To seek views on possibilities for introducing independent … · 2013-07-16 · This engagement...
Transcript of To seek views on possibilities for introducing independent … · 2013-07-16 · This engagement...
Engagement exercise
To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
DH INFORMATION READER BOX
Policy EstatesHR/Workforce CommissioningManagement IM&TPlanning/ FinanceClinical SocialCare/PartnershipWorking
Document purpose GatheringINFORMATION
Gateway reference 14691
Title ENGAGEMENTEXERCISETOSEEKVIEWSONPOSSIBILITIESFORINTRODUCINGINDEPENDENTPRESCRIBINGRESPONSIBILITIESFORPODIATRISTS
Author DepartmentofHealth
Publication date 3Sept2010
Target audience PPCTCEs,NHSTrustCEs,SHACEs,FoundationTrustCEs,MedicalDirectors,DirectorsofPH,DirectorsofNursing,DirectorsofAdultSSs,PCTChairs,NHSTrustBoardChairs,DirectorsofHR,DirectorsofFinance,AlliedHealthProfessionals,GPs,DirectorsofChildren’sSSs
Circulation list
Description Thisengagementexerciseprovidesbackgroundandinvitesviewsonpossiblechangestomedicineslegislation,whichwouldenablepodiatristtoprescribeindependently.ItmaytheninformandassistthedevelopmentofaformalpublicconsultationbytheMedicinesandHealthcareproductsRegulatoryAgency(MHRA)proposingamendmentstotherelevantlegislation.
Cross reference N/A
Superseded docs N/A
Action required Respondtothequestionsprovidedtothemailboxorinwriting
Timing Responses required by 26 Nov 2010
Contact details ShelaghMorrisAHPPLTRoom5E58QuarryHouse,QuarryHill,LeedsLS27UE01132546061
For recipient’s use
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists 222
Contents
About this engagement exercise 4
What is non-medical prescribing? 4
Who can respond to this engagement exercise? 5
How to respond 5
What podiatrists do Examples of podiatry roles
78
Where podiatrists work 10
How podiatrists are trained and regulated 10
How would podiatrist independent prescribers be trained? 11
What benefits would podiatrist independent prescribing bring? 13
Protecting the public 14
Governance and safeguards 15
Options for podiatrist independent prescribing 17
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists 3
Further considerations 22Controlled drugs 22Mixing prior to administration 23Prescribing of unlicensed medicines 24Off-label prescribing or supply of medicines 25Simultaneous prescribing and administration 26
Additional questions 27
Appendix 1 Non-medical prescribing and medicines supply mechanisms
2929
Appendix 2 Main conditions and medicines – podiatry
3131
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
44
About this engagement exerciseInJuly2009theDepartmentofHealth(DH)AlliedHealthProfessionalsPrescribingandMedicinesSupplyMechanismsScopingProjectrecommendedthatfurtherworkbeundertakeninordertoextendindependentprescribingtoappropriatelytrainedchiropodists/podiatrists(fromnowonreferredtoonlyaspodiatirsts),inordertoimprovethesafety,effectiveness,patientexperienceandproductivityofhealthcare.TheDHNon-MedicalPrescribingBoardacceptedtherecommendationsandagreedthatfurtherworkshouldbeundertakentoexploreindependentprescribingbypodiatrists.
Thisengagementexerciseprovidesbackgroundinformationandinvitesviewsonpossiblechangestomedicineslegislation,whichwouldenableappropriatelytrainedpodiatriststoprescribeindependently.Dependingontheoutcomeofthisexercise,andsubjecttoagreementbyMinisters,itmaytheninformandassistthedevelopmentofaformalpublicconsultationledbytheMedicinesandHealthcareproductsRegulatoryAgency(MHRA)proposingspecificamendmentstotherelevantlegislation.
Thisengagementexercisewillremainopenfor12weeks,endingFriday26November2010.
What is non-medical prescribing?Overrecentyearschangestothelawhavepermittedanumberofprofessions,otherthandoctorsanddentists,toplayanincreasingroleinprescribingandmanagingmedicinesfortheirpatients.Therearenowover16,000qualifiednurseindependentprescribersandaround1000qualifiedpharmacistindependentprescribers.Morerecently,Optometristshavebeenaddedtothelistofprofessionsabletoprescribeindependently.Evidencefromevaluationofnurseprescribingin20051andarecentevaluationofnurseandpharmacistprescribingbytheUniversitiesofSouthamptonandKeele(dueforpublication2010)indicatesthatsuchprescribingisvaluedbypatientsandgivesthemquickeraccesstothemedicinesthattheyneed.
1UniversityofSouthampton(2005)Evaluationofextendedformularyindependentnurseprescribing–ExecutiveSummary,DepartmentofHealth,London.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
5
Podiatristshavebeeninvolvedinthedirectcareofpatientsformanyyears.PodiatristshaveexperienceinthetreatmentofconditionswithmedicinesthroughtheuseofExemptions–whichenablealimitedlistofPrescriptionOnly(POM)andPharmacy(P)plusallGeneralSales(GSL)medicinestobesold,suppliedoradministeredinthecourseoftheirprofessionalpractice.TheseExemptionssitalongsidePatientSpecificDirections2andPatientGroupDirections3.Since2005,experiencedpodiatristshavebeenabletotrainasSupplementaryPrescribers(Appendix1containsfurtherdetailaboutthevariousnon-medicalprescribingandmedicinessupplymechanisms).
Thisengagementexerciseseeksviewsonpossibilitiesforintroducingindependentprescribingresponsibilitiesforpodiatrists.
Who can respond to this engagement exercise?Everyoneiswelcometorespond.Wehopetohearfromthepublic,patients/patientrepresentativegroups,healthcareproviders,commissioners,doctors,pharmacists,regulators,non-medicalprescribers,theRoyalCollegesandotherrepresentativebodies.
How to respondYoucanrespondinoneoftwoways:
• Byusingtheelectronicresponseform.Typeyouranswerstothequestionsintotheboxesprovided.Whenyouhavecompletedthefinalquestion(question11)andenteredyourdetailsbelowit,clickon‘Saveform’.Thiscreatesapdffilewhichyoushouldsavetoyourcomputerdesktop.Youcanthenemailthepdffiletousatahpprofessionalleadershipteam@dh.gsi.gov.ukusingthe‘Attachtoemail’optioninthe‘File’menuofthepdf.
