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)
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.
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 patientís needs.
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 patientís agreement. AHP are able to prescribe all medicines (including unlicensed medicines), with the current exception of Controlled Drugs.
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.
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.
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
Unlicensed drugs (not licensed in the UK)
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 patientí treatment and/or resume full responsibility for the patientís 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 patientís progress indicates that this action is necessary.
Monitor and asses the patients progress as appropriate to the patientís 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 patientís 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 Ė48 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.
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:
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
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.