A Physiotherapy Service Managers Perspective – Scrutiny & Viability Seamus Doherty Head of Physiotherapy Services WHSCT Vicki Quinn Consultant Physiotherapist – Orthopaedic ICATS WHSCT 27/06/13

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

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

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

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)

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

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

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.