Medicines use, prescribing and injection therapy are within the scope of the UK physiotherapy profession.
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All physiotherapists can give medicines advice to their patients. This is an expectation of reasonable physiotherapy practice for many conditions. They can also supply and administer medicines to patients under either a Patient Specific Direction, or a Patient Group Direction.
Physiotherapists who have additional prescribing annotations to their HCPC registration may prescribe all licensed medicines - including seven controlled drugs - which are within the scope of physiotherapy prescribing practice.
Injection therapy is the administration of medicines, and other selected products, to intra- and extra-articular tissues and joint spaces by invasive injection. Injection therapy also includes aspiration of joint spaces.
- UK medicines law sets out the framework for how health professionals may use medicines in their work.
- The HCPC sets the regulatory and educational framework for prescribing by physiotherapists
- The CSP provides guidance to help members use medicines appropriately in their work
Our publication PD019 Medicines, Prescribing and Physiotherapy gives detailed information on using medicines in physiotherapy practice.
The CSP has completed work with NHS England to identify further medicines to be included in any future Public Consultation to seek to update the lists of controlled drugs that physiotherapist independent prescribers may prescribe. These medicines are codeine and tramadol. Pregablin and gabapentin will also be included once they reclassified in April 2019. Further work with NHS England has currently stopped. This is because pressures on parliamentary time as a result of Brexit are leading to uncertainty about when, and what, necessary legislative steps could be taken in relation to the ongoing Chief Professions Officers Medicines Management (CPOMM) programme. We will let you know further updates when we have them.
There are two types of prescribing for physiotherapists:
- Supplementary prescribing is the use of a written clinical management plan (CMP) to prescribe agreed medicines in partnership with a doctor. The CMP can include any licensed or unlicensed medicines and all controlled drugs.
- Independent prescribing is the use of your own clinical reasoning and professional judgment to determine the nature and extent of any medicines to be used in the management of diagnosed and undiagnosed conditions. Independent prescribers may prescribe any licensed medicine from the British National Formulary, within national and local guidelines, for any condition within their area of competence within the overarching framework of human movement, performance and function. Independent prescribers may also mix medicines prior to administration and prescribe from a restricted list of seven controlled drugs.
Our publication PD026 Practice Guidance for Physiotherapy Prescribers contains detailed information.
- Supplementary and independent prescribing by physiotherapists is legal in all parts of the UK.
- Prescribing by UK physiotherapists is not allowed overseas.
- Physiotherapists cannot prescribe medicines for purely cosmetic purposes.
- Prescribing courses for physiotherapists are validated and approved by the HCPC.
- The HCPC sets separate prescribing standards for those annotated as prescribers.
- Courses validated for independent prescribing will automatically provide you with a supplementary prescribing qualification as well.
- You must not prescribe until your prescribing qualifications are added to your HCPC registration.
Injection therapy for therapeutic purposes has been part of physiotherapy practice since 1997. It is used to treat:
- Inflammatory pain from a range of orthopaedic and rheumatological conditions.
- Spasticity and dystonia from a range of neurological conditions.
- Chronic headache of musculoskeletal or neurological origin.
- Some bladder disorders in women's health physiotherapy.
Vaccinations and other subcutaneous injections are not considered to be ‘injection-therapy’.
- CSP members must undertake injection therapy training that meets the CSP educational expectations.
- You must consider which medicines framework you will use when practising injection therapy.
- If you need to prescribe medicines for injection therapy you must also complete an HCPC approved prescribing course.
You do not need extra insurance to be a prescriber or use injection therapy. The CSP PLI scheme covers all activities within the scope of physiotherapy practice, including prescribing and injection therapy. If you wish to include prescribing within your scope of practice you must ensure you are an HCPC ‘annotated prescriber’.
Your HCPC registration must be updated to show you are a prescriber before you start prescribing. This is so that you can prove you’re practising lawfully.
- PD019 Medicines, Prescribing and Physiotherapy
- Medicines frameworks for the prescribing professions
- Medicines frameworks for UK health professionals
- PD026 Practice Guidance for Physiotherapy Prescribers
- PD071 CSP expectations of educational programmes in injection therapy
- PD003 Use of medicines in physiotherapy injection-therapy services
- Transdermal medicines and physiotherapy practice
The Health and Care Professions Council sets the proficiency standards for prescribing and lists all the approved prescribing courses available to physiotherapists in the UK.
The Allied Health Professions Federation hosts the curriculum framework for non-medical prescribing educational programmes.
The Royal Pharmaceutical Society publishes the competency framework for all prescribers. We have contributed to the creation of this framework and endorse its publication. We expect all our prescribers to follow it.
The Medicines and Healthcare Products Regulatory Agency is the UK-wide statutory regulator for medicines and advises on all aspects of compliance with UK medicines law.