Evaluation of supplementary prescribing by dietitians and independent prescribing by radiographers

Start date

February 2019

End date

March 2024


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:

Phase 1:

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.

Phase 2:

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.  

Phase 3:

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.

Phase 4:

Will be the development of a model of implementation and an online tool-kit.


Phase 1:

  • We’ve completed the literature review and this is being prepared for publication.

Phase 2:

  • We’ve completed data collection for this phase and are now analysing the data.
  • We carried out 55 interviews with radiotherapy and dietetic service managers in England in our first round of interviews.
  • We then spoke to 12 managers 12-18 months after their first interview, to see if anything had changed in their service. 
  • We received 103 completed surveys from dietitian and therapeutic radiographer prescribers in our first survey, and 34 of these completed our follow-up survey 12-18 months later.

Phase 3:

  • We have completed data collection at all our case sites, 3 dietetics services and 4 radiotherapy services across England took part.
  • We interviewed 32 staff members and 27 patients, and received 180 patient questionnaires.
  • We also gathered information about prescriber and non-prescriber working practices, by collecting 513 self-reports from practitioners, and are assessing the safety of prescribing decisions.

Phase 4:

  • Our prescribing toolkits are now hosted on the NHS Learning Hub (  The catalogue is accessible to researchers and healthcare workers and includes the preparing to prescribe toolkit. More resources will be added as they are 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


Co-applicants and research team

Dr Saeideh Babashahi

Research Fellow

Kate Bennet

Medical Statistician

Bill Davidson

Patient and Public Voice Expert Adviser

Judith Edwards

Postgraduate research student

Sarah Griffiths

Macmillan Consultant Radiographer- University Hospitals Bristol NHS Foundation Trust

Kathryn Hart profile image

Dr Kath Hart

Senior Lecturer in Nutrition and Dietetics

Dr Natalia Ivashikina

Senior Lecturer in Global Health Economics - University of Sussex

Dr Yogini Jani

Health Foundation Improvement Science Fellow, Consultant Pharmacist for Medication Safety, Director of the UCLH Centre for Medicines Optimisation Research and Education - University College London Hospitals NHS Foundation Trust

Karen Shaw profile image

Dr Karen Shaw

Project Manager

Sam Sherrington

NHS Trafford CCG/Independent Consultant

Simon Skene profile image

Professor Simon Skene

Professor of Medical Statistics

Karen Stenner profile image

Dr Karen Stenner

Lecturer in Health Services Research


Stay connected


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The TRaDiP study is still recruiting dietetic and radiotherapy case sites in England, please get in touch if you th…
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Thanks to everyone who has completed our follow-up prescriber survey. We've had a great response so far. If you'v…
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🔎We're looking for two case sites in England - NHS dietetics service with a supplementary prescriber Dietitian - NH…


Patient prescribing leaflets

We’ve created a who’s who guide to prescribing to inform patients and carers about which healthcare professions could prescribe medicine.  This was developed with healthcare professionals, patients and carers and is also available as part of the toolkit on the NHS e-learning hub.

Research information sheets

Participant information sheets for the study are available here.

Manager interviews and prescriber surveys:

Case sites:

Research dissemination

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.

We presented some of our preliminary findings at the Health Services Research Conference in Sheffield in July 2022.  Links to our presentations are below:

Research team articles

Judith Edwards, Melaine Coward, Nicola Carey (2022) Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review BMJ Open

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.

Nicola Carey, Judith Edwards, Simon Otter, Heather Gage, Peter Williams, Molly Courtenay, Ann Moore, Karen Stenner (2020)A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists, BMC Health Services Research

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 themes

Find out more about our research at Surrey:

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