Evaluation of supplementary prescribing by dietitians and independent prescribing by radiographers
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 four sites where dietitians or therapeutic radiographers are prescribing. At these sites we will compare the impact of these prescribers versus non-prescribing colleagues.
In addition, we will identify two sites where dietitians or therapeutic radiographers are about to begin prescribing training. In these cases, we will collect data before and after the training to look at the changes resulting from the qualification.
We will be collecting a range of information using prescriber self-reporting tools, patient questionnaires and phone interviews, and data collected for us by hospital staff on-site.This will include:
- Staff reports on their prescribing and patient-facing activities
- Patient satisfaction and views
- Economic data
- Patient safety data
Case studies will be from different hospital or community-based clinics around England. 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.
- We’ve completed the literature review and this is being prepared for publication.
- We’ve carried out 55 interviews with therapeutic radiotherapy and dietetic service managers in England.
- Our prescriber surveys are now closed. We’ve received 103 completed surveys from dietitian and therapeutic radiographer prescribers and are now analysing these results.
- We have ethics approval to begin follow-up questionnaires and interviews with some of the managers and prescribers who have already taken part in the study.
- We’ve identified four case sites where dietitians or therapeutic radiographers are trained as prescribers, and two where they are planning to begin training in 2021. We have HRA and ethics approval to begin these studies and are working with each site to set this up.
- Our first prescribing toolkit event took place in April 2021. Service managers, prescribers and patients joined the team to discuss ideas for a toolkit to help implement non-medical prescribing in practice. We will now form a small working group to give feedback on the toolkit as it is developed.
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.
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.
Nicola is a Reader and lead for the Long Term Conditions and Ageing Cluster within the School of Health Sciences. Nicola is a qualified nurse who has worked in a variety of posts across the country in primary care as both a practice nurse and nurse practitioner. She also spent two years in the United States whilst undertaking her Master's in Public Health in community health education and was involved in several national and state level projects including the Youth Risk Behaviour Survey. Her research interests include quality improvement, workforce development, non-medical prescribing and patient self-management. She has significant experience in the conduct and management of multi-site studies and mixed methods research.
She has also previously worked as a member of the HTA pharmaceutical panel and the NIHR grant awarding body Research for Patients Benefit (RfPB) and is Vice-Chair for the Association of Prescribers.
Co-applicants and research team
Karen is a lecturer in the School of Health Sciences with extensive experience in health services research. Her research interests include the evaluation of extended roles in medicines optimisation and non-medical prescribing. She has published widely on the impact and implementation of prescribing by nurses and other healthcare professionals, with a focus on long-term conditions. Current interests include the expansion of prescribing rights to allied health professions and the impact of delegation of medicines administration to non-registered healthcare workers. She is experienced in multi-site studies and mixed method approaches. She is a member of the University of Surrey ethics Committee.
Research dietitian with a passion for improving the management of under-researched clinical populations and for the collection of accurate and robust dietary data to classify nutritional status, evaluate interventions and develop guidelines.
Experienced teacher across all levels from undergraduate to Continuing Professional Development for practising Health Professionals passionate about the communication of up to date science and scientific methods.
Simon Skene is Professor of Medical Statistics at the University of Surrey and Director of Surrey Clinical Trials Unit and Clinical Research Facility.
Simon has over 20 years’ experience as a medical statistician in teaching and research, including the design and analysis of studies investigating medicinal products, advanced therapies, diagnostic accuracy and surgery. His PhD focused on the analysis of very small samples of repeated measurements, addressing small sample issues in longitudinal analysis. He is a Fellow of the Royal Statistical Society and has consultancy experience in the pharmaceutical industry.
As Head of Statistics at the UCL Comprehensive Clinical Trials Unit, he provided leadership and statistical oversight on UK trials coordinated by the unit across phases I-III in multiple therapeutic areas including hepatology and gastroenterology, ophthalmology, neurology and surgery.
Simon's appointment at University of Surrey combines the role of Director of the Clinical Trials Unit (CTU) and Clinical Research Facility (CRF) with leadership in statistics to support decision based practice in medicine. He is additionally Head of Department of Clinical and Experimental Medicine which brings together the CTU, CRF and Surrey Sleep Research Centre (SSRC) with complementary sections comprising Research Design Service - South East (RDS-SE; Surrey), Surrey Health Economics Centre (SHEC), Clinical Medicine and Statistical Multi-Omics. The department is dedicated to academic excellence in education and the delivery of clinical research in health and disease.
Suzanne is a research fellow on the TRADIP project.
She originally trained as a barrister in the Netherlands, before moving to the UK in 2008 where she worked as a fundraiser in the arts sector for several years. She decided to retrain as a psychologist, completing both her BSc and her MSc (in Health Psychology) at the University of Surrey.
Since graduating in 2018 Suzanne has worked on several qualitative research projects, both within the academic world (including University of Surrey and Coventry University) and outside the academic world (Black Southwest Network, Bristol).
Most recently, Suzanne worked with Dr Nicola Carey and Dr Karen Stenner on a literature review on non-medical prescribing by optometrists.
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.
Sarah's 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.
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.
Yogini’s expertise and research interests include – patient safety, medication errors in paediatrics and care homes, health information technology evaluation and inter-professional education.
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.
Kate Bennett works as a Medical Statistician at the Surrey Clinical Trials Unit and Surrey Research Design Service.
Non-medical prescribing toolkit event
Our first NMP toolkit event was held on 29 April.
Research information sheets
Participant information sheets will be available here when we begin our data collection.
- Dietitian Participant Participant Information Sheet (PDF)
- Dietitian Therapeutic Radiographer Manager Participant Information Sheet (PDF)
- Therapeutic Radiographer Participant Information Sheet (PDF)
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 on here.
Research team articles
Jarmain Sally and Carey Nicola (2020) Exploring the roles and responsibilities of Non-Medical Prescribing leads in the South West of England Journal of Prescribing Practice.
Edwards Judith, Coward Melaine and Carey Nicola (2020) Paramedic independent prescribing in primary care – seven steps to success Journal of Prescribing Practice.
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