1. A Physiotherapy Service Managers Perspective – Scrutiny & Viability Seamus Doherty Head of Physiotherapy Services WHSCT Vicki Quinn Consultant Physiotherapist – Orthopaedic ICATS WHSCT /06/13

2. Scrutiny - Qualitative
Non-Medical Prescribing (NMP)
Should not be scrutinised in terms of a Training and Development opportunity
Is not well-matched to every physiotherapy service area
Non-Medical Prescribing ‘requires a high level of expertise and
should be an advanced practitioner’.
World Congress Physiotherapy October 2012
Is not suited to every physiotherapist ; even advanced practitioners
Clinical outcomes, process outcomes, cost outcomes, service outcomes

3. Quantitative - What We Know
Prescriber Type
Count of Registered Prescribers
Count of Prescriber Activity
(Feb-Mar 13)
% Prescriber Activity V
Registrants
Community Nurse
(restricted list)
632
242 38
NISP
(whole BNF)
188
114 61
PISP 33 24 71
Total
853
380 45
Caveats
Nurse and Pharmacist prescribers in primary/community care only
2 registration systems are transitioning therefore numbers may not be 100% accurate
Restricted List – Nurse Prescribers Formulary for Community Practitioners

4. Physiotherapy NMP - Current
Trust
Sub-
speciality
Number
Supplementary (S)
Independent (I)
State of Readiness
BHSCT
NHSCT
Resp.
Rheum. 3 S
Waiting prescription pads. Not on Trust register - query re drug budget. On professional register. Non medical prescribing Trust policy in place. Mentor in place.
SEHCT
SHSCT
MSK/Pain 1
Waiting prescription pads once data base goes live for the MSK staff. Required protocols and mentor in place and letters of recommendation ed??? in acute
WHSCT
MSK
Required protocols and mentor in place – registration to be completed to implement

5. Physiotherapy NMP - Prospective
Clinical outcomes, process outcomes, cost outcomes, service outcomes
Trust
Sub-
speciality
Number
Supplementary (S)
Independent (I)
BHSCT
NHSCT
Resp.
MSK 2
I (+ 3 Conversions)
SEHCT
SHSCT
Womens Health.
I (+ 4 Conversions)
WHSCT 1
I (+ 1 Conversion)

6. Challenges Service review – assessment of service need/value of NMP
NMP protocols / policies within ‘scope of practice’ in the respective Trusts
Robust Partnership & Support
- Close working liaison with medical colleagues / stakeholders
Knowing your staff and medical champions of NMP
- Consultant / GP mentors
- Acute V’s Community
Constraints of the service (Parameters)
- Clinical Management Plan; generic, individual patient
- Formulary as per practitioner/mentor discussion with respect to ‘scope of practice’
MSK Consultant Physiotherapist Therapeutic Radiographer
Analgesics Whole BNF; close liaison with Medical Consultants at Cancer Centre
Anti-inflammatories
Neuropathic meds.
Muscle relaxants
PPI; Ant-emetics, Laxatives

7. Benefit Analysis - Service Quality
Outpatient Respiratory Physiotherapy Service - Altnagelvin
- Robust PT to Consultant relationship within the current service
- PT practitioner keen to undertake NMP training to enhance the current service
- Defined ‘scope of practice’; Respiratory Framework standard – Bronchiectasis
- Rationalise the patient pathway; Modernisation & Reform
- Optimise patient management
- LTC Case Management Approach
Self-management
Self-referral
- Easily evaluated

8. Conclusion (Perspective)
Low hanging fruit picked too early, before the need for it, can still rot.
NMP is a fundamentally different Training & Development opportunity for Physiotherapists – while an extension to their pre- existing knowledge and skills it requires its own set of foundations.
Proposals to implement NMP should be scrutinized in the context of holistic service development in advance of personal professional development .
There is clear potential for a shift to ‘right person’ management; reducing unnecessary need for GP visits or referrals to medical consultants while enhancing and integrating services from a patient- centred perspective.