This presentation by Helen Marriott, AHP Medicines Project Lead, looks at prescribing and medicines supply mechanisms and the AHP Medicines Project. It was presented at the MS Trust Annual Conference in November 2014.

1. AHP Medicines
Project
Helen Marriott
AHP Medicines Project Lead
November 2014
www.england.nhs.uk

2. Introduction
• Prescribing and 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

3. Supply and administration mechanisms
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.

4. Mechanism Summary Additional notes
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

5. Current mechanisms available to 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

6. The AHP Medicines Project
• 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

7. August
2013
www.england.nhs.uk
May
2014
September
2014
October
2014
Devolved administrations
England
Scotland
Wales
Northern
Ireland

8. 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

9. 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

10. Process
Preliminary work to 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

11. 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

12. Case of need – Approval Process
• Case of need approved by:
NHS England SMTs
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NMP board
Ministerial approval
to commence
preparation for
public consultation
June 2014
August 2014
July 2014

13. 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
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14. Next steps…
On going
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

15. 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

16. 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

17. Thank you
www.england.nhs.uk
Email: h.marriott@nhs.net
Twitter: @marriotthelen