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I saw an article in Podiatry now (April 2009) and the author talks about access and supply of POMS as being the biggest change in Podiatry since the use of LA. My question is do we agree with this?

Also, the author talks about the possibility of independent prescribing by Podiatrists - is ths reality or fantasy??

Does anyone have any views??

My view is that this will be done in line with all the other HPC professions and nursing being offered relevant prescribing rights.

We lost whatever autonomy we had gained by introducing LA and surgery a loooong time ago.

I didn't see the Pod Now article - but I can imagine the rhetoric.

Cheers,

Was it not you that wrote the article? (Or a coincidence you are both called Paul and both studying for your MSc at Brighton?)

Ian

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This area is becoming very confusing with so many changes to the law. But basically Podiatrists can become full independent prescribers if they wish already. The Independent prescribing courses for non-medical staff hosted by many Universities now are open to AHP's (though they were written for nurses). We also have our own small "sale and supply" PoM list of antibiotics, injectable LA and steroids etc

The question is do you want full independent prescribing? I personally think a bigger list than we currently have rather than the full formulary would make more sense. Unfortunately though the Royal College of Pharmacists are opposing "limited list prescribers" due to the time it takes to police them - hence the "sale and supply" rather than "prescribe" element of our current PoM list. I would think a larger sale/supply list very likely in the near-ish future.

"sale and supply" = Podiatrists stock the medication and dispense directly to the patient - they are responsible for drug labeling, COSSH, advice sheets, dosages etc
"prescribe" = a prescription is written by the Pod on "official pad" and dispensed by Pharmacist

David, I believe we are the only profession in the HPC that has a PoM list? I think all Physios that are injecting steroids do so through a patient group directive?

Hi Laurence,

You may well be right (your last para). If so, I think this wil change. I can see in the not-too-distant future that any HPC-reg profession which wants to prescribe will be able to do so, with restrictions, provided that prescribing is relevant to that profession.

My understanding is that currently much of the content of our available POM list is also available over-the-counter?

In any case it is all still a far cry from us being our own masters when it comes to POMs.

Cheers,

Anyone have any details of these prescribing courses? Where they are, how long etc.

Any Pods actually done the course and operating as an independant prescriber?

I completed my Non Medical Prescribing course done through Stirling University almost 18 months ago now.
My nursing collegues who completed the same course are allowed to Independantly Prescribe (IP), but I am limited to Supplementary Prescribing (SP) at present until there is a change in the law.
If there is a change in the law i will be able to Independantly Prescribe without having to complete further training.
Using SP is time consuming and cumbersome, but it does support your prescribing decisions as you have to work using a Clinical Management Plan (CMP), and i see it as a way of gaining the evidence that Podiatrists can prescribe safely so that IP can come in the future.

The really crazy situation is that I am a SP (and a possible future IP), but as i graduated many years ago i am not entitled to use the sale and supply rights that more recent grads have, even though i have 20 years experience!!!

The prescribing course does allow full use of items in the BNF, but it is made very clear in the course that if you prescribe outwith your area of competance, then you can expect consequences, not only from your employer but the HPC.

The prescribing course was the best course that i have undertaken since i graduated, as it makes you look very closely at your practice and how you can improve the care for your patients. It is only by undertaking the course that you will begin to realise what IP could do for the profession and its standing in the eyes of the public and fellow health professionals.

Interesting.

So how does this impact your day to day practice?

As a for instance. I had a new assessment last week. Demented, large pressure ulcer plantar L1st, due to OA deformity.

To cut a long story short I arranged for some iodasorb ointment, biatain foam and a kerraped boot while we wait for ortho footwear.

I did this with a letter faxed to the GP who subsequently prescribed the items which took a week to arrive at the patients home.

Playing devils advocate, how does having SP (or IP) rights make this process any "better"?

Another case;

Housebound patient with chronic ulceration to the L3rd medial IPJ. We have suspected osteomyelitis from the start but have found it impossible to get her an X-ray to confirm and the GP has seemed a little ineffective. So we have liased with the GP in person and she is going to receive a 6 week course of high dose fluclox, this is at our recommendation.

If I had my own 'script pad would I have been able to just get her on the abx long before now, without even bothering the GP?

I know the details above are a bit lacking but I've got a clinic about to start.

With SP, the process you describe might be quicker by just contacting the GP, unless you could have predicted that this may happen and have CMP already in place, in which case you could have pulled out your Prescription pad and done a script.

If IP was allowed then both cases could have been dealt with without contacting the GP, which obviously would have helped the patients.

The argument is use SP to prove that Podiatrists can prescribe responcibly and then push for IP.
Nurse IP, will commonly use a CMP and SP, for those patients where the decisions are more difficult, as this affords them the support of a doctor.
A lot of new Nurse IP prescribe using SP until such time that they feel confident to do so themselves.

I find SP especially useful, for those Diabetic/Rheumatiod pts where breakdown can be predicted, and my CMP's contain antibiotics and dressings, and the pt can leave the clinic with a script.
I also use CMP for Nail Surgery patients and again, they contain dressings and antibiotics if required.
GP's i have dealt with have had no issue with my CMP and can only see a benefit for the patients. Admittedly they take a bit of setting up, but where the problem can be predicted they save a lot of time for the patient (dont have to see GP) and improve patient care.

Nurses have had to go through a similar, but look at them now with Nurse Led clinics that do a full range of prescribing for there specialist area - why not Podiatrists

We have to do the hard yards to earn the right to IP, as this will truely take the profession to another level