UK medicines law sets out the framework for how health professionals may use medicines in their work.
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.
Key facts on prescribing by physiotherapists
- 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.
- 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.
Controlled drug prescribing
The CSP is part of the NHS England Chief Professions Officers’ Medicines Mechanisms (CPOMM) programme. The outcome of a recent public consultation was strongly supportive of seeking the addition of four controlled drugs to the physiotherapist independent prescriber controlled drug formulary. The additional four controlled drugs are codeine, tramadol, gabapentin and pregabalin.
The proposed changes to medicines legislation and the findings of the public consultation were presented by CPOMM representatives including the CSP to the Commission on Human Medicines (CHM) on 1-2 July 2021.
You can read the minutes of the CHM meeting, which concerned proposals for widening access to medicines for seven groups of registered health professionals.
In summary, the CHM recommended accepting the proposal to increase the number of medicines within the physiotherapist independent prescriber controlled drug formulary.
The CHM recommendations have been passed to ministers in the Department of Health and Social Care in order for a decision to be made regarding changes to the Human Medicines Regulations. We have no indication of when any ministerial decision will be forthcoming.
As the CHM recommendation relates to controlled drugs, changes to the Misuse of Drugs Regulations are also required. This means the CPOMM team must also take the proposals to the Advisory Council on the Misuse of Drugs, which makes recommendations to ministers within the Home Office regarding changes to the Misuse of Drugs Regulations. We have no indication when this might occur.
Legislative change can only occur following decisions from both the Department of Health and Social Care and the Home Office. The CSP understands and shares members’ frustration at the length of the process and continues to work as part of CPOMM to ensure completion of this important work.