Making prescribing a reality: the next steps in practice

Andy Collen
Friday, February 2, 2018

What does the outcome from CHM mean?The recommendation made by the ad hoc group, and subsequent endorsement from the CHM, is the last major hurdle for the project in regards to influencing those who will ultimately advise government ministers on amendments to legislation. This means that we have successfully demonstrated that paramedic prescribing will be safe and appropriate, and will benefit patient care.However, rather than being seen as the end of the journey, this really only marks the start of the next leg. While the next phase is more predictable in terms of what needs to happen, it is less easy to predict when things will happen. You cannot complete a prescribing module with the hope that the law will change; and now that we know the law is very likely to change, there is a temptation to think this may expedite prescribing status.In reality, you can only become a prescriber after successfully completing a Health and Care Professionals Council (HCPC)-approved course once the law changes. This is because the annotation prescribers are given by the HCPC (2013) is the legal authority to prescribe and is only granted after completing a profession-specific approved training course and gaining a qualification.From this point, NHS England will work with the Department of Health and Social Care (DHSC) to make a submission to ministers requesting amendments to the Human Medicines Regulations (HMR) (2012), along with other consequential amendments to regulations that will be required to fully implement independent prescribing by paramedics. Of the many NHS Regulations, amendments must be made to the following:General Medical Services Contracts (NHS England, 2015a)Personal Medical Services Agreement (NHS England, 2015b)Charges for Drugs and Appliances (NHS England, 2015c)Pharmaceutical and Local Pharmaceutical Services (NHS England, 2013).There will also be further work with NHS England and the Home Office to consider the proposal for paramedic independent prescribers to be able to prescribe from the restricted list of six controlled drugs, which would require amendment of the Misuse of Drugs Regulations (Home Office, 2001). This is the same process for paramedics as it was for other professions achieving prescribing status previously. There are only two opportunities each year to recommend change to legislation—Easter and Autumn—and it is not certain whether we will see amendments to the HMR made early in 2018. While we cannot guarantee this, we hope that the amendments to the legislation happen earlier in the year.Alongside these goals, the College of Paramedics will continue to work in partnership with NHS England on key documents needed to support implementation, such as Practice Guidance and the Implementation Guide—the latter includes a self-assessment matrix for aspirant prescribers. These two documents will be published on the College website in due course. The other document is the Outline Curriculum Framework (Allied Health Professionals Federation; 2017) for allied health professional (AHP) prescribers. This document will be amended by the College with the support of NHS England, but it is owned by the Allied Health Professions Federations, who will publish this document on their website.Rather than being seen as the end of the journey, this really only marks the start of the next legADOBESTOCK/BORPHLOYThere is still lots of work to do, such as engaging with patient and public groups, universities, other professional bodies, the Association of Prescribers, and employers, among others, and we hope to be able to give more news on potential timescales on progress towards course enrolment dates as soon as possible.

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