• Alternatively,youmayprinttheformandsenditinhardcopyto:ShelaghMorris,ProfessionalLeadershipTeam,DepartmentofHealth,QuarryHouse,LeedsLS27UE
2Theterm“PatientSpecificDirection”isnotdefinedinlegislation.Itreferstothewritteninstructionofaprescriberwhichenablesapersontosell,supplyoradministeramedicinetoanamedpatient.
3Theterm“PatientGroupDirection”andtheassociatedlegalrequirementsaredefinedinmedicineslegislation.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
6
IfyouhaveanyqueriesorrequirefurtherinformationinrelationtothisengagementexercisepleasecontactAlexHill,[email protected].
Confidentiality of Your ResponseWemanagetheinformationyouprovideinresponsetothisengagementexerciseinaccordancewiththeDepartmentofHealth’sInformation Charter.
Informationwereceive,includingpersonalinformation,maybepublishedordisclosedinaccordancewiththeaccesstoinformationregimes(primarilytheFreedomofInformationAct2000(FOIA),theDataProtectionAct1998(DPA)andtheEnvironmentalInformationRegulations2004).
Ifyouwanttheinformationthatyouprovidetobetreatedasconfidential,pleasebeawarethat,undertheFOIA,thereisastatutoryCodeofPracticewithwhichpublicauthoritiesmustcomplyandwhichdeals,amongstotherthings,withobligationsofconfidence.Inviewofthisitwouldbehelpfulifyoucouldexplaintouswhyyouregardtheinformationyouhaveprovidedasconfidential.Ifwereceivearequestfordisclosureoftheinformationwewilltakefullaccountofyourexplanation,butwecannotgiveanassurancethatconfidentialitycanbemaintainedinallcircumstances.AnautomaticconfidentialitydisclaimergeneratedbyyourITsystemwillnot,ofitself,beregardedasbindingontheDepartment.
TheDepartmentwillprocessyourpersonaldatainaccordancewiththeDPAandinmostcircumstancesthiswillmeanthatyourpersonaldatawillnotbedisclosedtothirdparties.However,theinformationyousendusmayneedtobepassedontocolleagueswithintheUKHealthDepartments.
What podiatrists doPodiatristsarestatutorilyregisteredhealthprofessionalswhofocusonthediagnosis,managementandtreatmentoffootandlowerlimbdisorders.Theirkeyroleistohelppreventorcorrectdeformityandmaintainnormalmobilityandfunction.Podiatrists’managegaitproblemsandidentifyassociatedmedicalorsurgicalconditionsthatmayrequirefurtherreferralandmanagement.They
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
7
alsohelptorelievepainfulfootconditions,treatfootinfectionsandotherdisordersoftheskin,nail,softtissueandconnectivetissues,oftenworkinginconjunctionwithothermembersofthehealthcareteam.Podiatristscanalsogiveexpertadviceonfootwear.Specialistpodiatristsseemanypatientsathighriskofamputation,forexamplethosewhosufferfromimpairedbloodsupplytothelowerlimb,footulcersandwounds,orthoserequiringsurgery,forexampletocorrectbunions.Podiatristsareactiveinhealthpromotion,preventativehealthcare,treatmentandrehabilitationusingphysicaltreatments,medicinesandsometimessurgery.
Followingpre-registrationtraining,mostpodiatristsgainexperienceingeneralpractice,mainlyintheNationalHealthService(NHS),orintheprivatesector.Manypodiatriststhengoontospecialise,orworkexclusivelywithaspecificclientgroup.Perhapsthemostwellknownfieldsofspecialisationincludemusculoskeletal(suchasfunctionalfootandgaitproblems,alsoknownasbiomechanics,andsportsinjuries),diabetescare(assessingtheriskofandmanagingfootulcersandwounds)andrheumatology.Otherspecialismsareindermatology,footwear,surgeryandchildren’slowerlimbproblems.
Advancedandconsultantpodiatryroleshaveledthedevelopmentofpodiatrytoincreasinglevelsofresponsibilityfordiagnosis,onwardreferralandprovisionofspecialistinterventions.ThepublicincreasinglyuseNHSandindependentsectorpodiatristsdirectly(egself-referral)fordiagnosisandtreatment,withoutcontactingadoctor.
SincetheMedicinesAct(1968)wasintroduced,somepodiatristshaveusedmedicinessafelyandeffectivelyintheirprofessionalpracticethroughPatientSpecificDirectionsissuedbyadoctor.From1980,somepodiatristshavealsohadaccesstocertainmedicinesviastatutoryexemptions,allowingthemtosell,supplyandadministerfromalimitedlist.Forexample,since1980theuseofinjectablelocalanaestheticagentshasbecomeacommonpartofpodiatricpracticeforthosepodiatristsqualifiedtousethem.Today,thesepodiatristsareidentifiedontheHealthProfessionsCouncil’sregisterbyaspecialannotation,referredtoas‘localanaesthesia’.ReviewsofExemptionsovertheyearshaveextendedpodiatristsaccesstoawiderrangeofmedicinesforsupplyandsale,includingsomeanti-inflammatorymedicines,anti-fungalagentsandantibioticsforthetreatmentof
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
8
infections.Accesstotheseadditionalmedicinesrequiresafurtherqualification,andthosepodiatristsinpossessionofthisqualificationarealsoannotatedontheHPCregister,asthe‘POM’qualification.In2000,specialistpodiatristsweregrantedrightstosupplyandadministeranevenwiderrangeofmedicinesviaPatientGroupDirections.Allthesemechanismsareusedinabroadarrayofcommunityandacutesettings,witharangeofmedicinesused,spanningmusculoskeletaldisorders,diabetescare,skindisorders,footsurgeryandinthecareoftheelderly.
Examples of podiatry rolesMusculoskeletal conditionsPodiatristshaveaprimeroletoplayintheassessmentandmanagementofmusculoskeletalfootandanklepathology.Advancedpractitionersandconsultantpodiatrists,assess,diagnoseandmanagecomplexlowerlimbmusculoskeletalpathology/pain,includingtheprovisionofspecialistfootwearandin-shoecorrectivedevices.Theymayuseinjectiontherapyandrequestinvestigationssuchasultrasound,MRI,X-rayandbloodtests.
