Prescribing decisions are highly complex. Once you have worked out that you need to prescribe a drug, you then need to consider a multitude of other things, including medicines that could potentially interact, contraindications (such as poor renal function), dose, therapeutic effects, side effects and so on, and that’s before you’ve even thought about the legal and ethical aspects of prescribing.
Support for new prescribing professions
What happens when it doesn’t go according to plan? I remember the first time I prescribed a glucagon-like peptide-1 agonist injection for one of my diabetes patients and she became very ill, needing hospital admission. I felt responsible, so much so that I visited her when she got home to apologise for what had happened. But in fairness I had done nothing wrong: she had suffered a severe adverse drug reaction.
Although it was a hugely unpleasant experience for the patient, it did result in her finally giving up boiled sweets and sugar in her tea — which she had always denied having. Subsequently her sugar levels improved and she has since been managed with oral hypoglycaemic medicines only. So there was a positive outcome; but it was a stark reminder of the strength of these medicines.
Independent prescribing rights have recently been extended to physiotherapists and podiatrists. How will they cope with the complexities of prescribing? Some GPs find it challenging even after many years of practice. Rigorous training and education is essential for these allied health professionals to gain an in-depth knowledge and understanding of pharmacology and therapeutics. They will need to have access to medical histories to help them decide on the appropriateness of medication and to check for previous drug allergies or adverse drug reactions.
Alongside this they will need mentorship and ongoing clinical supervision from a doctor (or indeed a pharmacist) and will need to have a structure in place that enables them to keep up to date and be informed of relevant drug alerts.
Expanding non-medical prescribing in this way will no doubt provide better access to medicines for patients. I can think of many scenarios where this would be useful, for example: a podiatrist being able to prescribe for cellulitis or infected toenails; physiotherapists prescribing anti-inflammatories or joint injections for musculoskeletal problems or antibiotics and corticosteroids for respiratory conditions. This should also help free GP time, which is in short supply.
All in all, I believe extending prescribing rights to these highly skilled professionals has got to be a good thing — as long as they have the right kind of support and give full consideration to the many things that will impact on the choice of medicine for individual patients.
Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11127239
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