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Netizens

If you were asked to give a set of small clinical vignettes to highlight the potential scope of supplementary prescribing to enhance podiatric practice, what would they be?

What say you?

Cameron

__________________

Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

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Netizens

No takers. Well that does certainly surprise me. Supplementary Prescription Rights for Podiatrists are here but judging from the lack of response maybe we have no reason for them . Surely not.

Try these and someone out there add to them please.

Scenario One
Friday afternoon with a diabetic patient, neuroischaemic foot with infected ulcer. High blood sugar, spreading cellulitis. Need to prescribe topical and systemic antibiotics asap. Delay over weekend could end up with patient having a long stay in hospital.

Scenario Two
Similar scenarios with immuno-suppressed disease. need for antibiotics (speedily) with infection.

Scenario Three
The need for anti-fungal agents to treat patients more comprehensively and save the time and energies of the GP.

Scenario Four
The need to be able to offer injectible steroids for musculo-skeletal joint pain and inflammation.

Scenario Five
The need for analgesia/anti inflammatory drugs following podiatric surgery.

Scenario Six
The need to be able to prescribe prescription only antiperspirants for people suffering from hyperidrosis & bromidrosis


Cameron
Hey, what do I know/

__________________

Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

I thought supplementary prescribing was about medications pts are already on not new prescriptions

Cameron

The A.Pod.A.(Vic.) developed a number of case studies that were included in the professions submission to Government.

It is at

http://www.podiatryvic.com.au/S4/paper.html

__________________
Stephen Tucker
Calvary Health Care

My location

Cameron,

All of the scenarios you have outlined require fully independent prscribing rights and supplementary rights would not be of any use unless of course these pt's needed a repeat prescription or to have their doseage altered.

Persuing Sup. Presc. rights is pointless in my mind and group protocols can be used to better effect. Of course independent prescribing rights are what we should be aiming for. Though from what I understand the next time it will be promised will be just before the next election to happen when the next ice age arrived.

Akbal

Lawrence and Akbal

The scenarios are meant to be where the patient is under the doctor but point taken supplementary is more difficult to define than independent and hence was delighted to read Stephen's posting. Also got this contribution for Andrew Schox.

Antibiotics seem to be out, since the longer somebody's on them,
the more likely it is that they would need a medical review. However,
perhaps when longer term prophylactic use (for example in a setting
of chronic lymphoedema) and the pod is regularly reviewing the
extremities, rather than the GP
- Non-steroidal anti-inflammatories for arthosis of the foot,
mechanical pain etc, where the pod is doing follow up and adjunctive
therapy
- Topical corticosteroids where there is a known and possibly long
term dermatitis
- Perhaps something like topical terbinafine for recurrent tinea (if
it is a scheduled drug in the UK). Oral would probably require the GP
to do LFTs and the like if more than one repeat were given
- Corticosteroids for things like iontophoresis, or phonophoresis

Any more?

Cameron

__________________

Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

The POM's certificate will provide access to many of the things you mention but so will the pharmacist cheaper than a visit to the podiatrist. Maybe the way to go is to extend the list of POM's available to the podiatrist for sale or supply, I think this is what the Soc. is aiming at. Maybe more academics and institutions like yours should be petitioning the government.

Netizens

The new legislation has far reaching implications for podiatry in the UK. Whilst it only affects about 1% of the total population, if successful the model of care may influence the way podiatry is practiced in future within the NHS. Still the largest employer of pods in Europe. Forgive going over familiar ground to those subscribers who are up with the changes in legislation. but for others here is a short summary.

Supplementary Prescription for Allied Health Professions Podiatry, physiotherapy and medical imagers)

Background

To ease the burden on medics and improve access to medicines the Department of Health have opened access to trained Allied Health Professions so they can prescribe certain medicines within agreed Clinical Management Plans. This was in accordance with Section 63 of the Health and Social Care Act 2001 and Section 42 (for England & Wales) and Section 44 (Scotland). Further changes to the NHS Regulations in April 2005 (Prescriptions Only Medicines Order), have enabled three other professions to be able to train as supplementary prescribers. These were podiatrists, physiotherapists and radiographers. Previously this option was open to nurses and pharmacists. The guidelines are primarily for England but Medicines legislation permits the introduction of supplementary prescribing across the UK. There are no restrictions on the clinical conditions that may be dealt with by a supplementary prescriber. The intention is to aid in the management of specific long term medical conditions or health needs affecting the patient. Provided the incident is pre-empted in the CMP, acute episodes may be covered too.

Definition

Independent Prescriber
Responsibility for the assessment of patients with undiagnosed conditions and for the decisions about the clinical management required, including prescribing.

Dependent Prescriber (now refered to as Supplementary prescriber)
Responsible for continuing care of patients who have clinically been assessed by an independent prescribe. This might include prescribing informed by clinical guidelines and consistent with the agreed care plan. The dependent prescriber continue established treatments by issuing repeat prescriptions with the authority to adjust the dose or dosage form according to the patient’s needs.

Supplementary Prescriber
A voluntary partnership between an independent prescriber (doctor or dentist) and a supplementary prescriber to implement an agreed patient specific Clinical Management Plan with the patient’s agreement. AHP are able to prescribe all medicines (including unlicensed medicines), with the current exception of Controlled Drugs.

