Non-medical prescribing in the United Kingdom National Health Service: A systematic policy review

Abstract

Introduction Non-medical prescribing was introduced into the United Kingdom (UK) to improve patient care, through extending healthcare professionals’ roles. More recent government health service policy focuses on the increased demand and the need for efficiency. This systematic policy review aimed to describe any changes in government policy position and the role that non-medical prescribing plays in healthcare provision. Method The systematic policy review included policy and consultation documents that describe independent non-medical prescribing. A pre-defined protocol was registered with PROSPERO (CRD42015019786). Professional body websites, other relevant websites and the following databases were searched to identify relevant documents: HMIC, Lexis Nexis, UK Government Web Archive, UKOP, UK Parliamentary Papers and Web of Science. Documents published between 2006 and February 2018 were included. Results and discussion Following exclusions, 45 documents were selected for review; 23 relating to policy or strategy and 22 to consultations. Of the former, 13/23 were published 2006–2010 and the remainder since 2013. Two main themes were identified: chronological aspects and healthcare provision. In the former, a publication gap for policy documents resulted from a change in government and associated major healthcare service reorganisation. In the later, the role of non-medical prescribing was found to have evolved to support efficient service delivery, and cost reduction. For many professions, prescribing appears embedded into practice; however, the pharmacy profession continues to produce policy documents, suggesting that prescribing is not yet perceived as normal practice. Conclusion Prescribing appears to be more easily adopted into practice where it can form part of the overall care of the patient. Where new roles are required to be established, then prescribing takes longer to be universally adopted. While this review concerns policy and practice in the UK, the aspect of role adoption has wider potential implications.

Limited pharmaceuticalisation: a qualitative case study of physiotherapist prescribing practices in an NHS Trust in England following the expansion of non‐medical prescribing in the UK

“…The overarching framework for data gathering and analysis focused on the key rationality of increasing patient access to new medicines (Graham-Clarke et al 2019). Ethnographic methods included observations of physiotherapist consultations with patients experiencing a wide range of musculoskeletal conditions; semi-structured interviews with physiotherapists and other healthcare professionals associated with physiotherapist non-medical prescribing practice at the Trust and nationally; and sampling of national and local non-medical prescribing and Trustrelated documents via intertextuality.…”

“…These political reforms reflect the key rationalities of improving patient care through increased access to medicines without compromising patient safety, optimising the skills of non‐medical professionals to combat rising demand for health care, and increasing efficiency and productivity in response to fiscal constraints (Graham‐Clarke et al . ).…”

“…Non‐medical prescribing of controlled drugs – drugs controlled under the misuse of drugs legislation – is profession specific, and access requires additional regulatory and legislative change (Graham‐Clarke et al . , Pharmaceutical Services Negotiating Committee n.d.).…”

“…Since publication of Busfield's paper, restrictions on nurse and pharmacist prescribing in England have all but been removed, bringing their prescriptive rights into line with those of doctors (Pharmaceutical Services Negotiating Committee n.d.). Additionally, several allied health professions have had their authority to prescribe medicines extended, and recent legislative change has opened the door for paramedic and dietitian prescribers following appropriate training and qualification (Graham-Clarke et al 2019). These developments suggest that non-medical prescribers, alongside doctors, may now indeed be a contributive force to pharmaceuticalisationthe concept wherein human conditions, capabilities and capacities are translated or transformed into opportunities for pharmaceutical intervention (Williams et al 2011).…”

“…Lastly, we discuss the mechanisms and effect of this organising framework on the construction of physiotherapist prescribing and its influence on pharmaceuticalisation via increasing access to medicines. rising demand for health care, and increasing efficiency and productivity in response to fiscal constraints (Graham-Clarke et al 2019).…”