Diabetes Care Podiatristsareimportanttothemultidisciplinaryprovisionofdiabeticfootcareinlinewithlocalandnationalrequirements.Podiatrymanagementofcomplexdiabeticfootproblemsincludeswoundcare(includingdebriding4wounds),theselectionofappropriatedressings,physicaltreatmenttoremoveexcessivepressurefromvulnerablepartsofthefootandthemanagementofinfection.Timelyprescriptionofmedicinesfordiabeticfootinfectionsiscrucialinordertostoptheinfectionworsening,reducetheriskofamputationandavoidunnecessaryhospitaladmissions.Podiatristsalsoplayanimportantroleineducatingotherhealthprofessionalsinthescreeningofpatientsfordiabetesrelatedfootproblemsandadvisingupontreatmenttominimisetheriskofseriousfootproblems.
General podiatry carePodiatristsingeneralpracticeworkinarangeofclinicalsettingsdeliveringfootcaretoallages.
4Debriding–cleansingtopreventinfectionandpromotehealing.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
9
Footproblemscanseriouslyaffectqualityoflifebyreducingaperson’smobility,independenceandincreasingtheriskoffalls.Podiatristsrecogniseanddiagnosecommonfootdisorderssuchasskindiseaseorinfection,naildisordersaswellasrecognisingcausesoffootpain.Thismayincludeafullclinicalassessmentcomprisingahistoryandclinicaltests.Effectivepromptmanagementofmostcommonfootproblemsisessential.Footinfectionsrequirepatientadviceandinmanycasesaccesstothecorrectanti-microbialdrugssuchasantibioticsoranti-fungalagents.Managementofacutefootpainoftenrequiresanalgesiaaspartofthetreatmentplan.
Foot surgeryPodiatristsworkinginthisfieldofpracticewillhavesignificantexperienceofworkingwithpatientswithcomplexmedicalconditions.Theymaybeinvolvedintheconservativeandsurgicalmanagementoffootandanklepathologyacrossabroadpatientgroup.Correctivefootsurgeryisusedtoreducethepainandimmobilityofproblemssuchasbunions,hammertoesandtraumatisednerves.Patientsmayrequiremedicationssuchasanalgesia(forpainmanagement),antibiotics(inmanaginginfection),anticoagulants(followingsurgery),sedativesforpre-operativeanxietyandinjectablecorticosteroids.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
10
Where podiatrists workThereareatpresent12,581podiatristsregisteredinUK(2010figures)andtheirworkspansasignificantcross-sectionofthehealthcaresystem.MostworkintheNHS.Theyworkinhospitalsandinawidevarietyofcommunitysettings,includingbothGPpracticesandindependentpractices.Somepodiatristsprovidecareforpatientsintheirownhomes,innursinghomesordaycentres,inschoolsandinhealthcentres.TheSocietyofChiropodists&Podiatristsestimatesthataround55%ofpractisingmembersundertakeanelementoftheirworkintheprivatesector,andpodiatristsalsoworkinavarietyofoccupationalhealthsettings,inprisons,schools,industry,sportsclubsandfortheArmedForces.
How podiatrists are trained and regulatedPre-registrationtrainingofpodiatristsconsistsofanapprovedthreeorfour-yearuniversitycourseleadingtoaBSc(Honours)degreeinpodiatry.StudentswhoalreadyholdaBScinarelatedsciencesubjectcanalsofollowapre-registrationMScinpodiatry.GraduatesofboththeBScandMScpre-registrationcoursesareeligibleforstatutoryregistrationwiththeregulator–theHealthProfessionsCouncil(HPC).Registrantsareentitledtousetheprotectedtitles‘podiatrist’and‘chiropodist’.TheHPCsetsstandardsforpodiatrists’education,training,competence,conduct,behaviourandhealth.AnypersonwhowishestopractiseasapodiatristintheUKmust,bylaw,havetheirnameregisteredwiththeHPC.TheHPCalsoregulatesthefitnesstopracticeandre-registrationofthosealreadyontheregisterandhasthepowerstoremoveindividualsfromtherelevantregisteriftheyfallbelowthestandardsrequiredtoensurepublicsafety.
Thescopeofpodiatryisverywideandcoversavarietyofphysical,pharmaceuticalandrelatedinterventionsaimedatimprovingfoothealthandmobility.Apodiatrist’sscopeofpracticewillchangeovertimebecauseofexperience,specialisationinacertainclinicalareaorwithaparticularclientgroup,oramovementintorolesinmanagement,educationorresearch.Apodiatristmustundertakethenecessaryongoingtrainingandexperiencetodemonstratethattheyarecapableof
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
11
workinglawfully,safelyandeffectivelywithintheirgivenscopeofpracticeandmustnotpractiseinareaswheretheyarenotproficient.TheHPCapprovesthetraining,setsthestandardsrequiredofpodiatristsupplementaryprescribersandannotatestheirnamesontheregister.
Thisregulatoryprocesswouldalsoapplytopodiatristindependentprescribers.
How would podiatrist independent prescribers be trained?Thepresentmultiprofessionaltrainingisprovidedasanintegratedprogrammeforindependentandsupplementaryprescribers.Itisthelegislativeframeworkwhichdefinesthemechanism(s)availabletoeachprofessionandtheassessmentofcourseparticipants.Forexamplenursesandpharmacists,whosuccessfullycompletetheprogrammeareabletopracticeasbothindependentandsupplementaryprescribers.However,podiatristswhosuccessfullycompletetheprogrammeareonlyabletopracticeassupplementaryprescribers.Appendix1providesfurtherdetailsaboutindependentandsupplementaryprescribing.
