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Dietitians to be given greater prescribing powers to reduce demand on GPs

NHS England has set out proposals to reduce the need of patients to book GP appointments by giving greater prescribing powers to dietitians, radiographers, paramedics and orthoptists.

The proposals – set out in four separate consultation documents – have been designed to provide a more ‘efficient and convenient service’ for patients, while ‘reducing demand on other services’.

Under the proposals, radiographers and paramedics would be able to independently prescribe, and dietitians would be able to subscribe following agreement with GPs or other independent prescribers.

NHE England says that for many patients, an associated health professional is their lead clinician, but the patient may have to ‘make an additional appointment with their GP or doctor to get the medicines they need’.

Suzanne Rastrick, chief allied health professions officer at NHS England, said: ‘Our proposals will allow patients to get the medicines they need without delay, instead of having to make separate appointments to see their doctor or GP.

‘Breaking down barriers in how care is provided between different parts of the NHS is key to the vision set out in the NHS Five Year Forward View.

‘Extension of prescribing and supply mechanisms for these four professions creates a more flexible workforce, able to innovate to provide services that are more responsive to the needs of patients, and reduce demand in other parts of the healthcare system.’

The consultation on dietitians gave the example of CKD treatment, and said: ‘The frustration amongst doctors and patients alike is that the current system requires the patient’s consultant or GP to initiate and adjust medicines as advised by the dietitian in a separate additional appointment/consultation. As such, there can be several days delay between the dietitian’s appointment, and obtaining the prescription from the consultant or GP.’

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said: ‘In general we would be supportive of these groups being empowered to prescribe within their areas of expertise, it is always frustrating when GPs find their time being used to ‘rubber stamp’ clinical decisions which have quite appropriately been made by our colleagues.’

 

Readers' comments (11)

  • why not just get rid of us altogether? Glad i spent all that money and time and energy going to medical school. all in favour of extending prescibing but only as long as it is within a very limited scope. Also, are these new "super" AHPs going to be able to assess medications in terms of what a patient is already on, interactions, side effects etc. I would give an example of a nurse presciber in a surgical pre assesment clinci who told a patient to go any buy iron tablets as their GP had them "on entirely the wrong thing" for anaemia. This despite the fact that they had actually had a clear pernicous anaemia from thier bloods which was being entirely appropriately treated. Cant help feeling we would see more of this..........

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  • The idea of dietitian prescribing has some value. The CCG/ prescribing team dietitians definitely understand the supplements and their costs and indications better than we do. I don't envy them suddenly being out in a prescribing role, without the training or experience to say no in the face of patient demand.
    As regards the rest, it's just bizarre. In what scenario will a radiographer issue a prescription?

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  • And you can guarantee that if a paramedic prescribes, they'll be phoning the GP to follow up the patient ASAP in case they've screwed up.

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  • I've just wiped the floor with a dietitian who suggested to family their almost 90 years post stroke patient with no capacity and bed bound, having previously expressed she did not want to go down the same route as her mother (who was peg fed), should have peg feed. Not only then, full blood test was done without any discussion with the family or me (presumably to prevent re feeding syndrome), which showed abnormality which I would normally should be treated add in patient care, I spent over an hour sorting this with upset family.

    Their first concern seems to be how much calories do they need to put in, rather then treating the patient add a whole. Sorry, most FY1 had better understanding is holistic care.

    Save time for GPs? You are kidding right?

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  • Get rid of Drs..prescribing is easy...it's the easiest thing in the world to dish out drugs ...there's no point training people to know lots of stuff...train 'em to know a little bit of stuff instead ...that's all that's needed...it's far cheaper too. Everyone knows Drs are crap...and too expensive ...get rid of them...let as many people with as many different backgrounds as possible prescribe drugs...we will all surely be so much better off for it and it will save us all a packet. Get rid of Drs ...they are crap

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  • I welcome anyone and everyone having rights to prescribe. As long as it has nothing to do with us doctors who actually trained to do it, and these prescribers take full responsibility, indemnity and all problems and queries go back to them...the more the merrier. Bring it on. God bless and good luck to the patient.

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  • Making a difference Public Sector Reulatory Team Cabinet office March 2001 and i quote page 17
    "Outcomes"
    From Decenber 2001 GP's will no longer need to issue repeat prescriptions for Gluten free foods"

    As I am still issuing FP10 as I suspect most GP's are and the various NHS mangements since claim unable to comply, including my "membership organisation CCG" forgive me if I do not believe a word of another pre election promise.

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  • Oh my you physicians on your high horse please come down. There is prescribing capacity for a nutritionist. MD's do not know everything and I'm reminded of this on a daily basis. For every RN, RD, speech, OT or other healthcare provider giving presumed bad advice there too is a physician out there giving bad advice and you are more likely to do harm with your tunnel vision and prescribing power. Clearly there is a role for nutritionists (RDN) to prescribe enteral and parenteral nutrition. MD's typically do not possess the competency to do this but they can. Of course the RDN would need to be competent to do so. Try not to be so narrow minded.

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  • I have news for the individual who so unprofessionally stated that he just "wiped the floor with a dietitian". (I'm sure you are a joy to work with.) Administering inappropriate nutrition support to dying patients is a mistake made by physicians every day. I am quite certain that if a study were to be done looking at several facilities and several end-of-life patients, it would show this poor choice is made more frequently by physicians than it is by dietitians. My point is that just because you disagreed with this one dietitian, you are unfairly now painting us all with the same brush and I'm sure not giving this one another chance. I will, however, remember your phrase about wiping the floor the next time a doctor asks me to start a tube feeding on the DNR patient on the vent and high-dose pressors, or to initiate peripheral parenteral nutrition on the walking, talking, well-nourished patient who happens to have a low albumin, or to hold tube feedings on a patient because they have a residual of 20....I could go on and on, but I doubt it will get through to you anyway.

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  • On a daily basis RDs make requests for prescribable items based on nutritional needs in the context of clinical condition.

    We work alongside medics in this respect as part of MDTs and I have yet to find a clinician who does not find this valuable. This comes from the longstanding professional relationships we have with clinicians as part of a MDT, which seems sadly lacking from the experiences of Dr 'Wipethefloor' GP.

    Insulin-adjustment/ insulin pump recommendations in diabetes; advising on relevance and dose of phosphate binders in ESRD and loperamide/ sodium enrichment with high output ileostomies, requesting refeeding electrolytes etc,are all routine to dietitians currently.

    We often recommend cessation of medication inappropriate to condition, too. For example: calcium and vitamin D supplements in full enteral feeding and suspension of PERT during hydrolysed tube feed choice.

    This isn't a case of issuing a prescription pad and off we go to 'compete' with medics. It's about the rationalisation of current practice within an outdated model.

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