Scientific Abstract
V3. 11th May 2015 NHS Ethics ref: 14/LO/1874
Evaluation of Physiotherapist and Podiatrist Independent Prescribing
Background
A recent change to the prescribing powers of physiotherapists and podiatrists (PPs) means they are
now able to independently prescribe (IP), offering improved service efficiency, access to medicines,
and maximum use of their knowledge and skills. There is little evidence related to prescribing by PPs.
Reported benefits, such as cost savings, improved access, and quality of care relate mainly to
prescribing by nurses and pharmacists. There are ongoing concerns surrounding levels of support,
governance structures, and barriers such organisational and policy restrictions known to affect
implementation of the prescribing role. Introduction of PP-IP is widely supported, with
improvements to service delivery and standards of care keenly anticipated.
Aims and Objectives
The overall aim is to evaluate the effectiveness and efficiency of independent prescribing by
physiotherapists and podiatrists.
The objectives are to:
1. Describe and classify the services provided by podiatrist and physiotherapist independent
prescribers
2. Identify the factors that inhibit/facilitate the uptake and implementation of physiotherapist
and podiatrist independent prescribing.
3. Evaluate the contribution of physiotherapist and podiatrist independent prescribing to the
experience of patients and carers and its impact on choice, access, and self-reported health
outcomes
4. Identify the medicines management activities that enable podiatrist and physiotherapist
independent prescribers to contribute most effectively to successful care outcomes
5. Assess the quality, safety and clinical appropriateness of physiotherapist and podiatrist
independent prescribing
6. Evaluate the impact of physiotherapist and podiatrist independent prescribing on cost,
quality, effectiveness and organisation of care
7. Explore the prescribing models in current practice, their associated resources, and patient
utility
8. Evaluate the appropriateness and effectiveness of physiotherapist and podiatrist
independent prescribing educational programmes.
Plan of Investigation
This research will comprise a comparative case study of 7 sites where physiotherapists or podiatrists
use IP and 7 non-prescribing (NP) PP sites. A purposive sample of PP-IPs have been identified
through contact details provided in the earlier phase of the study, trainee PP-IP questionnaire, and
project advisory group, and matched with NP-PP sites. These are based in various care settings
including NHS outpatient clinics, NHS community clinics, and private practice allowing a match
between one PP-IP and NP-PP in each setting.
At each case-study site data will be collected as follows
i)
ii)
Semi-structured interviews with PP-IP/NP-PP & Team members (n-2-3)
A researcher will observe PP-IPs and NP-PPs engaged in real-time service delivery over
one working week (maximum 5 working days, 37.5 hrs clinical practice.
Scientific Abstract
V3. 11th May 2015 NHS Ethics ref: 14/LO/1874

iii)
iv)
v)
vi)
Electronic diaries will be used to collect information on medicines management
activities and work activities (n-60 patients per site)
Patient questionnaires (n-30)
Audio-recorded consultations and prescription (n-5)
Audit of patient records (n-15)
Patient follow up questionnaire (n-60)
Analysis will comprise initial analysis of individual units of data, followed by consideration of
convergent evidence across sites, and the case-study as a whole. Resource implications of different
models of care will be assessed. Write up and dissemination to all interested stakeholders will take
place toward the end of the project.
Research Team
The unique nature of our highly experienced team of researchers, combining specialist knowledge in
NMP, with professional expertise in physiotherapy, podiatry, pharmacy, and health economics,
provides a great opportunity to explore the effectiveness, efficiency and quality of PP-IP.
Impact
Describing the services provided by PP-IPs and determining the impact of these services, on
effectiveness, efficiency, quality and cost of services, will create evidence to inform those engaged in
policy development and commissioning services, guide professional bodies, healthcare
commissioners and managers and support wider implementation of the role. It will allow informed
decision making about the extension of prescribing rights to other healthcare professionals and nonmedical professionals in other countries who look to follow our experience.