Prescribing medicines – an essential competence for advanced and
consultant radiography practice Dianne Hogg, Vincent Goodey, Duncan Gavan, Nigel Thomas, Peter Hogg
Does the current inflexibility and limited scope of prescribing and administration of medicines for radiographer-led therapeutic and diagnostic procedures, negatively impact patient care and ultimately cost the NHS more?
I
t’s 2020. The Directorate of Integrated Unscheduled, Urgent and Emergency Care at Anywhere NHS Foundation Trust has just won a Health Service Journal award for excellence. Its one-stop shop approach is applauded nationally and the English Minister for Health is to visit to see for herself
how the directorate provides such excellent care for its patients. How? By valuing the contribution of all its team members, and enabling appropriate care at the point of contact where and when their patients need it. No professional territory is defended; responsibilities are divided with respect to patient need and professional skills and ability. Irrespective of where the patient steps out of the directorate flow they can leave without undue delay and with the medicines and future appointments they need. The directorate had a financial surplus at the end of the last financial year. This certainly seems like a pipedream in today’s current NHS climate, but it is one possible model of the future NHS1
and expectations, but we aren’t so far away... Nurses have been able to prescribe a wide range of medicines independently for over twelve
years, pharmacists almost ten years, podiatrists and physiotherapists a little over a year. Existing health services have improved and expanded and new ones have developed, because these health professionals can prescribe medicines independently... as part of a team. The idea of allowing non-medics to prescribe began with nurses almost 30 years ago in part sparked by the realisation that community nurses could not provide adequate care in many
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circumstances without asking a GP to prescribe medicines, dressings and so on once the community nurse had identified the need for that product. This continues to some degree, but tens of thousands of community nurses are now nurse prescribers, successfully managing wounds and other conditions within their scope of competence and in a timely manner. Non-medical prescribing interventions are now common and well-received by patients2
. They
shorten waiting times and also increase job satisfaction for the practitioner. New or expanded roles within healthcare have been developed as a direct result of the postholders being prescribers already3 and specialist role job descriptions increasingly require the postholder to be a prescriber. Independent prescribing involves prescribing medicines for any medical condition within the
prescriber’s ability and scope of practice. Doctors and dentists prescribe in this way and now non- medical practitioners independently prescribe on a daily basis in clinical areas such as:
• Emergency medicine, where in urgent care centres nurses prescribe bronchodilators such as salbutamol for acute asthma, antibiotics for urinary tract infections etc;
. This couldn’t be achieved overnight; hearts and minds need to change as well as skills
• Specialist nurses manage patients with heart failure – titrating their medicines up to therapeutic doses in response to tolerance;
• Specialist oncology nurses can prescribe and manage chemotherapy regimes; • Pharmacists prescribe to amend already prescribed medicines, eg to manage side effects, comply with local formulary or national guidelines; stop antimicrobials where the course end has been reached; or as a result of a medicines use review in a general practice setting to stop/start or alter the dose of a medicine or commence the patient on weight reduction programs or other public health interventions;
• Podiatrists manage the feet of patients with diabetes, prescribing analgesia for neuropathic pain or antimicrobials where appropriate;
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