TheHPChasalreadyapprovedanumberofcoursestoprovidetrainingforpodiatristsassupplementaryprescribers.AnoutlinecurriculumframeworkforpodiatristindependentprescribingwouldneedtobedevelopedandtheHPCwillhavetheauthoritytoapprovecoursesfortheprovisionofpodiatristindependentprescribingtraining.Podiatristsalreadyqualifiedassupplementaryprescribersmayberequiredtoundertakeadditionaltraininginordertopracticeasindependentprescribers.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
12
Eligibility for training as a podiatrist independent prescriber
Notallpodiatristswouldneedtotraintobecomeindependentprescribers.Itissuggestedthatallentrantstothetrainingprogrammewouldneedtomeetthefollowingrequirements:
• BeregisteredwiththeHealthProfessionsCouncil
• Bepractisinginanenvironmentwherethereisanidentifiedneedfortheindividualtoprescribeindependently
• Haveatleastthreeyearsrelevantpostqualificationexperience
• Havesupportfromtheiremployer
• Haveanapprovedmedicalpractitionertosuperviseandassesstheirclinicaltrainingasaprescriber.
PodiatristindependentprescriberswouldhaveanannotationontheHPCregister.ThiswouldalsorequirethemtoundertakeappropriatestepstomaintaintheirskillsandcompetenceinkeepingwiththeHPCregulatorystandards.TheHPCwouldneedtoamendtheirstandardsforpodiatrists,toreflectpodiatristindependentprescribingandtheyhaveindicatedtheirwillingnesstodothisinduecourseifproposalsmoveforward.
QUESTION
1. Do you have any comments on these eligibility criteria?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
13
What benefits would podiatrist independent prescribing bring?Independentprescribingwouldimproveoutcomesforpatients,whilstalsoprovidinggreatercost-effectivenessandchoiceforpatientsandcommissioners.Podiatristswoulduseindependentprescribingwhereautonomyinmedicinesusewouldfacilitateeffectivecareforthepatient,wherethetimelyinstigationofappropriatemedicinesmanagementwouldpreventadeteriorationinapatient’shealthstatusandwheretheappropriateuseofmedicineswouldenhancetheaimsoftheprogrammethathasalreadybeenestablishedforthepatient.Forexample:
• Timelymanagementofmusculoskeletalandrheumatologicaldisorderswouldreduceunnecessaryorinappropriatewaitingtimesfortreatment,hastenrecovery,andimprovepatientoutcomes.Presentlycarecanbedelayedwhenpatientshavetomakeadditionalvisitstodoctorsforprescriptions,ordoctorsarenotavailabletosupportsupplementaryprescribing.Viaindependentprescribing,podiatristswouldbeabletoimmediatelyandsafelyprescribethemedicinesneeded,adaptingandtailoringapatient’smedicinesalongsidetheirphysicaltreatment.
• Timelyprescriptionofmedicinesfordiabeticfootinfectionsiscrucialinordertohalttherapidprogressionofinfection,reducetheriskofamputationandavoidunnecessaryhospitaladmissions.Independentprescribingwouldallowthepodiatristtoplayacentralroleinalleviatingdelaysintimelyaccesstomedicinesinthecommunity.Servicecommissionerswouldalsohaveagreaterrangeofoptionsinmeetingtheneedsofpatientsinthesecircumstances.
• Ingeneralpodiatryclinics,effectivemanagementofcommonfootproblemsoftenrequiresspeedyaccesstoantibiotics,effectiveuseofanti-fungalagents,oranalgesiatomanagefootpain.Whereitissafetodoso,independentprescribingwouldallowpodiatriststopromptlysupplythenecessarymedicinestotheirpatients.Prompttreatmentwouldhelptoalleviatepatients’symptoms,encourageamorerapidrecoveryandavoidtheneedforpatientstomakeadditionalappointmentswithotherprescribers.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
14
• Patientsreceivingfootsurgeryfromapodiatristmayrequiremedicinessuchasanalgesia(forpainmanagement),antibiotics(inmanaginginfection),anticoagulants(followingsurgery),sedativesforpre-operativeanxietyandinjectablecorticosteroids.Prescribingofthesemedicinesbypodiatristindependentprescriberswouldenablerapidpatientcare,withareductionindelaysinreceivingnecessarymedicines,andwouldbeconsistentwiththeimplementationofnationalandlocalguidelines.
Independentprescribingwouldenableinnovativeserviceredesigntomakegreateruseofpodiatrists’skillsinareassuchasdiabetescare,toensurepatientsreceivethemedicinestheyneedatthetimetheyneedthem.Forexample,inareasasdiverseasdiabeticfootwoundcare,footsurgery,fungalskininfections,independentprescribingwouldenablepatientstoreceiveimmediateappropriatepharmacologicalmanagementalongsideotherphysicaltreatments,whilstavoidingdelaysassociatedwithadditionalappointmentswithotherprescribers.Independentprescribingcouldalsoprovidegreaterchoiceforpatientsandofferswideroptionsforservicesandcommissioners,reducingdelaysinaccessingtreatmentandimprovingoutcomes.
Independentprescribingwouldalsoenhancetheflexibilityandexpertiseoftheworkforceandtherebyimprovecareforpatientsnowandinthefuture.
Protecting the publicPodiatristindependentprescribinghasthepotentialtoimprovepatientsafetybyimprovingmedicinesmanagement,reducingthedelaysinreceivingcareandpotentiallyreducingavoidablehospitaladmissions.
Safeguardsareofutmostimportancebecauseindependentprescribingbyanyprofessioncarriesinherentrisks.Thetwomainriskswhichmustbeconsideredare:
• thepotentialrisktopatientsafetyofinappropriateprescribingofmedicines;and
• therisktopatientsafetyoffailuretoshareinformatione.g.iftheGPrecordwasnotupdatedinatimelymanner.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
15
Thefollowingprincipleswouldunderpinprescribingresponsibilitiesforpodiatrists:
• Patientsafetyisparamount.Prescribingresponsibilitiesshouldonlybeenablediftheywilldeliversafe,effectiveandmoreconvenientcareforpatients
• Prescribersshouldonlyprescribeandpracticewithinthelimitsoftheirclinicalcompetenceandscopeofpractice
• Prescribingmustbeunderpinnedbyrobustgovernancestructures
• Independentprescribersmusttakefullclinicalandprofessionalresponsibilityfortheirdecisions.Prescribersneedtobeabletorecognisewhentheyneedtoaskforsupportinrelationtoapatient’scare
• Trainingshouldbedeterminedlocally,withinanationallyagreedoutlinecurriculumforprescribingtraining
• Dispensingpharmacistsandthosechargedwithreimbursingprescriptionsneedtobeabletoidentifyprescriberseasilythroughanannotationontheprofessionalregister
• Asisthecaseforexistingprescriberswhoindependentlyprescribe,thesamestandardsoftraining,practice,governanceandregulationwillapplyregardlessofwhetherthepodiatristisworkingintheNHS,independentorothersettings.
