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Wilson N.1, Borthwick A.1, Pope C.1, Roberts L.1, Couch R.1
1University of Southampton, Southampton, United Kingdom
Background: In 2013, physiotherapists working in the UK were granted the legal right to independently prescribe medicines (following appropriate training and qualification); the first physiotherapists in the world to be awarded such rights. Amongst the profession, the development was viewed positively - independent prescribing surpassed the dependent model of supplementary prescribing held by the profession since 2005 and significantly advanced physiotherapy's project of professionalization. Although little has been published about the practice of physiotherapist prescribing of medicines, evaluations of non-medical prescribing by other (non-physician) groups has highlighted geographical and specialty variability. One way of understanding this variability is to use the concept of 'governmentality' which focusses attention on the ways that discourse shapes human behaviour towards particular ends. Non-medical prescribing is 'governed' by national and local institutional policy and processes. Taking the non-medical prescribing operational policies of one large National Health Service (NHS) Trust in England as a starting point, we draw on Foucauldian genealogy to explore the discourses and structures producing physiotherapist independent prescribing in this setting with an eye to Tamboukou's question: what is this 'now' within which all of us find ourselves?
Purpose: To explore the discourses and institutional processes that enable and constrain UK physiotherapist independent prescribing of medicines in an NHS Trust providing general and specialist services in England.
Methods: Data for this study were generated from 689 responses to the public consultation on proposals to introduce independent prescribing by physiotherapists in the UK and documentary archives related to the development and expansion of non-medical prescribing policy and practice in Great Britain. All materials were publically available and were critically analysed in the context of other socio-historico-political literature about the prescribing of medicines. A Foucauldian genealogical approach was taken to uncover the relations of power/knowledge within and through which physiotherapist independent prescribing practice is constituted.
Results: The findings bring to light a central discourse of patient safety governing independent prescribing by physiotherapists, which is sustained by other discourses about the scope of physiotherapy practice and the skills and knowledge of physiotherapists vis-à-vis prescribing medicines. These discourses produce and are supported by Trust-level institutional practices, for example surveillance of physiotherapist independent prescribers by doctors and members of the Trusts non-medical prescribing group, to mitigate for the risk posed by physiotherapist independent prescribing practice.
Conclusion(s): Undertaking a Foucauldian genealogy of physiotherapist independent prescribing provides insight into the ways in which discourses and power produce truths about physiotherapist independent prescribers and their practice, thereby revealing a history of the present.
Implications: This project demonstrates that the institutional practices and processes that are in place supposedly to enable physiotherapist independent prescribing of medicines are indeed constraining practice and fostering dependence. An appreciation of Foucaults genealogical approach opens up new possibilities for critical thinking about non-medical prescribing that could equip physiotherapists to resist these constraints and subsequently advance practice.
Funding acknowledgements: No funding was obtained for this study.
Topic: Professional issues
Ethics approval: Ethical approval was not required for this study as all documentary data are in the public domain.
All authors, affiliations and abstracts have been published as submitted.
