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Medicines and Prescribing
This page explains more about the medicines and prescribing rights of the professionals that we register.
The sale, use and production of medicines are covered in legislation, including the Medicines Act 1968 and Human Medicines Regulations 2012. Any changes to this legislation would be a policy decision for the Department of Health and Parliament along with the devolved administrations.
The Medicines and Healthcare Products Regulatory Agency (MHRA) is responsible for regulating medicines in the UK.
There are three main classes of medicines:
- Prescription only medicines (POMs) can only be sold and/or supplied to patients with a prescription from an appropriate practitioner (a doctor, dentist, or other independent or supplementary prescriber). See below for further information on prescribing.
- Pharmacy medicines (P) can only be sold or supplied at registered pharmacy premises or under the supervision of a pharmacist.
- Medicines on the general sale list (GSL) can be sold at a wider range of outlets (such as supermarkets), provided those premises are lockable and the medicines are pre-packed.
Prescribing means advising and authorising the use of a medicine and often involves issuing a written prescription. The law says who can and cannot prescribe medicines.
There are two different types of prescribing – independent and supplementary.
- An independent prescriber is someone who is able to prescribe medicines on their own initiative from the British National Formulary (BNF). Independent prescribers include doctors and dentists, as well as some non-medical health professionals.
Since 2013, registered chiropodists / podiatrists and physiotherapists have been able to become independent prescribers. Recent changes to legislation in April 2016 mean that registered therapeutic radiographers are now also able to train as independent prescribers.
- A supplementary prescriber is able to prescribe medicines in accordance with a clinical management plan (CMP) for a specific patient. The CMP is agreed between the supplementary prescriber, a doctor and the patient.
Registered chiropodists / podiatrists, radiographers and physiotherapists have been able to become supplementary prescribers since 2005. Recent changes to legislation in April 2016 mean that registered dietitians are now also able to undertake training as supplementary prescribers.
In order for registrants from these professions to become independent or supplementary prescribers, they need to complete an approved post-registration training programme. We have published standards for prescribing which we use in approving programmes.
We then annotate (mark) the register to indicate which individuals are able to practise as an independent or supplementary prescriber.
Supply and administration of medicines without a prescription
The law also allows local arrangements to be developed for professionals without prescribing rights to supply or administer medicines to certain types of patients, in certain circumstances.
- A patient specific direction is an instruction given by an independent prescriber to another professional to administer a medicine to a specific patient.
- A patient group direction (PGD) is a written instruction for the supply or administration of medicines to certain groups of patients by a named health professional. The instruction must be agreed and signed by a senior doctor and pharmacist and include detailed information, including the name of the professional who can supply or administer the medicine(s); the description, class, dosage and strength of the medicines to be supplied or administered; and the condition or clinical criteria for which a patient is eligible for treatment under the PGD.
Currently, the following professionals on our register are able to administer or supply medicines under a PGD:
Chiropodists / podiatrists
Prosthetists / orthotists
Speech and language therapists
Exemptions in legislation
The law contains ‘exemptions’ for certain professionals on our register to administer, sell and supply from a list of specific medicines on their own initiative, when that would normally be restricted to independent prescribers. Currently exemptions exist for three HCPC professions:
Paramedics can administer certain named medicines by injection on their own initiative for the immediate, necessary treatment of sick or injured people (i.e. in emergency situations). The legislation is regularly amended to extend or amend the list of drugs which paramedics can administer.
Chiropodists / podiatrists who are appropriately qualified can administer certain POMs, and sell and supply certain other POMs, in the course of their practice.
- Chiropodists / podiatrists can qualify to administer a range of POMs in their practice, including (but not limited to) a range of local anaesthetics. This entitlement appears on our register as ‘Prescription only medicines – administration’.
- They may also qualify to sell and supply a range of other POMs in their practice. This appears on our register as ‘Prescription only medicines – sale/supply’.
In order to use these exemptions, chiropodists / podiatrists must have successfully completed training in these areas and have the entitlement(s) annotated on our register. All existing approved pre-registration programmes in this profession include training in both areas. We also approve a number of post-registration programmes which allow chiropodists / podiatrists without one or both of these entitlements to gain them.
Recent changes to legislation in April 2016 have introduced exemptions for orthoptists to sell and supply certain medicines on their own initiative in the course of their professional practice. These medicines are in the form of eye drops and ointments for topical use, including a small number of antibiotics. In order to use the exemptions, orthoptists must undertake a relevant HCPC approved post-registration training programme and obtain an annotation on the Register.
The following are suggestions of sources of further information:
The lists of medicines which registered paramedics and appropriately qualified chiropodists / podiatrists may use under exemptions can be found in Schedule 17 to the Human Medicines Regulations 2012.
An up-to-date list for appropriately qualified chiropodists / podiatrists is also available from the College of Podiatry.
Information on PGDs is available on the NHS Patient Group Directions website. The MHRA has also produced useful guidance on PGDs available here.
The National Institute for Health and Clinical Excellence (NICE) Medicines and Prescribing Centre provides information about prescribing and patient group directions.
The National Prescribing Centre (NPC), which joined NICE in 2011 published guidance which can still be accessed on its archived website. This includes guidance on non-medical prescribing and a single competency framework for all prescribers (which is currently undergoing a review).
If you any questions about this page, please contact the Policy and Standards team: firstname.lastname@example.org.