Consultation proposes widening physiotherapist prescribing powers 

A consultation on proposals to allow physiotherapist independent prescribers to prescribe a wider range of controlled drugs has been launched by the government to ease pressure on other primary care prescribers and NHS services. 

The consultation covers four professional groups: paramedics, physiotherapists, operating department practitioners and diagnostic radiographers. 

For physiotherapists, the suggested changes would extend the current list of seven controlled drugs they are legally allowed to prescribe (temazepam, lorazepam, diazepam, dihydrocodeine tartrate, morphine sulfate, fentanyl and oxycodone hydrochloride), adding four further medicines commonly used in pain management:

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• codeine phosphate;
• tramadol hydrochloride;
• pregabalin;
• and gabapentin.

The document supporting the consultation outlines how current prescribing limitations cause ‘avoidable delays’ and mean additional unnecessary appointments and referrals can be required which increase demand on other prescribers, which can include nurses working in primary care. 

Physiotherapists were previously able to prescribe tramadol, gabapentin and pregabalin, but lost this authority when tramadol was reclassified as a Schedule 3 controlled drug in 2014, and pregabalin and gabapentin were added to Schedule 3 in 2019.

The Department of Health and Social Care (DHSC) believes these restrictions have contributed to treatment delays, fragmented care and unnecessary demand on GPs and other prescribers.

Anna Young, advanced practice nurse and non-medical prescribing lead for South Yorkshire Primary Care and an advanced practice training programme director for primary care, said having limitations on physiotherapy prescribing ‘creates unnecessary barriers’. 

‘Widening access to prescribing for a profession who are hugely competent and proficient in these areas will only benefit all our work and improve prescribing safety – the best person to prescribe a medication is the person who has conducted the consultation, managed expectations, discussed benefits vs risks and has made a shared decision.

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‘Prescribing is not a stand alone skill, it sits alongside the whole of the consultation and assessment and care planning process,’ Ms Young explained. 

With physiotherapists working in multidisciplinary primary care settings, including GP practices, alongside clinical pharmacists, the proposals aim to support more efficient service delivery and reduce the need for patients to attend additional appointments to access prescribed pain relief.

According to the consultation, the changes would also ‘make best use of physiotherapist independent prescribers’ clinical expertise’ and enhance job satisfaction by enabling professionals to work more effectively within their full scope of practice.

The broader consultation also proposes extending the list of medicines that paramedics can administer in emergency situations, enabling operating department practitioners to supply and administer medicines using patient group directions, and permitting diagnostic radiographers to train as independent prescribers.

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Any changes would require amendments to the Human Medicines Regulations 2012 and the Misuse of Drugs Regulations across all four UK nations. The consultation applies across England, Wales, Scotland and Northern Ireland.

A version of this article was first published by our sister title The Pharmacist