Governance and safeguardsTheHealthProfessionsCouncil(HPC)wascreatedbytheHealthProfessionsOrder2001andisthestatutoryregulatorof15healthprofessions,includingpodiatry.Aspartoftheirdutytoprotectthepublic,theHPChasastatutoryresponsibilitytosetstandardsofproficiencyforpodiatrists.Thiswouldincludesettingstandardsforindependentprescribing.TheHPCwouldalsohaveadutytoassessandaccrediteducationalinstitutionsasrecognisedprovidersoftrainingforpodiatristindependentprescribing.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
16
TheSocietyofChiropodists&Podiatrists(SCP)andtheInstituteofChiropodistsandPodiatrists(ICP)aretheprincipalprofessionalbodiesrepresentingtheUK’sregisteredpodiatrists.Togethertheywillproducedetailedguidanceforpractitionersrelatingtogoodpracticeforindependentprescribing,ifthisisintroduced.Ashasbeenthecasefornurses,pharmacistsandoptometrists,theNationalPrescribingCentreofferedtoproduceacompetenceframeworkforpodiatristindependentprescribers.However,thedevelopmentofasinglegenericcompetencyframeworkforallprescribersiscurrentlybeingconsidered.
Employerswillretainresponsibilityforensuringadequateskills,safetyandappropriateenvironmentsforpodiatristindependentprescribing.Employerswouldalsoberesponsibleforensuringthatthereisaneedforapodiatristtoundertakeprescribingresponsibilitiesbeforetheyembarkontraining–aswellasensuringthatthereisanopportunitytoprescribepost-training.ThesamestandardswouldapplyregardlessofwhetherthepodiatristisworkingintheNHS,independentorothersettings.
Continuing Professional Development (CPD):Allpodiatristsarerequiredtokeepup-to-dateintheirpracticeandarerequiredtorenewtheirregistrationeverytwoyears.TheHPCsetsstandardsforCPDwhichallregistrantsmustmeet.TheHPCundertakesarandomsampleauditeverytwoyearsaspartofthere-registrationprocess,toensurethatitsregistrantsaremeetingitsstandardsforCPD–thuskeepingup-to-dateandmaintainingtheirfitnesstopractise.Ifintroduced,podiatristindependentprescriberswouldhaveasimilarresponsibilitytokeepup-to-datewithclinicalandprofessionaldevelopmentsinmedicinesusetomaintaintheirregistration.
Access to the medical record:Ifindependentprescribingisimplementeditisessentialthatprescribingpodiatristshaveup-to-daterelevantandproportionateinformationaboutapatient’smedicalhistoryandmedicines.Thisisachievedbypatientconsent,togaineitherbydirectaccesstothepatientsfileinsecondarycare,GPrecordinprimarycareorthecommunityandviareferrallettersinoutpatientsettings.Individualprescribersmustassurethemselvesthattheyhaveallrelevantinformationandifthereisanydoubt,furtherinformationshouldbesoughtbeforeprescribingtakesplace.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
17
Updating the medical record:Itisessentialthatanyprescribingactivitybypodiatristsisknowntootherhealthcareprofessionalscaringforthesamepatient,suchasthepatient’sGPandpatientsinformedofthis.Nurseprescribersandexistingpodiatristsupplementaryprescribersarecurrentlyexpectedtoupdateapatient’snotescontemporaneouslyifpossibleandinanyeventwithin48hoursoftheepisodeofcare.Thismaybedoneelectronicallywherepossible,viaanemailorelectronicupdatetotheGP’sofficewherethepatient’snotesareheld,orbyfaxtotheGP’ssurgery,ensuringgoodinformationgovernanceproceduresaretakentoensureitssafetransfer.Therewillbearequirementonprescribingpodiatriststoupdatethepatient’srelevantmedicalrecordsinatimelymanner.
Options for introducing podiatrist independent prescribingIndependentprescribingbypodiatristscouldtakevariousforms,suchasthoseoutlinedintheoptionsbelow.Appendix2outlinesthemainconditionsandmedicinespertainingtopodiatrypractice.
Option 1. No changeHighlyskilledandexperiencedpodiatristswouldcontinuetobeeligibletotrainassupplementaryprescribers.Dependinguponlocalemploymentarrangements,appropriatelytrainedpodiatristswouldcontinuetosupplyand/oradministermedicinesunderPatientGroupDirections(PGD),patientspecificdirections(PSD),orexistingstatutoryexemptions.
Benefits
Theexistingarrangementshaveprovedsafeandinsomesettings,theyenablepodiatriststosupplypatientswiththemedicinesthattheyneed.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
18
Limitations
Recentscopingwork5hasindicatedthattheexistingarrangementsdonotbestsupporttheneedsofpatients,particularlywhenapodiatristisprovidingselfreferral,firstcontact,diagnostic,orcommunitycare.Wherepatientsrequiremedicinesmanagement,outsidethatspecifiedinaPatientGroupDirectionorexistingstatutoryexemption,theywouldcontinuetohavetovisitanotherprofessional.Theexistingarrangementsaredifficultandcostlytoadminister.
Underthisoption,thecreationofinnovativenewcarepathwayswillcontinuetobelimited.creatinglesschoiceandongoingunnecessarycostsforcommissioners.Consequently,anopportunitytoimproveoutcomesforpatientswouldbemissed.
Option 2. Independent prescribing for specified conditions from a specified formularyAppropriatelytrainedpodiatristswouldbepermittedtoprescribeindependentlyfromalistofspecifiedmedicinesforaspecifiedlistofconditions.
Benefits
Thisoptioncouldbenefitpatientsprovidedthattheircondition,andthedrugstheyneed,arelisted.
