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Prescribing

The Allied Health Professions (AHP) Medicines project:

This ongoing project was set up to consider extension to supply, administration and prescribing responsibilities for AHPs and to date the following has been achieved:

  1. Independent prescribing by therapeutic radiographers
  2. Supplementary prescribing by dietitians
  3. Use of exemptions by orthoptists.

These are in addition to the previous existing AHP medicines mechanisms;

  1. Independent prescribing by physiotherapists and podiatrists
  2. Supplementary prescribing by diagnostic and therapeutic radiographers

Supply, administration and prescribing of medicines by radiographers

Medicines include contrast agents as well as medicines that might be given before, during or after a diagnostic imaging procedure or during the treatment period for radiotherapy patients.

The law currently states that radiographers are allowed to supply and/or administer medicines using patient specific directions (PSDs) or patient group directions (PGDs) and both diagnostic and therapeutic radiographers can train to become supplementary prescribers and therapeutic radiographers can train to become independent prescribers.

Patient specific directions

A Patient Specific Direction (PSD) is the traditional written instruction, signed by a doctor, dentist, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.

Further information about the use of patient-specific directions in healthcare settings and a list of FAQs on this issue have been published here.

Patient group directions

A Patient Group Direction (PGD) is a written instruction for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.

Information on the use of PGDs is available on the NHS Patient Group Directions (PGD) website here.

There is a tool available “To PGD or not to PGD" to help you decide if you need to consider whether a PGD is appropriate. The aim is to ensure that patients receive safe and appropriate care and timely access to medicines, in line with legislation. The tool can be accessed here.

Supplementary prescribing

Supplementary prescribing is defined as a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient-specific clinical management plan (CMP) with the patient's agreement. Diagnostic and therapeutic radiographers can be supplementary prescribers.

Independent prescribing

Independent prescribers are responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing. They assume full accountability for the prescribing decisions they make. They may instruct another person to administer the medicines under the terms of a PSD. An independent prescriber may be a medical prescriber (doctor/dentist only) or a non-medical independent prescriber (nurse, pharmacist, optometrist, physiotherapist, podiatrist or therapeutic radiographer). 

Therapeutic radiographer independent presecribers may NOT prescribe controlled drugs. Additional legislation will need to be changed with the Home Office  before prescribing from a list of controlled drugs is permitted.

For a searchable list of HCPC approved supplementary and independent prescribing courses (including conversion courses) please go the HCPC website.

Curricular and practice guidance

Radiographers who are registered with the Health and Care Professions Council (HCPC) and have undergone and passed a validated course of education and training in either supplementary or independent prescribing are eligible to have their HCPC entry annotated to describe their status as a supplementary and/or independent prescriber. Therapeutic radiographer supplementary prescribers may undertake a conversion course to become an independent prescriber. 

SCoR provides practice guidance for radiographer prescribers: Practice Guidance for Radiographer Independent and/or Supplementary Prescribers (2016) on the policy and guidance document library here . 

To qualify as a supplementary or independent  prescriber, radiographers have to successfully complete a course approved by HCPC, the curriculum for which is Outline Curriculum Framework for Education Programmes to Prepare Physiotherapists, Podiatrists and Therapeutic Radiographers as Independent/Supplementary Prescribers and to Prepare Dietitians and Diagnostic Radiographers as Supplementary Prescribers. 

Therapeutic radiographer supplementary prescribers can qualify as a independent  prescriber, by successfully completing a conversion course approved by HCPC, the curriculum for which is Outline Curriculum Framework for Conversion Programmes to Prepare Physiotherapist, Podiatrist and Therapeutic Radiographer Supplementary Prescribers as Independent Prescribe

Both curricular are available here http://www.ahpf.org.uk/AHP_Prescribing_Programme_Information.htm

The Competency Framework for all Prescribers

This document defines the skills and knowledge for all prescribers including nurses, allied health professionals and doctors. Hazel Boyce is an Advanced Therapy Radiographer and supplementary prescriber at Bristol Cancer Institute working mainly in On Treatment Review worked  on the recent review and update of the  framework.

Click here to read 'A Competency Framework for all Prescribers'.

Clinical Management Plans (CMPs):

See below for examples of clinical management plans. which are used in supplementary prescribing

Assistant Practitioners and IV injecting

Only certain named registered and regulated health care professionals, such as radiographers, are allowed to use patient group directions. Non-registered practitioners are not allowed BY LAW to use patient group directions and so must not administer prescription only medicines (POM). Generally IV saline IS a POM although prefilled, single use syringes specifically intended for mechanical flushing of ports and catheters are classified as medical devices under the law and, in this case, assistant practitioners and other non-registered health care staff can use them. SCoR obviously expects all members to work competently and lawfully within their scope of practice and hence would not support an illegal practice and so flushing (which is, of course, administration) would not be covered by professional indemnity insurance unless the prefilled syringes (as described above) were in use.

Other links and useful resources

NHS Evidence (including access to BNF) has a search facility for authoritative, evidence-based information from hundreds of trustworthy and accredited sources here.

electronic Medicines Compendium (eMC) contains up to date, easily accessible information about most of the licensed medicines available for use in the UK. Includes patient information leaflets (PILs) and Summaries of Product Characteristics (SPCs). These include SPCs for contrast media.

Medicines & Healthcare products Regulatory Agency (MHRA) provides SPCs and PILs not on eMC and information about Yellow Card.

Sue Johnson is the professional lead on the safe use of medicines for the Society and College of Radiographers and will be able to answer your questions, email suej@sor.org

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