will just mean things will get sorted out more quickly for the patients,' she says. The team has a good relationship with the local GPs, who welcomed the involvement of physios in the process, but it still takes time to get a prescription signed by the GP.

'It will mean our patients will be able to walk away with a prescription,' she says.

But she cautions against physios thinking the new arrangement will open up scope for them to treat conditions other than the ones they're knowledgeable about. Her team had considered trying to monitor patients being treated for heart failure.

'We realised that monitoring it was way beyond our competence. You may think you can help more people with more conditions, but my advice is to stick to your area of expertise.'

Working together

CSP professional adviser Pip White (right) has devoted the last three years to trying to pull off this coup for the profession. But it's not just about physios - podiatrists have also been working towards the same goal.

Many of their meetings with Department of Health officials have involved representatives from other professions too, including pharmacists, nurses and optometrists.

'It's really been collaborative working,' says Ms White. 'By understanding our similarities, we've been able to move forward. In many ways, we're very, very similar to podiatrists.'

Physiotherapy's emphasis is on movement, performance and function - but having prescribing rights will mean physios can ensure their patients have appropriate medication to help them achieve these goals - whether that is managing chronic pain, helping to alleviate the symptoms of asthma or dealing with stress incontinence.

'I really hope this decision is going to promote physiotherapy as the rehabilitation profession,' she said.

And it could help prevent unnecessary hospital admissions, she predicts.

'We'll be able to offer more community-based care, particularly where conditions are stable. And where a patient starts to deteriorate we'll be able to pick that up sooner, meaning fewer hospital admissions.'

It could also mean fewer drugs are prescribed, says Jane Dixon, a supplementary prescriber, working for a hospital in the independent sector.

'We're aware of the potential interaction of drugs, and of the fact they might not work at all. Some patients may not be taking their drugs properly. If you're on a drug for bladder control it's not like taking an asprin when you have a headache. You have to take the single dose at the same time every day.'

Ms Dixon's experience is that - far from hostility from the medical profession - doctors are happy to let her get on with something she's trained to do: 'The consultants don't want you running around with a piece of paper for them to sign. When they know you've got the skills to do it, they want you to get on with it.'

Lynn Eaton

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