Allied Health Professionals: Prescribing Responsibilities

Lord Markham Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Bradley (Lab)]

I beg leave to ask the Question in my name on the Order Paper and declare my interests as listed in the register.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

In September 2023, we completed two consultations to amend the Human Medicines Regulations to enable dental therapists, dental hygienists and pharmacy technicians to supply and administer medicines without the need for a prescription. We aim to publish the consultation response in the next few weeks. In December 2023, the Misuse of Drugs Regulations 2001 were amended to enable independent prescriber paramedics and therapeutic radiographers to prescribe certain controlled drugs.

[Lord Bradley (Lab)]

I thank the Minister for that response, but primary and community health services, particularly general practice, are under great work- force pressure and waiting times for patients are unacceptably long. Although the plan to extend pharmacy prescribing is welcome, an important next step must be to extend appropriate independent prescribing and referral rights to a wide range of allied health professionals, including speech and language therapists, occupational therapists, diagnostic radiographers and many more similar professions.

As the Minister will know, the Lords Integration of Primary and Community Care Committee’s recent report supported this, and there was previously an unpublished NHS scoping report. Will the Minister now publish that report and act on the Lords committee’s recommendations to quickly implement the benefits for speedy and integrated patient care?

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[Lord Markham (Con)]

I thank the noble Lord for his question and absolutely agree with the direction of travel. We are keen that every clinician should work at the top of their profession, and to bring in people with allied skills who can supplement that and prescribe as well. We need to be careful, because there is obviously a danger of overprescribing. But in general, we totally agree and want to extend this as far as possible.

[Lord Butler of Brockwell (CB)]

My Lords, I congratulate the Government on fulfilling their promise, made in reply to a Question for Short Debate in this House, to extend prescribing rights to paramedics by the end of last year. However, that was no fewer than four years after the extension had been approved by the Advisory Council on the Misuse of Drugs. Why did it take so long? Will the Minister undertake that future properly approved extensions will be implemented more quickly?

[Lord Markham (Con)]

Yes, because the noble Lord is correct: it should not take so long. We all agree with the approach. So noble Lords understand, there is a two-step process. First, the body to which we are trying to extend this needs to be agreed by a review of the Commission on Human Medicines; then, the Advisory Council on the Misuse of Drugs need to take a look at it. We are all aware of the dangers of anti-microbial resistance, which is why we need to be careful about things such as antibiotic prescribing. But in general, we want to do this as fast as possible.

[Lord Grade of Yarmouth (Non-Afl)]

My Lords, I am sure that most people will welcome the extension of prescribing facilities to pharmacies. Does the Minister understand that the rate of closure of independent pharmacies in the UK—these vital community facilities —is absolutely accelerating? Will he undertake to look at the rate of closure and understand why these small, independent businesses, which are the pillars of communities, are closing at such a rate? They are just financially unsustainable.

[Lord Markham (Con)]

I agree with my noble friend that not only are they the pillar of communities, but they are the front line in a lot of health services. This is about trying to put more business and activity their way to increase their viability, both in terms of paying for treatments such as these and increasing footfall generally. I completely agree with my noble friend that we want as many of these small businesses thriving in their own right, but also as a vital part of the health ecosystem.

[Lord Allan of Hallam (LD)]

My Lords, increasing the range of health professionals who can prescribe is welcome, but does the Minister agree that this makes it even more important that people are able to see their entire medical record in one place, as the Times Health Commission has proposed? What does the Minister make of that proposal, and what are the Government doing to ensure that, wherever you get a prescription, that record is located in one central point?

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[Lord Markham (Con)]

It will not surprise noble Lords to know that I am totally in favour of the digital project and having this information available in one source. With Pharmacy First, in a matter of a few months we will have a system whereby everything it does will automatically update the GP records. That is important because once we have done it for pharmacies, we can do it for all other groups. We are absolutely moving in that direction.

[Baroness Whitaker (Lab)]

My Lords, to return to speech therapy, the Minister will be aware that the Royal College of Speech and Language Therapists wrote to the Secretary of State last November highlighting how independent prescribing responsibilities would help, for instance, patients with quite potent cases of head and neck cancer. Can the Minister be a little more specific and give a timeline for when speech and language therapists will be able to undertake independent prescribing training, so that these people can really have some help?

[Lord Markham (Con)]

I will need to get back to the noble Baroness on the precise timeline. We have an SI debate taking place shortly on physician associates, and a key step is that first, you have to be part of a legally regulated body. Once you are, the formal reviews can take place, along with the training. I will write giving the details, but we are keen to allow speech therapists and others to prescribe as well.

[Baroness Browning (Con)]

My Lords, people on the autistic spectrum who need prescribed drugs for their condition and associated reasons have to have a psychiatrist prescribe them because psychologists cannot do so. I am not for one minute suggesting that all psychologists should be allowed to prescribe, because they are quite a range of people. However, in parts of the country where there is no psychiatrist—I speak from personal experience—who can prescribe to autistic patients, can we see whether certain psychologists with a knowledge of autism could be trained to fill that gap?

[Lord Markham (Con)]

Yes, I will happily undertake to do that. There are a couple of mechanisms we can use. We can give them an independent prescribing ability, or we can give patient group directions on a certain number of items. That is what we are doing with Pharmacy First, for instance, in respect of the seven conditions. Clearly, we could look at doing that with the relevant autism drugs.

[Baroness Meacher (CB)]

My Lords, the steps so far taken by the Government to delegate prescribing to pharmacists seem pretty sensible. However, can the Minister assure the House that, bearing in mind that correct prescribing requires correct diagnosis, the Government will be extremely reluctant to delegate out the roles of doctors to healthcare professionals who do not have the benefit of a doctor’s training?

[Lord Markham (Con)]

I suspect that we are starting to get on to the debate we will have shortly on physician and anaesthetist associates. In both cases there is definitely a role for them, because we want to support doctors in the surgery and allow them to train and teach at the top of their profession. Clearly, however, we need to be sure of what such people can do and where they need extra supervision, and that is what we are setting out.

[Baroness Merron (Lab)]

My Lords, further to the Minister’s reply to my noble friend Lord Bradley, what is the Government’s plan to increase and integrate the number of independent prescribers being trained as part of the long-term workforce plan? Given that community pharmacists are already trained to vaccinate against Covid-19 and flu, will the Government be expanding the service to include the delivery of MMR jabs, in order to help address recent measles outbreaks?

[Lord Markham (Con)]

First, on the long-term workforce plan, yes, we want to increase the number of allied health professionals by 25% by 2030. We see a lot of that group—some 20%—coming through via apprenticeships. It has been proven just how well pharmacies managed to supplement MMR vaccinations in the Covid and flu space, so it is a good idea. I will need to take that idea back to the department, rather than agreeing to it on the hoof, but I will come back on it because it is an excellent one.

[Baroness Hoey (Non-Afl)]

My Lords, the Minister will know that the Health and Care Professions Council has suggested three times that sports therapists should be statutorily regulated and could also take part in prescribing. Can the Minister say when this might be likely to get legal agreement?

[Lord Markham (Con)]

I apologise: I am not quite sure what kind of therapists the noble Baroness is referring to.

[Baroness Hoey (Non-Afl)]

Sports.

[Lord Markham (Con)]

Yes, this very much applies to sports, and it goes to the whole social prescribing space and the role of physios. I know that physios are listed in the 15 professional groups we are looking to expand this out to. I will provide the details on the exact timing.