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Supplementary Prescribing

Discussion in 'United Kingdom' started by nicola selhuber, Aug 17, 2009.


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    As a podiatrist who has recently become a supplementary prescriber (related to an NHS musculoskeletal post) I am keen to make contact with other podiatry prescribers in the UK and, hopefully, to learn something from their experience. Is there anyone out there who can give me the benefit of their experience to date in non-medical prescribing (supplementary) especially with regard to pain management strategies. I look forward to hearing from you.
     
  2. M Staines

    M Staines Member

    Hi Nicola

    I have been a Prescriber for about two years. We are very limited in prescribing pain killers (one drug only for independent.
    Are you considering CMP for prescribing a greater range of drugs??. I work in the area of diabetic foot wounds where antibiotic prescribing is most useful. We are restricted to three antibiotics for independent prescription as I'm sure you know.

    There are a number of issues. Are you a member of a prescribing forum? Involved with the NPC?


    Regards Mike Staines
     
  3. Dear Mike
    thank you for taking the time to respond to my question. My understanding of supplementary prescribing is that it can only take place with a clinical management plan (CMP) in place for each patient concerned, and the CMP must be agreed with the independent prescriber at the initial assessment. I am aware of other resources such as NPC and that prescribing is quite well established in the specialism of diabetic podiatry. I have developed some hypothetical cmps as part of the portfolio of evidence needed to pass the course, one is for mgt of OA, one for plantar fasciitis/heel pain syndromes, one for painful neuropathic conditions, such as entrapment neuropathies, or CRPS. As you have been prescribing for years you must have been instrumental in establishing podiatry prescribing in your workplace and did it take you a while to gain confidence in prescribing or was there already an established prescribing practice. How was this perceived by your independent prescriber, are they always available when you need them to jointly assess a patient?
     
  4. M Staines

    M Staines Member

    Hi Nicola

    There are a few items you can prescribe independently. I really need to find the link for you but I believe its Co-dydramol... I will have a look when I'm back at work (on leave at the moment).

    I( really haven't got too involved with CMP's. Its frustrating as my nurse colleagues have almost open access to the BNF. We complete the same course but legislation limits us. However, not really appropriate for us to prescribe for asthma huh.

    I trained with few Physios who are in a similar position to yourself (MSK work).
    I don't think they prescribe much at all.

    I diabetes its a really tricky area. So many have renal failure, Liver problems and poly-pharmacy.

    You really end up as a bit of a pathfinder...a little "neck on the block" but its far more interesting and you knowledge of prescribing helps you to understand the dangers and benefits. Its amazing how the doctors have such a relaxed attitude

    You will need a really good mentor and independent prescriber if you use CMP's. You can create generic type plans and adapt them..its so time consuming... Have you done your OSCE yet?

    Its a stunning fact that less than 50% OF ALL QUALIFIED PRESCRIBERS EVER PRESCRIBE A SINGLE ITEM.

    No other podiatrist in our trust has decided to do the non-medical prescribing course. We really need to get podiatrists motivated.

    I believe the legislation will evolve to give us greater access but it needs to be driven forward by us and SOCAP


    Regards Mike staines
     
  5. Admin2

    Admin2 Administrator Staff Member

  6. martinharvey

    martinharvey Active Member

    Hi Mike and Nicola,

    The DOH document published 15th July 2009 : "Allied health professions prescribing and medicines supply mechanisms scoping project report" strongly recommends independent prescribing rights for suitably trained Podiatrists.

    It correctly identifies the problems encountered by SP Pod's in primary care in both NHS and private practice in supplying prescriptions in a timely manner, appropriate to the fact that in most instances we diagnose the condition and then formulate and administer the treatment and management of the condition. This is really not what the intent was behind SP which was aimed at the continuing pharmacological management of chronic conditions already diagnosed by the Doctor responsible for the Pt's care.

    If the recommendations of the report are implemented then it will add a new and most interesting level of practice to the profession.

    Nicola, on the subject of CMP's I find the basic templates that you will find on the DOH website http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Supplementaryprescribing/DH_4123030 to be quite adequate. Whilst the Guidelines or protocols supporting the Clinical Management Plan naturally have to be robust and specific, as do the procedures for reporting ADR's, the actual details of the Medicines that may be prescribed by the SP can be as wide-ranging as both your IP and yourself feel to be justified in a particular case, allowing the SP to change and titrate the medication as appropriate.

    A discussion forum for Pod prescribers on prescribing issues would perhaps be a useful way to disseminate information that is specific to this area of practice especially as we are currently quite few and far between, although if independent prescribing does come in then hopefully our numbers would grow substantially as the benefits came to be recognised by colleagues.

    Cheers,

    martin
     
  7. dgroberts

    dgroberts Active Member

    The district nurses who work upstairs in this very building have their own 'script pads and seem to be able to directly prescribe anything in the MIMS.

    A practical example last week. I saw a lady with a significant foot ulceration, the DN came down for a chat abut it and I suggested dressing types and a regime, she then fills the pad out and gets the dressing delivered to the pt's house.

    What happens at the moment is we have to write a GP letter for them to do it. I'm sure the GP's would welcome direct prescribing in such cases, less work for them!

    Why can't we do that?
     
  8. podpaul

    podpaul Active Member

    Hi Nicola,

    I'm a SP and also work within the MSK area in a number of London based Polyclinics.

    Unfortunately to date I have not once prescribed do to the difficulties that we have had setting up CMP's which I think is in part realtaed to our referral process and that GPs referring into our service are often requiring a diagnosis from the Podiatrist.

    How do you get around this problem? Do you often reccommend pharmacological managment for biomechanical type problems such as heel pain?

    How are you getting on with prescribing in your role? Hopefully the consultation into independent prescribing for Podiatrists will bring us good news!

    Would love to hear how you are putting your skills into practice!

    Regards,

    Paul.
     
  9. Ian Reilly

    Ian Reilly Active Member

    Just a pedantic point – only SP’ers actually PRESCRIBE. The other drugs we have on exception and we SUPPLY, PROVIDE OR ADMINISTER. Having been part of the pharmacology education process we need to use the right language...

    Cheers

    Ian
     
  10. podpaul

    podpaul Active Member

    Hi Ian,

    Thanks for that reminder, I remember my Pharmacology lectures with you very well at UCN!

    I had picked up on the same point that you make, but my post was directed to Nicola who from her post states that she is a Supplementary Prescriber.

    I took the 6 month course myself and so am also qualified as a Supplementary Prescriber - and was looking to see how Nicola was managing to use this scope of practice.

    But I totally agree that correct use of the terminology is very important!

    Paul.
     
  11. Ian Reilly

    Ian Reilly Active Member

    I was part of the group that put the SP competencies together. All very fascinating but I thought then that a “repeat prescription” would be of little use in the MSK world without that independent first prescription. Maybe in the rheumatology world proper for those lucky pods working in that environment. My understanding is that it is our diabetes colleagues who have been able to use SP best – and then with mixed activity country-wide.

    Roll in independent prescribing...!

    ATB

    Ian
     
  12. podpaul

    podpaul Active Member

    I totally agree - I think its very heavily dependent on whether you are working in a hospital setting as I just cant seen to find a way for it to work in the community where i'm based - hopefully its just a matter of time now until we get IP!?

    Cheers Ian

    Paul.
     
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