The British Association of Prosthetists and Orthotists

by

Lord Bradley Oral Question:

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.

Issue to press the Government on What did the report say, and will the Government publish it?

#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]
Issue to press the Government on When will the Government start the process of extending independent prescribing responsibilities to dietitians, occupational therapists, orthoptists, diagnostic radiographers, speech and language therapists, prosthetists and orthotists, and operating department practitioners?

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.
Issue to press the Government on Will the Government act on the Committee’s recommendation? If so, when? If not, why not?

[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