Prescribing, administration and supply of medicines by allied health professionals

Prescribing, administration and supply of medicines by allied health professionals

• 1.
  AHP Medicines Project Helen Marriott AHP Medicines Project Lead November 2014 www.england.nhs.uk
• 2.
  Introduction • Prescribingand medicines supply mechanisms • Supply and administration of medicines • Patient Specific Directions (PSD) • Patient Group Directions (PGD) • Exemptions (from the Medicines Act) • Non-medical prescribing • Supplementary prescribing • Independent prescribing www.england.nhs.uk
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  Supply and administrationmechanisms Mechanism Summary Additional notes A Patient Specific Direction is a doctor's (normally written) instruction that enables a person to supply or administer a medicine to a named patient. www.england.nhs.uk Useful in both primary care and secondary care. Wide-reaching (can encompass controlled drugs (CDs)). Relies on input of doctor. A Patient Group Direction is a written instruction for the supply and/or administration of a licensed medicine to a patient or group of patients, where the patient may not be individually identified. It must be agreed/signed by a doctor and senior pharmacist, and approved by the employer. It authorises named registered health professional(s) to supply/administer a licensed medicine. Useful in many settings in primary care and secondary care. Can be slow to set up. Does not allow mixing of medicines. CDs: Schedules 4 and 5 may be included. Midazolam (now schedule 3) can also be included. An Exemption (to medicines legislation) allows the sale, supply and administration of specific drugs in specific circumstances. Useful in some settings. Used by podiatrists, paramedics, optometrists and midwives. Inflexible - only for named medicines.
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  Mechanism Summary Additionalnotes Supplementary Prescribing is a partnership with an independent prescriber (doctor) for a named patient, via an agreed patient-specific, clinical management plan. The supplementary prescriber can alter dosage, and remove or write prescriptions according to that plan. www.england.nhs.uk Useful in some settings in primary care and secondary care. Original guidance stated: 'Intended use mainly for long-term conditions and continuing care'. Dependent on link to and agreement of doctor. Independent Prescribing involves taking full responsibility for prescribing decisions and autonomously writing prescriptions. Most flexible and responsive mechanism. Involves full responsibility for independent assessment, diagnosis and prescribing. Limitations on CDs. Prescribing mechanisms
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  Current mechanisms availableto AHPs Allied health profession www.england.nhs.uk Patient Specific Directions Patient Group Directions Exemptions Supplementary Prescribing Independent Prescribing Physiotherapists 2000 2005 2013 Podiatrists 2000 1980, 1998 Revised 2006 2005 2013 Radiographers 2000 2005 Dietitians 2003 Speech and language 2003 therapists Occupational therapists 2003 Orthoptists 2003 Paramedics 2000 1992 Revised 1998, 2000, 2004 Prosthetists and orthotists 2003 Art therapists Music therapists Dramatherapists
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  The AHP MedicinesProject • In 2009 the Department of Health commissioned the Allied Health Professions Prescribing & Medicines Supply Mechanisms Scoping Project Report Phase 1 • Independent prescribing for physiotherapists and podiatrists • The amendments to legislation were laid in the summer of 2013 www.england.nhs.uk
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  August 2013 www.england.nhs.uk May 2014 September 2014 October 2014 Devolved administrations England Scotland Wales Northern Ireland
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  AHP medicines project- Phase 2 • Jointly funded initiative by NHS England and the Department of Health • The project team has been in place since October 2013 • The current proposals: • Independent prescribing by paramedics • Independent prescribing by radiographers • Supplementary prescribing by dietitians • Use of exemptions by orthoptists www.england.nhs.uk
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  www.england.nhs.uk Helen Marriott Project Lead George Hilton Project Administrator Steven Sims Project Support Officer Hannah-Rose Douglas Analyst X4 Professional Body Project Officers AHP Medicines Project Team
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  Process Preliminary workto identify the case of need Development of statutory public consultation Public consultation Commission on human medicines (CHM) Changes to legislation www.england.nhs.uk Evaluation •Aligned with NHSE objectives & priorities •Approved by NMP board
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  Case of need- Benefits Patient safety • Clearer lines of responsibility • Reducing onward referral and admissions and their associated risks • Reducing risks and costs associated with delays in care • Medicines optimisation Patient experience • Reducing inconvenience of multiple appointments • Support to self-care as close to home as possible • Enable service re-design to improve access to services www.england.nhs.uk Clinical effectiveness • Provision of best care, first time, in the right place • Reduce long-term condition episodes requiring admission • Improved health and well-being Value for money • Effective use of resources • Supports service re-design • More flexible, responsive and empowered workforce
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  Case of need– Approval Process • Case of need approved by: NHS England SMTs www.england.nhs.uk NMP board Ministerial approval to commence preparation for public consultation June 2014 August 2014 July 2014
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  Project Board •Oversee the governance of the project whilst providing support and guidance to the programme of work • Co-chaired by: Suzanne Rastrick (CAHPO) Bruce Warner (Deputy Chief Pharmaceutical Officer • Meet monthly basis www.england.nhs.uk
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  Next steps… Ongoing Prepare online consultation & supporting documents October – December 2014 Stakeholder Engagement www.england.nhs.uk November 2014 Commission on Human Medicines Late 2014 Seek approval to publish public consultation - NHSE - NMP board - Ministers Early 2015 Publish public consultations
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  Consultation Documents •Four separate online consultations Supporting documentation • Draft impact assessment for each proposal • Draft practice guidance for each profession • Draft outline curriculum framework for independent and supplementary prescribing education and training programmes (Paramedics, Radiographers, Dietitians) • Draft outline curriculum framework for conversion programmes to prepare radiographer supplementary prescribers as independent prescribers (Radiographers) • Draft outline curriculum framework for education and training programmes for the use of exemptions by orthoptists (Orthoptists) www.england.nhs.uk
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  Your help…. 1)Managing stakeholder expectations 2) Think about implementation NOW! 3) Identifying where IP by physio’s and podiatrists will improve quality of patient care and service delivery www.england.nhs.uk
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  Thank you www.england.nhs.uk Email: [email protected] Twitter: @marriotthelen