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J. Mullan1, J. Smithson2, N. Walsh1, I. Frampton2
1University of the West of England, School of Health and Social Wellbeing, Bristol, United Kingdom, 2University of Exeter, Exeter, United Kingdom
Background: Legislative change in the UK in 2013, enabled physiotherapists holding a post graduate non-medical prescribing qualification to independently prescribe certain drugs that assist in patient management. Prescribing in physiotherapy is highly regulated. As registered independent prescribers, physiotherapists are required to prescribe within the law.
Purpose: The purpose of this research was to explore the experiences of musculoskeletal (MSk) physiotherapy independent prescribing within UK primary care and identify the implications for physiotherapy practice. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose, occurring alongside the development of physiotherapy First Contact Practitioner (FCP) roles in primary care.
Methods: A critical realist approach was used, with qualitative data collected via 15 semi-structured interviews with Physiotherapists (N=13) and General Practitioners (GPs) (N=2) in primary care. Thematic analysis was applied.
Results: The 13 physiotherapy participants were all involved in MSk primary care services, with eight being physiotherapy independent prescribers. The GPs worked in primary care.
The emergent UK drug dependency and opioid addiction debate featured in discussions of the experiences of physiotherapy independent prescribing. Two aspects were apparent: firstly, the need to recognise it as an issue that all health professionals in primary care had to work together to address and support the patients involved. Secondly, it provided both a context and a cause to the frustrations articulated around the Controlled Drugs legislation, particularly pertinent to physiotherapists working as prescribers in the MSk speciality within primary care. The legislation about the accepted Controlled Drugs list (which both features and omits certain pain medication relevant in musculoskeletal care) brought this to the forefront of participants minds. One participant, who was a GP, was particularly concerned about the opioid addiction crisis, not because there was any concern about physiotherapists being able to safely prescribe, but because of the current challenges that GPs were facing in relation to patient addiction, and the potential for manipulation of the system by addicted patients to illicit more prescriptions for drug misuse.
The emergent UK drug dependency and opioid addiction debate featured in discussions of the experiences of physiotherapy independent prescribing. Two aspects were apparent: firstly, the need to recognise it as an issue that all health professionals in primary care had to work together to address and support the patients involved. Secondly, it provided both a context and a cause to the frustrations articulated around the Controlled Drugs legislation, particularly pertinent to physiotherapists working as prescribers in the MSk speciality within primary care. The legislation about the accepted Controlled Drugs list (which both features and omits certain pain medication relevant in musculoskeletal care) brought this to the forefront of participants minds. One participant, who was a GP, was particularly concerned about the opioid addiction crisis, not because there was any concern about physiotherapists being able to safely prescribe, but because of the current challenges that GPs were facing in relation to patient addiction, and the potential for manipulation of the system by addicted patients to illicit more prescriptions for drug misuse.
Conclusions: Prescribing physiotherapists felt well equipped to have difficult conversations with patients who were at risk of, or were, opioid dependent. However, they were not necessarily able to start the deprescribing processes as the controlled drugs that were not permitted for prescribing were the same ones that in turn, they were not able to deprescribe. This resulted in having to refer back to the GP, undermining the potential benefits of becoming a physiotherapy independent prescriber.
Implications: There was a realisation that as MSk specific practitioners in primary care, the nature and accessibility of the FCP role, particularly as independent prescribers, placed these individuals and the physiotherapy profession increasingly in the frame for addressing and contributing to the management of this crisis. Prescribing physiotherapists reported a sense of lack of trust and autonomy in their clinical decision making in having key controlled drugs not included or indeed removed from their permitted formulary. They felt well placed to identify and address opioid dependency in patients with MSk conditions, but not fully enabled to action relevant interventions due to external constraints of legislation.
Funding acknowledgements: Self funding
Keywords:
Opioid drug dependency
Controlled drugs
Independent prescribing,
Opioid drug dependency
Controlled drugs
Independent prescribing,
Topics:
Professional issues
Service delivery/emerging roles
Primary health care
Professional issues
Service delivery/emerging roles
Primary health care
Did this work require ethics approval? Yes
Institution: NHS Health Research Authority
Committee: Health Research Authority
Ethics number: IRAS project ID 238300, Protocol number 1718/29
All authors, affiliations and abstracts have been published as submitted.
