Physiotherapists could prescribe pregabalin again to take pressure off GPs
The Government is consulting on changes that would allow physiotherapists to prescribe pregabalin and gabapentin once more to take pressure off GPs.
Under the proposals, physiotherapist independent prescribers would be able to also provide codeine and tramadol.
Physiotherapists were previously able to prescribe tramadol, gabapentin and pregabalin prior to changes in their controlled drug scheduling, the consultation notes.
Making the changes would ‘make it more convenient and safer for patients to get the medicines they need at the time and place they need them’.
Under current rules, patients often need to be referred to another prescriber to get the pain medicines, leading to ‘avoidable delays’.
And the need for additional appointments places extra demand on GPs, the consultation notes.
‘These delays can have a direct impact on patient outcomes, especially where timely pain management is essential to recovery and rehabilitation,’ it states.
The change would also make services more efficient by making ‘best use of physiotherapist independent prescribers’ clinical expertise’ and reducing pressure on primary care, it adds.
Such changes had already been consulted on in 2020 and the Commission for Human Medicines is supportive, the consultation says.
Under current legislation physiotherapy prescribers can already prescribe seven controlled drugs; temazepam, lorazepam, diazepam, dihydrocodeine, morphine, fentanyl and oxycodone.
Pregabalin and gabapentin were reclassified as class C controlled drugs in 2019 over concerns around misuse, illegal diversion of the drugs and addiction.
A report published last month by the NHS Business Services Authority found a further fall in the prescription of dependency forming medicines in England.
But gabapentinoids are the only drug in the category to increase with 17 million items prescribed in 2024/25 compared with 11 million in 2015/16.
GPs are advised to carry out regular reviews for people taking dependency-forming drugs for chronic pain.
Discussions around withdrawing an opioid, benzodiazepine, gabapentinoid, Z-drug or antidepressant should happen when the medicine is no longer benefiting the patient, problems of dependency have developed or the harms outweigh the benefits, NICE said in 2021.
The consultation is open for 12 weeks and will close on 28 October 2025.
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
Related Articles
READERS' COMMENTS [16]
Please note, only GPs are permitted to add comments to articles
More evidence that the Government doesn’t understand the problem, won’t effectively consult with those that do understand the problem (GPs) and consequently won’t take any action that actually helps.
This clever with a drug of addiction!
addictive drugs that don’t work. why?
So long to keeping a lid on addictive drugs . Doesn’t their physio work? Maybe they should be seeing people rather than emailing them a leaflet as seems to happen round my way
Show me the evidence that these drugs work other than turning them into addicts
I hope all the above filled in the consutlatoin survey too.
It is wider, and covers a number of things that should not be happening.
Why are physios prescribing these things anyway?
What skills do they have in managing addiction, side effects (including neuropsychiatric with tramadol and pentinoids), and withdrawal programmes and withdrawal effects?
Why would the be initiating (and probably NOT maintaning repeat prescriptions, which they would require us to sign for) of second and third and fourth line drugs which are not just restricted for use by GPs, but GPs are actively punished if they are prescribed by anybody – through the QOF scores ?
They can keep the repeat prescriptions then too!
Has anyone ever been helped by this rubbish?
“Prescribing physiotherapists”??
Didn’t know they existed.
But they certainly shouldn’t be doling out the gabbies.
(And frankly neither should we).
Utterly disastrous proposal. Just as we have spent much time in exerting downward pressure on the use of these drugs in the light their poor efficacy in many patients, this will open flood gates and cause massive problems for the inevitable transfer into repeat prescribing
Hey why stop there? Lets add Morphine, diazepam and Tramadol and bundle in Osteopaths too – these guys/girls know their stuff. Theres nothing a lowly GP can prescribe that can’t be done better by someone trained to do something else. Everyone knows that.
They wont even issue sick notes, so not much chance of them prescribing a CD
What a terrible idea. I’m not sure that pregabalin provides any benefit that isn’t delivered by their opioid initiation effect, with the possible exception of true radiculopathy for the short term, and occasional use in epilepsy. I don’t think it should ever be used for anxiety. Alongside benzodiazepines, the popularity of this drug in the ex prison population tells you all you need to know about it’s value.
Headline 2030: GPs to be completely replaced by cheaper lesser trained staff to relieve pressure on GPs.
Really, really bad decision. Essentially no benefit for msk conditions but plenty of evidence of harm (heart failure, drowsiness, falls, respiratory depression)/ diversion/abuse of these drugs. Their prescription should be being limited not expanded.
These drugs have no evidence of benefit in MSK conditions and plenty of evidence of harm/ diversion/death. Prescribing should be being restricted, not expanded