Limitations
Patient’swhoseconditionormedicinesneedsdonotappearonthelistsofprescribablemedicinesandconditionswouldnotbeabletobenefit.Asthepodiatryprofessionspansalargerangeofpatientgroups,eitherthelistsofconditionsandmedicineswouldneedtobeextensive,orcertaingroupsofpatientswouldbeexcluded.Inaddition,alimitedformularyandlistofconditionswouldneedupdatingregularly,tosupportongoingcurrentbestpractice.Thiswouldrequirelengthyadministrativeandlegislativeprocessesandmaynotberesponsivetotheneedsofpatientsordevelopmentsinclinicalcare.
5DepartmentofHealth(2009).AlliedHealthProfessionalsPrescribingandMedicinesSupplyMechanismsScopingProjectReport.www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103949.pdf
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
19
Option 3. Independent prescribing for any condition from a specified formularyAppropriatelytrainedpodiatristswouldbepermittedtoprescribeindependentlyforanyconditionwithintheircompetencebutonlyfromalistofspecifiedmedicines.
Benefits
Awiderrangeofpatientscouldbenefitfromthisoption,thancouldunderoption2.
Limitations
Patientswhosemedicinesneedsdonotappearonthelistofprescribablemedicineswouldnotbeabletobenefitfully.Aswithoption2,thelistswouldbedifficulttoadministerandthisoptionwouldbepotentiallyunresponsivetotheneedsofpatientsandcurrentbestclinicalpractice.
Option 4. Independent prescribing for specified conditions from a full formularyAppropriatelytrainedpodiatristswouldbepermittedtoprescribeindependentlyanymedicinewithintheircompetence,butonlyforspecifiedconditions.
Benefits
Awiderrangeofpatientswouldbenefitfromthisoption,thancouldbenefitunderoption2.
Limitations
Patientswithaconditionthatdoesnotappearonthelist,wouldnotbeabletobenefitfully.
Aswithoption2,thelistswouldbedifficulttoadministerandkeepup-to-date,andpotentiallyunresponsivetotheneedsofpatientsandcurrentbestclinicalpractice.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
20
Option 5. Independent prescribing for any condition from a full formulary Appropriatelytrainedpodiatristswouldbepermittedtoindependentlyprescribeanymedicineforanycondition,withintheircompetence.
Benefits
Patientswouldbeabletomakedirectcontactwithappropriatelytrainedpodiatristsandreceivethecareandmedicinestheyneed,withouthavingtomakeadditionalappointmentswithotherprescribers.Agreaternumberofpatientscouldbenefitfromimprovedcare,fastercareandgreaterconvenience.
Limitations
Thisoptionhasnoobviouslimitations.Itisthemostflexibleoptionandstandstobenefitthemostpatients.
Option 6. A combination of the above options Appropriatelytrainedpodiatristswouldbeabletoprescribeindependentlybysomecombinationoftheaboveoptions.Thiscouldbeachievedinanumberofways.Forexample,prescribinganymedicinewithintheprescriber’scompetenceinahospitalsetting,butonlyfromalistofspecificmedicinesinacommunitysetting.
Benefits (based on the example above)
Thisapproachcouldbenefitpatients,providedthattheirconditionorthemedicinetheyneedwasonthelist,forthesettinginwhichtheircarewasbeingdelivered.
Limitations (based on the example above)
Thisapproachcouldbedifficulttoadministerandregulate,particularlyforindividualpodiatristswhoworkinacombinationofdifferentsettings.Patientswhoseconditionsormedicinesneedsvaryfromthedefinedlistwouldnotbeabletobenefitfully.Thisoptionwouldalsocreateariskthatpatientsmovingbetweensettingswouldbeunabletoreceiveconsistentcare.
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
21
QUESTION
2. Which of the above options do you believe would safely add the most value to patient care? (if option 6, please provide details)
3. Have you any comments on the arrangements outlined above for the governance of independent prescribing by podiatrists if the proposals are taken forward? Are there other factors which should be taken into account?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
22
Further considerationsControlled drugsControlleddrugsareprescriptionmedicinescontainingdrugscontrolledundertheMisuseofDrugslegislation.Examplesincludebenzodiazepine,morphine,andpethidine,butalsomorecommonlyuseddrugssuchasdiazepamorcodeinepreparations,whichpodiatristsmayneedtousetohelpcontrolapatient’spain.Theyareclassifiedbylawbasedontheirbenefitwhenusedinmedicaltreatmentandtheirharmifmisused.Ifpodiatristsaretobeabletoprescribecontrolleddrugsindependentlyaspartofanyoftheaboveoptions,separateamendmentswouldneedtobemadetolegislationgoverningcontrolleddrugswithintheUKbytheHomeOfficeandtheDepartmentofHealthandPersonalSocialServicesinNorthernIreland’sMisuseofDrugsRegulations).
Podiatristsarecurrentlyabletoprescribecontrolleddrugsviasupplementaryprescribingarrangements.Atpresent,nurseindependentprescriberscanprescribefromalistof13controlleddrugs,butonlyforspecifiedconditions.Pharmacistindependentprescriberscannotasyetprescribeanycontrolleddrugindependently.Optometristindependentprescriberscannotprescribecontrolleddrugs.However,changestoUKmisuseofdrugsregulationsareanticipatedtoenablenurseandpharmacistindependentprescribingofcontrolleddrugs,thusremovingthepresentrestrictionsfornurseandpharmacistindependentprescribers.
QUESTION
4. In what circumstances would it benefit patients if appropriately trained podiatrists, were able to prescribe controlled drugs independently?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
23
Mixing of medicines prior to administration Clinicalpracticesometimesrequiresthemixingoftwolicensedmedicines,forexamplecorticosteroidandlocalanaestheticagents,inthemanagementofcertainmusculoskeletaldisorders,thuscreatinganunlicensedmedicine.InMay2010,newguidanceonmixingwasissued6whichclarifiedthat:
• Doctorsanddentistscanmixmedicinesthemselvesanddirectotherstomix
• Nurseandpharmacistindependentprescriberscanmixmedicinesthemselvesanddirectotherstomix
• Supplementaryprescriberscanmixmedicinesthemselvesanddirectotherstomix,butonlywherethatformspartofthewrittenClinicalManagementPlanforanindividualpatient.
QUESTION
5. In what circumstances would it benefit patient care if appropriately trained podiatrist independent prescribers were able to mix medicines themselves prior to administration or direct others to do so?
