Extended Scope Practice - Non-Medical Prescribing
Over the last 4 years, 3 physiotherapists have qualified as independent non-medical prescribers (NMP). We each are specialist Respiratory Physiotherapists working within a multi-disciplinary team (2 in Adult Cystic Fibrosis and 1 in Bronchiectasis).
Working as independent NMP in inpatients, MDT clinics, and physio-led outpatient clinics has streamlined the process for assessment of new medications. This enables timely access to appropriate medications and advice, which includes drug administration and timing of medications. We provide close follow up in relation to tolerance and adherence to the medication, preventing unnecessary prescribing and therefore providing potential cost savings.
We only work within our respiratory expertise and competencies with support from our medical teams. We have regular CPD opportunities through the hospital NMP group including all other specialities and disciplines.
We carry out regular audits of our practice and maintain our competencies through the national competency framework.
Overall, we feel the role of independent NMP has improved the quality of our service for all our patients. We, as therapists, have benefitted from increased knowledge and autonomy within our roles, improving job satisfaction and decreased time spent requesting prescriptions from medics. This has further cost saving potential.
Our Trust has also benefitted from our NMP roles providing improved and positive patient experiences, due to comprehensive and timely treatment sessions, and improved throughput of patients aimed at reducing waiting times.
NMP has been an important and valued addition to our roles and would recommend this extended scope role to those working in specialist areas.
Emma Pilkington, Band 7 Cystic Fibrosis Physiotherapist, University Hospitals Bristol NHS Foundation Trust
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The main cause of morbidity and mortality in children with complex neurological problems is respiratory complications.
There are various factors which increase the risk of respiratory infections. These include:
- Gastro-oesophageal reflux
- Aspiration
- Hyper salivation
- Sleep disordered breathing
- Reactive airways
Many of these complications can be managed and minimised to either prevent or reduce the morbidity and mortality for these children. In NHS Lanarkshire the paediatric physiotherapy and nursing service carry out combined assessment and treatments to reduce the potential respiratory risks. The addition of a non-medical prescriber physiotherapist has improved the service in several ways.
NHS Lanarkshire runs a neuro-respiratory clinic which is managed by two paediatricians; one with an interest in respiratory and another with an interest in neurology. Children are assessed for the above risk factors. The prescribing physiotherapist and a nurse assess the clinic participants a few weeks prior to their first attendance. Medications which will treat these problems can be prescribed and airway clearance physiotherapy can be started. This allows the effectiveness of medications and physiotherapy to be assessed on the first visit to the clinic. In addition other therapeutic avenues can be explored prior to the clinic; examinations such as sleep studies or swallow assessment by a speech and language therapist can be arranged. This means respiratory risk factors have been assessed and some interventions carried out prior to the first clinic appointment. This makes the outcomes of the first clinic more thorough.
In addition this change reduces waiting time for interventions and reduces the need for multiple appointments at the beginning. In addition the physiotherapists and nurses assess patients who are at risk of respiratory illness which will require hospital admission. In addition to reducing the risk factors mentioned above; the children can be prescribed antibiotics if required and swabs can be taken to check for atypical infections. Having a physiotherapy independent prescriber means these risk factors can be managed using physiotherapy and pharmacological means which reduce the need for hospital assessments and admissions. This reduces bed days taken up by neuro-respiratory children. In addition children find it less distressing to stay at home than be in hospital.
Richard MacPhee, Paediatric Respiratory Physiotherapist, Douglas Street Community Health Clinic
