Many words can be used to describe the characteristics of dietitians. In this case, resilience and determination are the terms that best describe our journey leading to prescribing rights for the UK Dietetic profession in March 2016.
Medicines management was one of the biggest challenges for us as the legislation surrounding medicines is highly complex. There are two mechanisms which patients can use to obtain the
medicines they need; Supply and Administration (SAM) and Non-Medical Prescribing (NMP). A significant aspect of our journey involved using the right terminology and demonstrating we understood the differences between, and the limitations of, each mechanism.
This mechanism allows certain trained and experienced healthcare professionals to supply or administer a course of medicines at the request of a Doctor. The type of medicine, dose and patient(s) are identified in advance. No changes can be made to any of these parameters, if the patient’s circumstances change for instance. These mechanisms were primarily intended for use with patients who required a short supply for a specific condition, (e.g., chloramphenicol for eye infections).
This mechanism allows specific professional groups to train as prescribers in order to be able to provide patients with a prescription for the medicines they require to manage their condition. There are two types of prescribing rights:
Independent prescribing – where the healthcare professional makes the diagnosis, assesses and treats the condition and manages the medicine, without prior agreement of a doctor.
Supplementary prescribing - where the patient is firstly diagnosed by a doctor, who then delegates responsibility for medicines management to the appropriate healthcare professional.
The Review of Prescribing, Supply and Administration of Medicines in 1999, proposed that prescribing rights be extended to a range of health professionals in order to improve services to patients, make better use of the skills of professional staff and thus make a significant contribution to the modernisation of the health service. This review marked the start of our journey to becoming prescribers. In 2003, legislation was changed to enable dietitians to use SAMs with their patients. Unfortunately, this was never going to be an ideal solution to the challenges facing dietitians when treating their patients where diet and medicines are the main criteria for managing long term conditions (e.g. insulin and diabetes, phosphate binders and chronic kidney disease and pancreatic enzymes and cystic fibrosis).
After many years of lobbying, the Department of Health considered extending supplementary prescribing rights to the dietetic profession. We were finally given the opportunity to present our case of need to NHS England and the Non-Medical Prescribing Board. Our case was accepted and we were given the green light to proceed to an eight-week public consultation, and presentation to the Medicines and Healthcare products Regulatory Agency (MHRA) who would ultimately advise Government Ministers whether to accept our case, and change legislation in parliament.
Each stage of this journey required the preparation of detailed documents that described our specialist knowledge, skills and training; how changing legislation would improve patient care, reduce risks, and provide economic benefit. We had to produce reports, impact analyses and case studies as requested whilst also gathering support from key healthcare professions such as doctors, nurses and pharmacists and also patient representative groups.
The BDA strongly believed that dietitians had a robust case for being able to prescribe for their patients. However, the reality of the NHS under great pressure to increase delivery of patient services at a time when resources are limited, perhaps made the biggest difference to progressing this agenda. Ultimately the time was right. Each time someone told us it was too difficult, or asked us to evidence our knowledge, skills and experience, we met the challenge and remained focused on the goal. Fundamentally, we believed passionately that we could make a real difference to patient outcomes and NHS services.
The story doesn’t end there though; we continue to build the case for independent prescribing rights, which will allow us to transform dietetic care across the acute hospital and community settings.
Carole Middleton / Prescribing Project Lead
Head of Education & Professional Development
The British Dietetic Association