Non‐ medical prescribing in Australasia and the UK: the case of podiatry

Abstract

BackgroundThe last decade has witnessed a rapid transformation in the role boundaries of the allied health professions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategy of health care 'modernisation' has encompassed calls for the redrawing of professional boundaries and identities, linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domain of medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped to meet the challenges posed by changing demographic, social and political contexts. The prescribing of medicines by non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects these changes.MethodsUsing a range of key primary documentary sources derived from published material in the public domain and unpublished material in private possession, this paper traces the development of contemporary UK and Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sources include material from legislative, health policy, regulatory and professional bodies (including both State and Federal sources in Australia).ResultsTracing a chronological, comparative, socio-historical account of the emergence and development of 'prescribing' in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reforms on the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled with demands for workforce flexibility and role transfer within a climate of demographic, economic and social change has enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply, administration and prescription of medicines.ConclusionAs a challenge to medical dominance, these changes, although driven by wider healthcare policy, have met with resistance. As anticipated in the theory of medical dominance, inter-professional jurisdictional disputes centred on the right to access, administer, supply and prescribe medicines act as obstacles to workforce change. Nevertheless, the broader policy agenda continues to ensure workforce redesign in which podiatry has assumed wider roles and responsibilities in prescribing.

Patient’s Perception of Nigerian Physiotherapists as Supplementary Prescribers

“…In the last decade of health care modernization, there has been redrawing of professional boundaries and identities and greater workforce flexibility [1]. Several tasks and roles previously within the exclusive domain of medicine have been delegated to allied health professionals, with the reshaping of workforce to meet the challenges posed by changing demographic, social and political contexts [1].…”

“…Several tasks and roles previously within the exclusive domain of medicine have been delegated to allied health professionals, with the reshaping of workforce to meet the challenges posed by changing demographic, social and political contexts [1].…”

“…There has been paradigm unrelenting transformation of boundaries in the statutory roles of allied health professions, creating new roles and expanding the existing traditional roles; and this is a strategic approach towards improving health care [1]. Inter-disciplinary skills, adequate knowledge and experience of health professionals are required to achieve this modernization [2].…”

The impact of workforce redesign policies on role boundaries in `generalist¿ podiatry practice: expert views within the professional body

“…Policy level solutions have emphasised the need for workforce flexibility and an expansion in role boundaries for the allied health professions (AHPs), such as podiatry [1,5,6]. Much of the literature on workforce change in the health professions has focused on extended roles, such as prescribing or podiatric surgery, with little attention paid to the impact of these reforms on generalist practice [7][8][9]. This study aimed to address the issue of role flexibility and reform on non-specialist podiatry practice in the UK, often referred to as general podiatry or 'core' podiatry, through the eyes of expert podiatrists drawn from the ranks of its professional body [10,11].…”

Doctor - pharmacist collaborative prescribing in a multidisciplinary surgical preadmission clinic: Expanding the role of the preadmission clinic pharmacist

“…[56] The paper concluded that the changes were met with resistance on the right to access, administer, supply and prescribe medicines from the traditional prescribing workforce. However, the broader policy agenda allowed workforce redesign to continue, and podiatry has assumed wider roles and responsibilities in prescribing.…”