The 1968 Medicines Act¹ provides public safeguards in the governance of medicines and outlines the restrictions on who is legally entitled to prescribe them.  Any change to the legislation requires a clear rationale and a firm case of clinical need to allow other healthcare professionals to access and prescribe medicines². Thus, doctors are by far the largest group of prescribers, who along with dentists, can prescribe on registration. Allied Health Professionals (AHPs) form a significant part of the healthcare workforce with over four million patient contacts per week³.  However, it wasn’t until 1999 that the prospect of prescribing was formally proposed for some AHPs, as a solution to the emerging workforce challenges facing the National Health Service².

Initially, only nurses and pharmacists could become non-medical prescribers, then in 2005, suitably qualified podiatrists were afforded the status of supplementary prescribers, affording a limited autonomy in prescribing practices². In 2013 podiatry, alongside physiotherapy, became the first of the AHPs to be granted legislative rights as independent prescribers. Constituting a decade since non-medical health professionals were permitted to act as independent and supplementary prescribers, able to prescribe within their scope of practice upon completion of an approved education programme⁴. Following a UK wide public consultation in 2015, NHS England welcomed new legislation allowing independent prescribing by therapeutic radiographers, supplementary prescribing by dietitians, and the use of exemptions within the Human Medicines Regulations 2012 by orthoptists. Currently, nurses, pharmacists, optometrists, physiotherapists, paramedics, chiropodists or podiatrists, radiographers and community practitioners may undertake further professional training to qualify as non-medical prescribers⁵.

Independent prescribers are accountable for assessing patients with undiagnosed or diagnosed conditions and can make decisions about the clinical management required, including prescribing. Independent prescribers must work within their level of professional competence and expertise.

Supplementary prescribing involves a partnership between an independent prescriber (e.g., a medical doctor), a supplementary prescriber and the patient to implement an agreed clinical management plan for an individual patient.

The benefits of non-medical prescribing by Allied Health Professionals

Prescribing by non-medical healthcare professionals makes it easier and quicker for patients to get the medicines they need, increasing patient choice and providing ease of access to medicines necessary for effective practice, resulting in improved patient care². Whilst also making better use of the skills of the AHP workforce, giving them increased autonomy and a broader scope of practice. Prescribing rights align well with the increasing number of advanced AHP roles such as First Contact Practitioners, Advanced Clinical Practitioners, and Consultant AHPs, allowing a more complete package of care within one episode of care.

Individuals in Specialist AHP roles support individuals in their management of injury and medical conditions through assessment, diagnosis, and treatment. Having gained the independent and supplementary prescribing qualification the cycle of assessment, treatment and review is undertaken by the professional who better understands their presenting problems.

The example of the physiotherapist’s role in the early recognition and management of pain can prevent it from becoming a chronic syndrome. Pain will interfere with active movement of the limbs and trunk, reducing muscle control and range which will interfere with regaining normal function.

Following NICE guidance appropriate and timely prescribing and review of analgesia will support the patient’s participation in exercise therapy. Later supportive de-prescribing of that same analgesia will reduce an individual’s dependence upon medication as their function and symptoms become more manageable.

To support all prescribers in prescribing safely and effectively, a single prescribing competency framework was developed because it became clear that a common set of competencies should underpin prescribing, regardless of professional background⁴.

The future

Although the ability for some AHPs to act as independent and supplementary prescribers has been a significant step forward for AHPs it has not been a seamless process.  There are ongoing difficulties illustrating the problematic nature of the supply, administration, and prescribing rights for some AHPs². It has also been reported that up to a third of AHPs may not use their prescribing qualification compared to 10% of nurses⁶. Research indicates that prescribing barriers are post and person-specific, whilst facilitators are likely to be generic⁶. There are still limits to practice which constrain the scope of the professions² and there are still some AHPs who are not permitted to act as prescribers, although it has been noted that the extension of prescribing responsibilities to other professional groups is likely to continue where it is safe to do so and there is a clear patient benefit⁴.  Further exploration is required to establish whether the practice of other AHPs could be enhanced by being afforded these rights.

References

1. UK Government. The 1968 Medicines Act.
2. Fitzpatrick MTJ, Borthwick AM. A decade of independent prescribing in the UK?: a review of progress. 2022;8:1-7.
3. Dougall D, Buck D. My Role in Tackling Health Inequalities A Framework for Allied Health Professionals.; 2021. https://www.kingsfund.org.uk/publications/tackling-health-inequalities-framework-allied-health-professionals
4. RPS. A Competency Framework for all Prescribers. R Pharm Soc. 2021;(September).
5. NHS England. Non-Medical prescribing by Allied Health Professionals. Accessed May 12, 2022. https://www.england.nhs.uk/ahp/med-project/
6. Graham-Clarke E, Rushton A, Marriott J. A Delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting physiotherapist and pharmacist non-medical prescribing. PLoS One. 2021;16(2 February):1-17. doi:10.1371/journal.pone.0246273