Who qualifies?
A registered podiatrist who names held on a relevant part of the Health Professional Council membership register with an annotation signifying that the individual registrant has successfully completed an approved programme of training for supplementary prescribing.

Criteria
Capable of studying at university level (Level 3)
Have at least three years relevant post qualification experience.
Have the support of employer.
Work with indpendent prescriber

Range of drug to prescribe.
Medicines prescribable under supplementary prescribing arrangements
The Clinical Management Plan (CMP) may include and General Sales List, Pharmacy or Prescriptions Only Medicine prescribable at NHS expense, with current exception of Controlled Drugs.

These include:

Antimicrobials
Black triangle drugs http://www.mca.gov.uk/ourwork/monito...drugs.htm#What
British National Formulary less suitable for prescribing http://www.socialaudit.org.uk/5016-BNF.htm
Products outside UK Licence (off label use)
Off label drugs
http://www.healthatoz.com/healthatoz...rt02172005.jsp
Unlicensed drugs (not licensed in the UK)
http://www.keele.ac.uk/depts/mm/MTRA...e/unlicpsc.htm

Conditions
The independent prescriber must be a doctor or dentist. They are responsible for the diagnosis and parameters of the CMP.

A clinical management plan (CMP) must be put into place and in writing before supplementary prescribing can happen.

CMP must be agreed between the Independent and supplementary prescriber.

The supplementary prescriber has the discretion in the choice of drugs, frequency product and other variables in the relation to medicines only within the limits specified by the CMP.

The patient must be fully informed and in complete agreement.

A joint assessment would normally occur within 12 months of the start of the CMP.

The independent prescriber can at any time review the patient’ treatment and/or resume full responsibility for the patient’s care.

The independent prescriber and the supplementary prescriber must share access to, consult, keep up to date and use common patient record to ensure patient safety.

Role of the Supplementary Prescriber

Prescribing for the patient in accordance with the CMP (altering the medicines and/or dosage prescribed, within the limits set out in the CMP, if monitoring of the patient’s progress indicates that this action is necessary.

Monitor and asses the patients progress as appropriate to the patient’s condition and the medicines prescribed and responding accordingly.

Working at all times within their clinical competence and their professional Code of Conduct and consulting the independent prescriber as necessary.

Accepting professional accountability and clinical responsibility for their prescribing practice.

Passing prescribing responsibility back to the independent prescriber, if the agreed clinical reviews are not carried out within the specific interval or if they feel that the patient’s condition no longer falls within heir competence.

Having input into the development of the CMP

Reporting adverse events which are clinically significant and keeping the independent prescriber informed of them.

Alerting the independent prescriber of any clinically significant events.

Recognising when they are not competent to act and passing the prescribing responsibility back to the independent prescriber.

Recording prescribing and monitoring activity in the shared patient record within 24 –48 hours.

Need to keep themselves abreast of clinical and professional developments. From 2005, AHPs need to meet the requirements of the Standards for Continuing Professional Development of the HPC and submit evidence of CPD.

Training
Preparation and training for supplementary prescribers involve at east 26 taught days of university tuition and 12 days of supervised practice learning. The program may be spread over 3 to 6 months, within twelve months. All components of assessment must be passed before qualification. An out line framework is given here:
<http://www.dh.gov.uk/assetRoot/04/08/90/03/04089003.pdf>


Reference
Supplementary prescribing by nurses, pharmacists, chiropodists/podiatrists, physiotherapists and radiographers within the NHS in England: A guide for implementation Department of Health (Gateway Reference:4941) May 2005
http://www.dh.gov.uk/assetRoot/04/11/00/33/04110033.pdf

Interesting Sites
Sumplementary Prescribers
http://64.233.161.104/search?q=cache...podiatry&hl=en

http://64.233.161.104/search?q=cache...podiatry&hl=en

NB
The scope and access to drugs as a supplementary prescribers (UK) are far greater than an independent prescriber in Australia for example.

What say you?

Cameron Hey, I am 55 today.

__________________

Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

Happy birthday Cameron, I have a few years to go to get there.

Thanks for taking the time to type out the detailed reply but I mentioned in my reply to the MHRA see the first of those links, the crown report has been all but ignored. The view of June Crown was the Pod's should be given independent prescribing rights. I feel that supplementary provision is generally speaking a waste of time, as without doing any further study a group protocol or patient group directions(PGD) can do more including allowing assess to antimicrobials even.

Maybe getting these set up maybe moore useful.

Akbal

Sorry Guys looks as if this thread ended a week ago , but i have just found this site .
I was recently enrolled on the first validated course for PAMs in the Uk for SP . I too belived that PGDs were the way forward .
But it has since become clear to me that the Goverment in the fullness of time will give Independant rights to Pams .
But only if we can prove that we our able to be effective as supplementary prescribers .
It is interesting that the govt are making pharmacists do supplementary prescribing before allowing independant .
What i belive they are doing is making sure that this is at post graduate level . I dinot think they will ever intend for it to be at undergrad level .

charles (newbee)