UK non‐medical CD prescribing law: permissive or restrictive?

Abstract

N ursing and pharmacy were the first professions permitted to engage in independent non-medical prescribing following an amendment to regulation (reg.) 2 of the Prescription Only Medicines (Human Use) Order 1997 (POM Order) in May 2006. 1 Optometrists were added to this list of prescribers or "appropriate practitioners" in June 2008. 2 Continuation of the list was transferred to reg. 214 of the Human Medicines Regulations 2012 (HMRs), which repealed much of the POM Order, in August 2012. Since that time, other professions have gained independent prescribing rights under the HMRs. These include: podiatrists and physiotherapists in August 2013; 3 therapeutic radiographers in April 2016; 4 and paramedics in April 2018. 5 Reg. 214 of the HMRs stipulate which medicines-specifically, those containing certain controlled drugs (CDs)-that each group of appropriate practitioners are permitted to prescribe. Doctors, dentists, supplementary prescribers (ie non-medical prescribers working under the terms of a clinical management plan co-signed by a doctor or dentist), nurse independent prescribers and pharmacist independent prescribers are appropriate practitioners in relation to any prescription only medicine

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

“…Far from enabling the delivery of seamless care, independent prescribing appears to maintain limits to practice that constrain the scope of the profession [ 29 , 30 ]. This is manifest in two exemplars which have necessitated further submissions to the Commission on Human Medicines (an advisory, non-departmental body sponsored by the Department of Health and Social Care) and the Advisory Council on the Misuse of Drugs (sponsored by the Home Office) over the last year (2021).…”

“…Such a serious assertion demands attention, and on closer inspection accounts in part for the problems which have recently beset podiatry. The disjunction between the MDRs and the HMRs affected the paramedic profession in 2018, as the HMRs were amended to allow paramedic independent prescribing, but, crucially, no corresponding amendment was made to the MDRs [ 29 , 30 ]. However, the key to the problem, for Gallagher, is the fact that the Misuse of Drugs Act (1971) “prohibits possession, production, supply, import and export of CDs…as allowed by regulations”, but, crucially, does “not prohibit the act of prescribing CDs” [ 29 , 30 ].…”

“…The disjunction between the MDRs and the HMRs affected the paramedic profession in 2018, as the HMRs were amended to allow paramedic independent prescribing, but, crucially, no corresponding amendment was made to the MDRs [ 29 , 30 ]. However, the key to the problem, for Gallagher, is the fact that the Misuse of Drugs Act (1971) “prohibits possession, production, supply, import and export of CDs…as allowed by regulations”, but, crucially, does “not prohibit the act of prescribing CDs” [ 29 , 30 ]. No restriction was placed on doctors or dentists, yet the advent of nurse and pharmacy independent prescribing saw the introduction of a new amendment to the MDRs – regulation 6B – which gave “authority” for these groups to prescribe CDs, when it was not actually required.…”

“…No restriction was placed on doctors or dentists, yet the advent of nurse and pharmacy independent prescribing saw the introduction of a new amendment to the MDRs – regulation 6B – which gave “authority” for these groups to prescribe CDs, when it was not actually required. Subsequently, when physiotherapy and podiatry were granted independent prescribing, another “authority” was granted in the MDRs – regulation 6 C – which is also deemed unnecessary [ 29 , 30 ]. For podiatry, however, there were even further implications, which were not revealed in Gallagher’s work, but which came to light in late 2019, uncovered by the authors of this paper.…”

“…In short, podiatrists across the country were supplying these products to their patients without realising that approvals outlined in the Human Medicines Regulations had been revoked or omitted from the Misuse of Drugs Regulations. Advice from the Home Office to the authors suggested that the latter trumped the former (a point contested by Gallagher [ 30 ]).…”