A decade of independent prescribing in the UK: a review of progress

Abstract

Background 2022 marks a decade since the profession of podiatry secured independent prescribing rights in the UK. Widely viewed as a significant milestone, its advent appeared to herald a new age of practice, with increased autonomy, a broader scope of practice and improved patient care. Access to any medicine within the British National Formulary (with a few notable exceptions) seemed to signal an end to the perennial difficulties and frequent disappointments in obtaining ease of access to medicines necessary for effective practice. Main body Recent attempts to expand the scope of prescribing practice to include access to a broader range of controlled drugs (CDs) have led to unanticipated complications which may even threaten existing rights. These issues highlight the limitations of current independent prescribing and the continuing inability of podiatrists to access certain key medicines, primarily controlled drugs. Reliance on specified ‘lists’ of approved medicines, whether a controlled drug list for prescribers or the use of statutory exemptions by non-prescriber podiatrists, remain inflexible and difficult to change. The data underpinning much of this paper is derived from the work undertaken by the authors as representatives of podiatry on NHS England’s Chief Professions’ Officers’ Medicines project, in particular involving submissions to the Commission on Human Medicines and the Advisory Council on the Misuse of Medicines, spanning the years 2017–2021. It describes a complex process, and highlights a misalignment between two legislative frameworks that threaten to unravel existing rights. Short conclusion Ongoing difficulties relating to controlled drugs illustrate the problematic nature of current supply, administration and prescribing rights in podiatry. Efforts to keep pace with periodic legal reclassifications of medicines are constrained by limited and inflexible legal mechanisms, and formal approval for extended access via prescribing remains unpredictable and complex. For prescriber and non-prescriber1 (1Non- prescriber podiatrists are those who are neither supplementary or independent prescribers, but do enjoy existing administration and supply rights to certain medicines.) podiatrists alike, the profession of podiatry faces a new challenge to its ability to access medicines, and to realise its full clinical potential.

Independent prescribing in the UK: insights from the Department of Health Allied Health Professions Medicines Project team

“…Professions, by nature, do not easily cede authority over task domains or agree to blur role boundaries in areas considered central to professional identity [4, 17]. The prescribing of medicines is a core function of medical practice and one previously exclusive to doctors8 [4, 28–32]. Indeed, although softening rigid professional boundaries via increased role flexibility is a longstanding government policy objective [7–9], the study data do reflect an underlying resistance to change.…”

“…66 Securing access to specific lists of controlled drugs was also undertaken, involving a submission to the Advisory Council on the Misuse of Drugs of the Home Office, requiring similar documentation, with changes sought to the Misuse of Drugs legislation. See Fitzpatrick and Borthwick 2022 (ref [28]).…”

A multi‐professional survey of UK practice in the use of intra‐articular corticosteroid injection for symptomatic first metatarsophalangeal joint osteoarthritis

“…Different healthcare professionals treat people with first MTPJ OA; following changes in regulations for prescription only medicines in the UK, nurses and allied health professionals now prescribe and administer intra‐articular corticosteroids [23]. Data demonstrate that intra‐articular corticosteroids are used in the management of first MTPJ OA, but little else is known about this practice [17].…”

The Misuse of Drugs Regulations 2001: A case study in poor legislative drafting

“…6C, which explicitly authorises both physiotherapist and podiatrist independent prescribers to prescribe medicines in this category. This situation undermines the ability of the allied health professions to fully utilise their skills within the current legislative framework (Fitzpatrick and Borthwick, 2022). For example, podiatrists across the country with requisite qualifications were supplying compound analgesics to their patients without realising that approvals outlined in the Human Medicines Regulations had been omitted from the Misuse of Drugs Regulations.…”