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progress on extending prescribing responsibilities to more allied health professionals –

Briefing from the #PrescribingNow coalition – 06/02/2024

Introduction

• Despite assurances given to peers during the passage of the Medicines and Medical Devices Act in 2020, there has been no substantive movement on extending independent prescribing responsibilities to dietitians, occupational therapists, orthoptists, diagnostic radiographers, and speech and language therapists.
• The Government has also undertaken no assessment of the benefits of doing so, as confirmed by a series of written questions by MPs during 2023, most recently in October 2023.[1]
• In February 2023, the British Dietetic Association, the Royal College of Occupational Therapists, the British and Irish Orthoptic Society, the Society of Radiographers, and the Royal College of Speech and Language Therapists, launched the #PrescribingNow campaign. The coalition has since been joined by the British Association of Prosthetists and Orthotists and the College of Operating Department Practitioners.
• Coalition letters to Secretary of State for Health and Social Care in February 2023 and September 2023 remain unanswered. So do letters from individual organisations.
• In December 2023, the House of Lords Integration of Primary and Community Care Committee recommended, ‘More community disciplines should be given independent prescribing and referral rights, going further than the recently announced plans from the government for pharmacists’.[2]
• The coalition welcomes this recommendation. It is now time for the Government to act on it and finally start the moves to extending independent prescribing responsibilities to dietitians, occupational therapists, orthoptists, diagnostic radiographers, speech and language therapists, prosthetists and orthotists, and operating department practitioners, in the interests of our patients, other healthcare professionals, the wider health and care system, and the public purse.

Assurances to peers during the passages of the Medicines and Medical Devices Act in 2020

Responding to Baroness Thorton’s amendment on 11 November 2020, Baroness Penn said:

• I know that a number of NHS professional groups are keen to see their members taking on responsibility for supplying or prescribing medicines. We have recently seen papers put forward by the British Dietetic Association, the Royal College of Occupational Therapists, the British and Irish Orthoptic Society, the Society of Radiographers and the Royal College of Speech and Language Therapists. I am very grateful to the professional groups for the careful consideration that they have given to these issues.
• I reassure noble Lords that NHSE/I [NHS England] already has extensive joint working and engagement under way with these and other professional groups to consider whether any other changes would help keep patients safe and well. This will build on the historic work with various professional bodies and the devolved Administrations, over the last few years, which resulted in a number of changes, including allowing paramedics and therapeutic radiographers to be independent prescribers. As well as this, a wider scoping project is being led by NHS England and NHS Improvement, with the devolved Administrations and professional bodies, on the current and potential future use of medicines supply, administration and prescribing mechanisms by a range of non-medical healthcare professionals.[3]

In a follow-up letter to peers dated 24 November 2020, Lord Bethell commented:

• The noble Lord, Lord Ramsbotham emphasised how some allied health professionals are keen to take on prescribing responsibilities to better support their patients and increase capacity in their home trusts. I know this is a heartfelt desire and I am keen to work with NHSE&I to ensure we can support these moves where it is safe and appropriate to do so.
• Significant moves have been made over the past few years enabling allied professions to take on extended roles with medicines, including enabling orthoptists and speech and language therapists to use patient group directions; diagnostic radiographers and dietitians to be supplementary prescribers; and paramedics and physiotherapists to be independent prescribers. NHSE&I is currently scoping the next phase of this programme of work and I expect it to report to me in April next year. I would not wish to pre-empt its findings because it is important that we act on evidence and prioritise the greatest benefits for patients and NHS need.

The NHSE scoping report which Lord Bethell said would be with him by April 2021 has not been published. It is not clear, therefore, what the report said about extending independent prescribing responsibilities to us. This is despite some of us submitting material to the scoping exercise.

#PrescribingNow campaign February 2023

• The #PrescribingNow campaign was launched in February 2023 calling for independent prescribing responsibilities to be extended to us.[4]
• The Government has not responded to letters we sent them in February and October 2023.
• Numerous MPs have tabled written questions or written to ministers.
• The Government’s replies have been disappointing, revealing no assessment has been taken of the benefits of extending prescribing responsibilities to us, despite the 2020/21 NHSE scoping exercise.
• The Government saying we are already able to supply or administer medicines to their patients via Patient Group Directions misses the point, and ignores the arguments peers made back in 2020.
• As detailed in the campaign’s briefing, without independent prescribing responsibilities, we cannot play our full part in supporting our patients, other healthcare professionals, and the wider system.[5]

House of Lords Integration of Primary and Community Care Committee report December 2023

• In December 2023, the House of Lords Integration and Community Care Committee report recommended extending prescribing responsibilities to more community disciplines:
• More community disciplines should be given independent prescribing and referral rights, going further than the recently announced plans from the government for pharmacists. The DHSC should build on this work and investigate whether other community clinicians can be given similar rights. POD and community clinicians are trained to a high level and could be given (new or enhanced) prescribing and referral rights that reduce demand on GPs as either prescribers or referrers. For example, orthoptists could monitor and prescribe glaucoma treatments. (Paragraph 168)
• The Committee’s report quoted from the #PrescribingNow coalition’s Q & A.
• We very strongly welcome and support the Committee’s recommendation.

