The announcement of changes to laws allowing paramedics to independently prescribe marks a pivotal step in the progression of the profession. Having come into force on 1 April, it is the culmination of a long journey that has patient care at its core.
It is anticipated that advanced paramedics who undertake the required additional training will be qualified to prescribe by early 2019. Those who successfully complete an approved prescribing programme will have their Health and Care Professions Council (HCPC) registration annotated to record their ability to practise as a prescriber.
Education providers with existing HCPC-approved prescribing programmes will now be able to admit paramedics. However, approval from the HCPC is still needed for any education provider wishing to start a new prescribing programme.
The HCPC is currently upgrading its registrant system to include the new annotation, with a planned completion date of September 2018. This will mean that annotation for paramedic registrants who have successfully completed an approved prescribing programme will be listed on the HCPC online register.
Road to prescribing
Plans to develop the profession to incorporate independent prescribing were first considered over a decade ago in the Department of Health and Social Care's (DHSC) (2005) strategic review of NHS ambulance services in England. It was recommended that prescribing for paramedics should be actively explored. This encouraged the College of Paramedics (CoP) to campaign to review the legislation around non-medical independent prescribing.
The Allied Health Professions (AHP) Medicines Project was set up as a joint initiative by NHS England and the DHSC to extend prescribing, supply, and administration of medicines to allied health professions.
Ministerial approval to take the proposal to introduce independent prescribing by advanced paramedic practitioners forward to the public consultation phase was granted by NHS England on 15 August 2014. The NHS England Allied Health Professions Medicines Project Team, in partnership with the CoP, developed a case of need for the proposal based on improving quality of care for patients.
These improvements related to safety, clinical outcomes and experience, as well as the efficiency of service delivery, and value for money. Approval of the case of need was received from NHS England's medical and nursing senior management teams in May 2014, and from the DHSC (then the DH) non-medical prescribing board in July 2014.
The public consultation opened on 26 February 2015 and ran for 12 weeks. Unfortunately, following the close of the consultation, the Commission on Human Medicines (CHM) and Medicines and Healthcare products Regulatory Agency (MHRA) felt unable to recommend independent prescribing for advanced paramedics. The CoP and NHS England went back to the CHM in July 2017 with case studies and an implementation plan to try and get further discussion. By December, the CHM made its decision to support independent prescribing by paramedics. This was followed by the amendment of the Human Medicines Regulations (2012), bringing paramedic prescribing into law.
Implementation
To support its implementation, the CoP has produced an Implementation Guide (CoP, 2018a) and Practice Guidance (CoP, 2018b). This will support prescribing activity and decision-making by prescribers in order to promote safe and effective care.
The Practice Guidance provides the necessary information underpinning appropriate decision-making and actions for paramedics annotated with the HCPC as independent and supplementary prescribers.
Some of the key principles include the following:
By contrast, the Implementation Guide sets out the administrative and procedural steps needed to enable advanced paramedics in the UK to act as independent and supplementary prescribers. Importantly, it emphasises that only paramedics practising at an advanced level can act as prescribers—this typically means educated to Master's level. Additionally, they will have the necessary skills and knowledge to take on expanded roles and the scope of practice to care for patients. This involves a high level of autonomy and complex decision-making skills.
The selection of paramedics to be trained to independently prescribe is listed as the responsibility of employing organisations. The key principles recommended to follow when prioritising potential applicants are:
Paramedic prescribers will be expected to keep up to date with evidence and best practice in the management of conditions for which they prescribe, and in the use of relevant medicines.
Impact of prescribing
The introduction of independent prescribing will undoubtedly bring a host of benefits, improving patient safety by reducing delays in care and creating clearer lines of responsibilities for the prescribing of medicines.
By having a wider range of professionals who can act as prescribers, geographical or skill gaps in services can be filled. This means more timely access to medicines for patients and care closer to home. Not only will this meet the needs of patient groups who find it difficult to access services, such as those who are housebound, it will prevent unnecessary trips to hospital—thereby reducing pressure on emergency departments. Additionally, appointments with other health professionals to access medicines needed by patients can be prevented.
As paramedics are increasingly working in a wider range of multidisciplinary settings, such as GP practices and primary care; community services; secondary care including critical care units, out-of-hours, urgent and emergency care services; and within integrated workforce models, the impact of independent prescribing on patients will be strongly felt.