The importance of pharmacology to health care professionals cannot be overestimated. Members of the three professions, physiotherapy, podiatry and radiography, encounter patients on a daily basis, many of whom will be on drug therapy. Patients are increasingly likely to be receiving at least one drug; many older patients are likely to be on more than one drug, and prescription of eight or nine drugs at the same time is not uncommon. This is known as polypharmacy and it increases the chance of patients experiencing adverse effects or the effects of drug–drug interactions.
Depending on the nature of their work, health care professionals may spend some considerable time with individual patients who might have questions about their drug therapy. Some health care professionals may be treating mainly older patients, or younger patients or high-risk patients, and will become experienced and familiar with drugs in their areas of expertise.
Health care professionals can be ideally placed to spot adverse drug reactions and to play an important role in the long-term monitoring of commonly prescribed drugs. As professionals, they should be able to advise patients or know when to refer them to other experts in the health care team. Drug therapy of disease is ever expanding; new drugs exist for effective treatment or cure of more diseases than ever before. Correct use of drugs is paramount. It is therefore important for health care professionals to have an understanding of therapeutic uses of medicines, normal doses, adverse effects, interactions with other drugs, precautions and contraindications. It is equally important to be able to judge whether a change in a patient’s condition is caused by drug therapy, or a change in the disease process. Medication can lead to symptoms such as dizziness, fatigue, dry mouth, constipation and patients may or may not associate new symptoms with drug use. Health care professionals are increasingly involved in the administration of drugs to patients, either as an exemption to the Medicines Act 1968, under patient group directions, or as supplementary prescribers. The Medicines Act 1968, and additional secondary legislation since then, provides a legal framework for the manufacture, licensing, prescription, dispensing and administration of medicines. An exemption to the Medicines Act allows certain professionals, including podiatrists, access to specified prescription-only medicines, providing they are appropriately registered with the Health Professions Council. The use of patient group directions allows many health care professionals to administer prescription-only medicines to specific groups of patients without a normal prescription. Podiatrists, radiographers and physiotherapists are now included in the list of health care professionals who can train to prescribe medicines alongside doctors (and dentists) as supplementary prescribers.
Prior to 1994, only doctors, dentists and veterinary practitioners were allowed to prescribe medicinal products in the United Kingdom. That year the law was changed to enable district nurses, midwives and health visitors to prescribe from a limited formulary of dressings, appliances and some medicines. This formulary of medicines was extended in 2002.
A review of prescribing, supply and administration of medicines for the Department of Health (1999) (Crown Report 2) recommended two types of prescriber: independent and supplementary.
Over the next few years, supplementary prescribing by nurses and pharmacists was introduced and legislation to allow this was changed in April 2003. A similar process occurred with podiatry, physiotherapy and radiography and led to extension of supplementary prescribing to these professions in April 2005. In a further development in 2006, nurses and pharmacists became eligible to train as independent prescribers.
Non-medical prescribing is now the term applied to prescribing by members of the health care professions who are not ‘medically’ qualified.
Prescribing can be described in the following three ways:
1. to order in writing the supply of prescription-only medicine for a named patient;
2. to authorize by means of an NHS (National Health Service) prescription the supply of any medicine (prescription-only, pharmacy or general sales list item) at public expense;
3. to advise a patient on suitable care or medication, including over-the-counter drugs, and therefore with no written prescription.
All health care professionals who are involved in prescribing, and/or administration of medicines have to abide by standards set out by their respective professional bodies. For podiatrists, radiographers and physiotherapists, this is the Health Professions Council. Health care professionals have a responsibility to consult documentation produced by the professional bodies and be accountable for prescribing and administering drugs. All members of health care professions have a responsibility to reduce the risk of errors in prescribing, must assess and appraise their own practice and show a commitment to continuing professional development. This is essential not least because information about drugs and associated legislation is constantly changing. New drugs come on the market, and others are withdrawn or reclassified. Reliable sources of information are the British National Formulary (BNF), the Monthly Index of Medical Specialities (MIMS), the British Pharmacopoeia (BP), patient information leaflets (PILs) and summaries of product characteristics (SPCs) supplied by medicines manufacturers. Official bodies concerned with the use, quality and safety of medicines are the Commission on Human Medicines (CHS, formerly the Committee on the Safety of Medicines), the Medicines and Healthcare Products Regulatory Agency (MHRA) and the National Institute for Health and Clinical Excellence (NICE).