[1] https://questions-statements.parliament.uk/written-questions/detail/2023-09-19/200543

[2] https://committees.parliament.uk/committee/649/integration-of-primary-and-community-care-committee/news/198938/integration-is-key-to-health-service-improvement-says-lords-committee/

[3] https://hansard.parliament.uk/lords/2020-11-11/debates/BA33FB80-686D-40A3-802D-867ED6691A6E/MedicinesAndMedicalDevicesBill  

[4] https://www.rcslt.org/policy-and-influencing/england/campaigns/

[5] https://www.rcslt.org/wp-content/uploads/2023/02/Q-A.pdf

The British Association of Prosthetists and Orthotists has awarded Lynne Rowley the BAPO Lifetime Achievement Award.

The award has been made to reflect Lynne’s long service, during which she made a unique and dedicated contribution to both BAPO and the profession during what were challenging times. In particular, we wish to pay tribute to her leadership during the Covid-19 pandemic.

On hearing of the award Lynne said “I am taken aback by this award and it means the world to me. You will know that the P&O profession has been a major part of my life and it’s lovely to have that recognised by such a wonderful fraternity of colleagues.

It’s been an honour and a privilege to know and work with you all…Thank you again for the nomination and the award. I feel touched and greatly appreciate it”.

An article providing further details relating to the award and the career of Lynne Rowley will appear in BAPO Connect.

After the success of our 2023 regional conferences in Scotland and South England, BAPO is excited to announce that we will hold our next regional conference in Wales on Friday 8th March 2024 at the Future Inn Cardiff Bay, Hemingway Road, Cardiff, CF10 4AU

The theme for the one-day event is People and Place: Enhancing the quality of prosthetic and orthotic services in Wales. Our programme will consist of a mix of invited speakers and free papers.

The event is targeted at P & O professionals and the wider P & O community. It is open to both BAPO members and non-members. It is a great opportunity to enhance knowledge, support continuing professional development, network with colleagues and engage with exhibitors face-to-face.

The programme will start at 11:00 am and conclude at 4:00 pm. Registration and the exhibition will start at 10:00 am. There will be a 1-hour lunch break and a 30-minute coffee break in the afternoon to allow delegates to network with colleagues and friends.

Come along to learn, collaborate, communicate and share ideas!

Speakers

Kerrie Phipps

National Allied Health Professions (AHP) Lead Primary & Community Care | Arweinydd Proffesiynau Perthynol i Iechyd (AHP) ar gyfer Gofal Sylfaenol a Gofal yn y Gymuned

Kerrie provides professional leadership and expert strategic advice, on a national basis, relating to the role of Allied Health Professionals working across Primary and Community Care, in line with the vision of A Healthier Wales, the Strategic Programme for Primary Care and the AHP Framework in Wales – ‘Looking Forward Together’.

Her role focuses on optimising the AHPs offer and accessibility across Primary and Community Care, in order to support a preventative, pro-active whole system pathway approach to recovery and rehabilitation provision, which prioritises services at or close to home and enables citizens throughout Wales to live as independently as possible for as long as possible.

Kerrie has over 30 years of experience working across health and social care and is passionate about AHPs utilising their unique skill set to support presenting needs, delivering person-centred support within a place-based care model of care. She is a leader committed to creating a culture of compassionate care, and inspiring greater collaboration to bring positive, inclusive and productive transformation.

Summary of Presentation:

Optimising the AHPs offer and accessibility across Primary and Community Care in Wales

The AHP Framework for Wales identified AHPs need to be utilised more effectively to inspire and enable people to lead healthier lives, be more easily and directly accessible, and work at the top of their ability with visible and transformational leadership. With ‘strong primary care’ at the heart of everything that they do.

This translates into the AHP ambition in Wales, for well-integrated services, rooted in the community, with the full range of practitioner levels and prudent optimisation of AHP skill set.

Doug Young

Improving Quality with Digital Manufacturing

Doug Young studied at the National Centre for Training and Education in Prosthetics and Orthotics at Strathclyde University in Scotland, graduating in 2006. Since then he has worked across the UK in both the NHS and private sectors. His specialism lies in complex orthotic problem solving, lower limb biomechanics and neurological conditions. His passion for high quality orthotic treatment inevitably led him into 3D printing where he has developed extensive knowledge and experience.

Dr Nicky Eddison

BAPO Chair, Associate Professor / Consultant Orthotist 

Presentation – The current status of the UK prosthetic and orthotic workforce and implications for the future

Dr Nicky Eddison received her PhD in biomechanical optimisation of ankle-foot orthoses and footwear combinations in 2018 from Staffordshire University and currently holds the position of Association Professor at the Centre for Biomechanics and Rehabilitation Technologies at Staffordshire University. In addition, Nicky is a consultant orthotist and service manager at the Royal Wolverhampton NHS Trust.  In March 2024, Nicky will take the position of Chair of BAPO.

Nicky has a portfolio of peer-reviewed publications, achieving impact within the orthotics profession both nationally and internationally and across the wider healthcare domain of Allied Health Professions. Her research interests include biomechanical optimisation, prescription footwear, gait analysis, digitalisation in healthcare, and health inequalities.