6NationalPrescribingCentre(2010).Mixingofmedicinespriortoadministrationinclinicalpractice:medicalandnon-medicalprescribing.Gatewayref:14330
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What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
24
Prescribing of unlicensed medicinesUnlicensedmedicinesarethosewhichdonothaveaMarketingAuthorisation(orproductlicence)whichisvalidintheUK.Theprescribingofunlicensedmedicinesispermittedunderlegislationsubjecttocertainconditionswhicharethattherelevantmedicinalproductsaresuppliedinresponsetobonafideunsolicitedorders,formulatedinaccordancewiththespecificationsofcertainprescribersforusebyindividualpatientsontheprescriber’sdirectpersonalresponsibility,andinordertofulfil“specialneeds”.Theproductmustbemadebyapersonholdingamanufacturer’slicenceforthispurpose.
QUESTION
6. In what circumstances would it benefit patient care if appropriately trained podiatrist independent prescribers were able to prescribe unlicensed medicines for their patients?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
25
“Off-label” prescribing or supply of medicinesThesearemedicineswhichhaveaproductlicenceandaUKmarketingauthorisation,butareprescribedorsuppliedforadifferentusetothosedetailedinthesummaryofproductcharacteristics.Anexampleistheuseoflowdoseamitriptyline(anantidepressant)whichisalsoused“off-label”atalowdoseforthetreatmentofneuropathicpain.Presentlydoctors,dentists,nurseandpharmacistindependentprescribers,andalliedhealthprofessionsupplementaryprescribersareabletoprescribemedicinesinthisway.
QUESTION
7. In what circumstances would it benefit patient care if appropriately trained podiatrists, acting within their level of competence, were able to prescribe medicines ‘off label’ independently?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
26
Simultaneous prescribing and administrationForsafetyreasons,itisalongstandingprinciplethatprescribersprescribemedicinesandapharmacistthensuppliesthemedicinesinaccordancewiththatprescription.However,incertaincircumstancesitmaybeinapatient’sbestinterestsforaprescribertobeabletosupplyoradministeramedicinetothatpatientimmediately,withoutwaitingforapharmacisttodispenseit.Forexample,apatientmaybenefitfromthedeliveryofacorticosteroidinjectionforarthritispain,duringthecourseofanoutpatientappointment,ratherthanhavingtowaitforanotherappointmenttohavetheinjectiondelivered.PodiatristsarealreadyabletosupplyalimitedrangeofmedicinesdirecttotheirpatientsunderExemptionsandsimilararrangementsexistunderPatientGroupDirections.Insuchsettings,thesuppliesofmedicinesmustbestoredsafelyandinaccordancewithanyspecialconditionsrelatingtospecificmedicines.
Itisnothowevertheintentionthatpodiatristindependentprescribersshould,asanormalroutine,supplymedicinesdirecttotheirpatients.Thedispensingofprescriptionsproperlylieswithpharmacists.Thesale,supplyandadministrationarrangementsexistingunderExemptionsandPatientGroupDirectionswouldremainunchanged.
QUESTION
8. How would it benefit patients and in what settings, if appropriately trained podiatrists were able to supply and/or administer medicines that they had prescribed independently?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
27
Additional questions:9. Can you offer any information about potential costs and benefits of podiatrist independent prescribing for the impact assessment, eg. Benefits in terms of time savings to GPs, costs relating to the numbers of podiatrists likely to go forward for training, or any other factors?
10. Can you offer any information on how these proposals would impact on equality in your area, particularly concerning disability, ethnicity, gender, sexual orientation, ages, religion or belief, and human rights? Could any group be excluded, or better included because of the proposal, and will there be any problems or barriers for any minority group?
Engagement exercise – To seek views on possibilities for introducing independent prescribing responsibilities for podiatrists
About this engagement exercise
What is non-medical prescribing?
Who can respond to this engagement exercise?
How to respond
What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
28
11. Are there any other implications for implementing independent prescribing for podiatrists?
Name
Patient/Public AHP Doctor Nurse Pharmacist
Organisation(ifapplicable)
Areyourespondingonbehalfoftheorganisation
Email:
TelNo:
Nowclickon‘Saveform’tocreateapdfwhichyoucanemailtousatahpprofessionalleadershipteam@dh.gsi.gov.uk(pleaserefertopage5ifyouneedmoredetailedinstructionsonhowtodothis).
Save form
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How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
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29
APPENDIX 1Non-medical prescribing and medicines supply mechanisms7
Mechanism summary
Patient Specific Directionisaprescriber’s(normallywritten)instruction,whichenablesapersontosupplyoradministeramedicinetoanamedpatient.
Patient Group DirectionwithintheNHSisawritteninstructionforthesupplyand/oradministrationofalicensedmedicinetoapatientorgroupofpatients,wherethepatientmaynotbeindividuallyidentifiedbeforepresentingfortreatment.TheDirectionmustbeagreed/signedbyadoctorandaseniorpharmacist,andapprovedbytheemployer–typicallyaPCTorNHSTrust.Itauthorisescertainnamedregisteredhealthprofessional(s)tosupply/administeralicensedmedicine.
Patient Group DirectionsoutsidetheNHSarerestrictedtoindependenthospitals,clinicsandagenciesregisteredwiththeCareQualityCommissioninEnglandandequivalentsinthedevolvedadministrations.Theycanalsobeimplemented,subjecttoconditions,bytheDefenceMedicalServices,theUKPoliceForcesandtheUKPrisonServices.TheDirectionenablesthesale,supplyand/oradministrationofalicensedmedicinetoapatientorgroupofpatients,wherethepatientmaynotbeindividuallyidentifiedbeforepresentingfortreatment.TheDirectionmustbeagreed/signedbyadoctorandaseniorpharmacist,andapprovedbythebodyorrepresentativespecifiedinmedicineslegislation.Itauthorisescertainnamedregisteredhealthprofessional(s)tosupply/administeralicensedmedicine.
Exemptions(tomedicineslegislation)allowsale,supplyandadministrationofspecificdrugsinspecificcircumstances.
7FurtherdetailscanbefoundinDHandNationalPrescribingCentreguidance,andanoverviewwithdefinitionsinMedicinesMatters(DH,2006).
