Evaluation of independent prescribing by therapeutic radiographers and supplementary prescribing by dietitians (TRaDiP)
A recent change in the law allows dietitians and therapeutic radiographers, working at an advanced level, to prescribe medicine for patients that they treat. Before they can prescribe, dietitians and therapeutic radiographers must pass a prescribing training programme.
Dietitians, who manage diet and feeding for many health problems, can prescribe medicines from a treatment plan agreed with a doctor. This is known as ‘supplementary prescribing’. Therapeutic radiographers, who deliver radiotherapy and manage the side effects of this for people with cancer, can assess patients and prescribe medicine without the need of a doctor. This is known as known as ‘independent prescribing’. Research on prescribing by other professionals, such as nurses and pharmacists, shows benefits to patients and to the NHS. From talking to patients, we know that faster access to medicines is important and this change may be welcomed if patient safety is assured.
We aim to study the effect of dietitians and therapeutic radiographers prescribing on patients, staff and services. We will study how prescribing is used and identify where it works well, to help managers to plan services. The study will be conducted by an experienced research team, including a patient advisor, and will be guided by clinicians, managers and a patient group to advise when best to approach patients and help design tools and written information.
Plan of investigation
This study will be conducted in four phases.
Will be a literature review, to understand the roles of advanced practice dietitians and therapeutic radiographers in medicines management and to assess the impact of their prescribing activities on patients and organisations.
Will be a survey of the current therapeutic radiography and dietetic services provided in England and surveys of dietitian/therapeutic radiographer prescribers. The surveys will explore how and where dietitian and therapeutic radiographer prescribing is being put into action.
Will consist of a comparative case study of 6 sites where dietitians or therapeutic radiographers are being trained as prescribers.
The case study will be carried out at three points:
- Before their training begins
- During training
- After training is complete.
Case studies will be from different hospital or community-based clinics around England. We will observe patient consultations, speak to patients and carers, and gather economic data. This data will be used to assess the impact of dietitian/therapeutic radiographer prescribing on patients, staff and services.
Will be the development of a model of implementation and an online tool-kit.
This study has now begun, and we are working on phase 1 and 2. We are also preparing for the phase 3 case studies. The study will run until November 2022.
The study is currently paused due to the Covid19 outbreak and we will restart work as soon as it is appropriate to do so.
- Phase 1:
- We’ve completed the literature review and are writing this up for publication.
- Phase 2:
- We’ve carried out 40 interviews with therapeutic radiography and dietetic service managers in England.
- We’ve received 25 completed surveys from dietitian and therapeutic radiographer prescribers.
- Phase 3:
- Phase 3: We are looking for 6 case sites where dietitians or therapeutic radiographers are about to begin prescribing training.
Following our recruitment process, we have welcomed two additional Public and Patient Voice Expert Advisors to the study Project Advisory Group. We held our second Project Advisory Group meeting in March 2020.
We always welcome input from patients or carers using dietetic or therapeutic radiographer services. If you’d like to help with our work, please contact us on TRADIP@surrey.ac.uk.
As we make progress with the project, we will make our findings available through publications and a number of events. The details of these will be listed here.
This study is funded by the National Institute for Health Research (NIHR) policy research programme (project reference PR-R19-0617-21001). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Co-applicants and research team
Mr Bill Davidson (Patient and Public Voice expert adviser)
Bill is an experienced patient consultant and has been a member of many advisory panels for the NHS and Health Education England, providing input on diverse topics including building projects and consultant recruitment. He has wide experience of public speaking to patient and professional audiences, including as a guest lecturer and trainer for medical professionals. Above all he is a passionate advocate for inclusion, engagement and genuine co-production.
Mrs Sarah Griffiths (University Hospitals Bristol NHS Foundation Trust)
Sarah is a Macmillan Consultant Radiographer specialising in Palliative Radiotherapy at Bristol Cancer Institute. Her interest in the management of treatment related side effects and the psychological support of cancer patients led to the development and implementation of a radiographer-led review service in Bristol. As Co-chair of the Prescribing Group of the College of Radiographers she was part of the team who were successful in securing Independent Prescribing rights for Radiotherapy Radiographers with The Council for Human Medicines.
Dr Natalia Ivashikina (University of Sussex)
Natalia is a Senior Lecturer in Global Health Economics. Natalia has an interest in research in the methodology of economic evaluation in clinical trials, including studies conducted in low-income settings. Her research covers all stages of planning and executing economic evaluations, such as undertaking systematic reviews of economic evidence, data collection, statistical data analyses and economic modelling.
Dr Yogini Jani (University College London Hospitals NHS Foundation Trust)
Dr Yogini Jani is a Consultant Pharmacist for Medication Safety, a Health Foundation Improvement Science Fellow at UCLH NHS Foundation Trust and also the Director of the UCLH Centre for Medicines Optimisation Research & Education. Yogini’s expertise and research interests include – patient safety, medication errors in paediatrics and care homes, health information technology evaluation and inter-professional education.
Miss Sam Sherrington (NHS Trafford CCG/Independent Consultant)
Sam is an experienced registered nurse and leader within the NHS and is a CEO of her own business. Most recently Sam spent over 3 years in the national team for NHS England, leading on nursing, midwifery, care and finance portfolios, and was Mayoress of Bolton for 2018/19 (starting in May 2018). Sam holds a clinical Masters degree and a post graduate diploma in leadership and management. Sam is a member of the Council for National Association for Primary Care, Chair of UK Association for Prescribers, founding Director of Health Education Cooperative and Co-chair of European Committee Prescribing Research in Medicines Management (PRIMM). Her interests include leadership, transformation and delivering outstanding care for patients, families and communities.
“Preparing to Prescribe” toolkit. This toolkit takes you on a step-by-step basis through the requirements you need to meet before you register on a non-medical prescribing programme (NMP) in the UK.
Stenner Karen, Edwards Jude, Mold Freda, Otter Simon, Courtenay Molly, Moore Ann, Carey Nicola (2018) ‘Medicines management activity with physiotherapy and podiatry: A systematic mixed studies review.’, Health Policy 122 (12) pp. 1333-1339 doi: 10.1016/j.healthpol.2018.10.004
Courtenay M, Carey N, Gage H, Stenner K, Williams P (2015) ‘A comparison of prescribing and non-prescribing nurses in the management of people with diabetes’, JOURNAL OF ADVANCED NURSING 71 (12) pp. 2950-2964 doi: 10.1111/jan.12757
Carey N, Stenner K, Courtenay M. (2014) 'An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England.'. BMC Health Serv Res, England: 14 (1) doi: 10.1186/1472-6963-14-27
Research information sheets
Participant information sheets will be available here when we begin our data collection.
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