Independent prescribing rights - 10 years on

Much has improved since 2013. We now have a UK-wide prescribing competency framework for all prescribers, which the Health and Care Professions Council (HCPC) has adopted as the regulatory standards. The curricula frameworks for prescribing have been refreshed as has our own practice guidance for prescribers. 2015 saw the introduction of legislation for limited controlled drug prescribing by physiotherapists, 2021 saw a recommendation by the Commission for Human Medicines that this list be increased by a further four drugs. Wales is looking to introduce a national assurance framework for prescribers. More than 2,000 HCPC registered physiotherapists (three per cent) are now annotated as prescribers (HCPC FOI July 2023), compared with only 500 in 2016.

What next

Some things we continue to work on: we know that the limited formulary for controlled drugs creates barriers to practice in areas where physiotherapists are extending their reach into services. We are awaiting ministerial action on this. Accessing wholesale stocks of medicines remains prohibited by individual physiotherapists, impacting some private practitioner prescribers. This issue may be partially alleviated by the rise in the availability of online pharmacy solutions, enabling the rapid fulfilment of a physiotherapist’s prescription. And Patient Group Directions (PGDs) – whilst not a prescribing issue directly – the limitations of them mean that non-prescriber physiotherapists need to look ever more closely to see if there is a need for them to train as prescribers.

Where do we need to be looking to in the future? Advanced practice and the language used in NHS policy documents give us a good indication.

Interpretations 

The CSP set the definition of the scope of independent prescribing to secure legislative change in 2013. We are aware there have been barriers to a physiotherapist’s prescribing work relating to the local interpretation of this definition. For example, there are many myths out there; that we can only prescribe for MSK conditions, or that we can’t prescribe antibiotics, or we don’t have the necessary applied science knowledge to prescribe safely. None of these are true. Yet, we know this has happened in advanced practice frailty and paediatric services. We have worked in partnership with affected members giving them the tools needed to successfully resolve their local barriers. If you are affected by this issue, please get in touch so we can help you. We continue to work with NHS England and our fellow AHP prescribing professional bodies to reach consensus to overcome such barriers.

Get qualified

The future direction of NHS services sets great store in the value of advanced practitioners and their role in optimising future services. Prescribing is a skill acquired post-registration, and whilst not restricted to defined advanced practice roles, it is undoubtedly helpful in maximising the value of these roles. As physiotherapists maximise their full capabilities across the breadth of the profession, and continue to realise their potential and impact in emerging AP roles, individual physiotherapists who aspire to develop their capabilities really need to plan ahead. If a prescribing qualification would add value and impact to any role, then physiotherapists need to get a prescribing qualification under their belt.   

Yes, there remain ongoing challenges, but we now know the positive impact that physiotherapist prescribing can have on patient care. The ask now is that members who are in relevant roles and pathways, have conversations with their employer to maximise the opportunities they may have to acquire prescribing skills.