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Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
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30
Mechanism summary
Supplementary Prescribingisavoluntaryprescribingpartnershipbetweenindividualmembersofcertainregisteredhealthcareprofessionalsandanindependentprescriber(doctor)toprovidetreatmentforanindividualpatient,withthatpatient’sagreement,throughawrittenclinicalmanagementplan.TheSupplementaryPrescribercanalterdose,removeorwriteprescriptionsaccordingtothatplan.
Independent Prescribinginvolvestakingfullresponsibilityforprescribingdecisionsandautonomouslywritingprescriptions.
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What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
31
APPENDIX 2Main conditions and medicines – podiatry
System Medicine category Indicative conditions Evidence/guidance
Gastro- Mucosalprotectants Chronicpainconditions NICECG017(dyspepsia)Intestinal requiringopioid System analgesiause
MSKconditions requiringNSAID/anti-
plateletuse
Anti-motility Conditionscausing Antimicrobialsareacuteuncomplicated reportedtobediarrhoea–during responsiblefor25%ofmedicalmanagement acutediarrhoea.Earlyofinfection(inpost- managementcanreduceoperativesituationsor thechanceoflongertermseverediabeticinfection) complications
DrugSaf.2000Jan;22(1):53-72.Drug-induceddiarrhoea.ChassanyO,MichauxA,BergmannJF
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How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
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32
System Medicine category Indicative conditions Evidence/guidance
Gastro- Oralrehydration Duringacutediarrhoea ProgressionofsuchIntestinal therapy (earlymanagement) clinicalpresentationSystem wouldindicatereferralon(continued) formedicalmanagement
insecondarycare
Laxatives NSAIDusehasawell NHSClinicalKnowledgereportedincidence Summaries(CKS)forofdyspepsia–Upper ConstipationBowel.(TheNSAIDsincludeaspirin(33%),ibuprofen(17%),naproxen(11%),piroxicam(9%),indomethacin(8%),anddiclofenac(7%))
BrJClinPract.1995Mar-Apr;49(2):67-70.Gastrointestinalside-effectsofNSAIDsinthecommunity.JonesRH,TaitCL
Additionallylowerbowelproblemssuchasconstipationisseen.Thereforemanagementofthisisrequired
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How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
33
System Medicine category Indicative conditions Evidence/guidance
Cardiovascular System
CPRadrenaline Cardiaccollapse
Stroke
NICECG8(MS);NICECG68(Stroke);NICECG35(PD)NICECG92–VTEpreventionNICECG5,chronicheartfailure
Anticoagulants
Post-operativeconditionswithprolongedreducedmobility
NHSClinicalKnowledgeSummaries(CKS)forStrokeandTI
Thromboprophylaxis(surgeryorinanyclinicalsituationwereapatientisimmobilised)
NICE:CG92Venousthromboembolism–reducingtherisk:fullguideline
AssessmentusingtheVTEproformaisrequired–toidentifyriskfactors
(Low-MolecularweightHeparin/Enoxaparin)
Skeletalmusclerelaxants
Nocturnalcramp BNF
DrugSafetyUpdateJune2010(cautioususe)
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What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
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34
System Medicine category Indicative conditions Evidence/guidance
Cardiovascular Calciumchannel Raynaud’sphenomenon BNFsystem (continued)
blockers
PeripheralvasodilatorsIntermittentclaudication
BNF
TASC
SIGN2006
Respiratory Oxygen Useinday-casetheatre Anaphylaxis(adrenaline/System settings chlorphenamine/atropine)
Asthma(Acute)–inStimulants Life-savingsituations clinicalsetting/during
responsetoprocedure(Salbutamol)
Generallyincommunityclinical(surgery)settingabilitytostockandadministerinlifesavingevents.TheIPstatuswouldaffordaccess
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How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
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35
System Medicine category Indicative conditions Evidence/guidance
Central Nervous Neuropathicpain Chronicpain NICECG96(neuropathicSystem medicines management pain)
e.g.Tricyclicantidepressants Diabeticneuropathy
MSK/rheumatoidpain
BritishPainSocietyGuidelinesforopioiduseinpainmanagement
Post-operativecare WHOanalgesicladder
Opioidanalgesia CRPS NHSClinicalKnowledge
ChronicpainservicesSummaries(CKS)forNSAIDprescribing
Torsiondystonia Adultandpaediatric RoyalCollegeofspasticityequinusfoot Physicians–Spasticityin
Adults–ManagementUsingBotulinumToxin
Musculoskeletal Localcorticosteroid LocalInflammatory NHSClinicalKnowledgeand Joint injections disordersofjointsand/or Summaries(CKS)forDisease softtissuese.g.OA SprainsandStrains
Rheumaticdiseases RA/OA
NSAIDs Localinflammatory
Rubefacientsdisordersandinjuriesofjointsand/orsofttissues
Nutirceuticals e.g.strains,sprains,muscleandligamenttears,swelling,bruising
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What podiatrists do
Where podiatrists work
How podiatrists are trained and regulated
How would podiatrist independent prescribers be trained?
What benefits would podiatrist independent prescribing bring?
Protecting the public
Governance and safeguards
Options for podiatrist independent prescribing
Further considerations
Additional questions
Appendix 1
Appendix 2
36
System Medicine category Indicative conditions Evidence/guidance
Musculoskeletal and Joint Disease (continued)
Systemiccorticosteroids
Skeletalmusclerelaxants
Degenerativejointdisorder/softtissueinjuries
Systemicinflammatorydisorders/connectivetissuedisorders
NICETA160/TA161–Osteoporosis
http://www.nice.org.uk/nicemedia/live/12131/43326/43326.pdf
Bisphosphonates Osteoporosis
Anaesthesia Sedatives Pre-operativeanxiety
Chronicmusclespasm
Localanaesthesia
Inhalational
Procedure&operativemanagement
anaesthesia Acuteseverepain
Other injectable medicines
Sodiumchloride0.9%forinjection
Associatedwithinjectiontherapy
Waterforinjection
Antimicrobial Antibiotics–topical,oralandIV
Woundinfection
Post-injectioninfection(rare)
http://www.nice.org.uk/nicemedia/live/10934/29243/29243.pdf
Post-operativeinfection
Skininfections
Cellulitis