School of Clinical Sciences, QUT, Brisbane, Australia.
School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
J Foot Ankle Res. 2022 May 11;15(1):35. doi: 10.1186/s13047-022-00541-8.
2022 marks a decade since the profession of podiatry secured independent prescribing rights in the UK. Widely viewed as a significant milestone, its advent appeared to herald a new age of practice, with increased autonomy, a broader scope of practice and improved patient care. Access to any medicine within the British National Formulary (with a few notable exceptions) seemed to signal an end to the perennial difficulties and frequent disappointments in obtaining ease of access to medicines necessary for effective practice.
Recent attempts to expand the scope of prescribing practice to include access to a broader range of controlled drugs (CDs) have led to unanticipated complications which may even threaten existing rights. These issues highlight the limitations of current independent prescribing and the continuing inability of podiatrists to access certain key medicines, primarily controlled drugs. Reliance on specified 'lists' of approved medicines, whether a controlled drug list for prescribers or the use of statutory exemptions by non-prescriber podiatrists, remain inflexible and difficult to change. The data underpinning much of this paper is derived from the work undertaken by the authors as representatives of podiatry on NHS England's Chief Professions' Officers' Medicines project, in particular involving submissions to the Commission on Human Medicines and the Advisory Council on the Misuse of Medicines, spanning the years 2017-2021. It describes a complex process, and highlights a misalignment between two legislative frameworks that threaten to unravel existing rights.
Ongoing difficulties relating to controlled drugs illustrate the problematic nature of current supply, administration and prescribing rights in podiatry. Efforts to keep pace with periodic legal reclassifications of medicines are constrained by limited and inflexible legal mechanisms, and formal approval for extended access via prescribing remains unpredictable and complex. For prescriber and non-prescriber (Non- prescriber podiatrists are those who are neither supplementary or independent prescribers, but do enjoy existing administration and supply rights to certain medicines.) podiatrists alike, the profession of podiatry faces a new challenge to its ability to access medicines, and to realise its full clinical potential.
2022 年标志着足病医学在英国获得独立处方权十周年。这被广泛认为是一个重要的里程碑，它的出现似乎预示着一个新时代的到来，即自主权增加、实践范围更广、患者护理得到改善。可以获得英国国家处方集（有几个明显的例外）中的任何药物，这似乎结束了长期以来在获得有效实践所需药物方面的获取便利性方面所遇到的困难和频繁的失望。
最近，扩大处方实践范围以包括获得更广泛的受控药物（CDs）的尝试带来了意想不到的并发症，甚至可能威胁到现有的权利。这些问题凸显了当前独立处方的局限性以及足病医生仍然无法获得某些关键药物（主要是受控药物）的持续能力。依赖于指定的“批准药物清单”，无论是处方医生的受控药物清单还是非处方医生的法定豁免，仍然缺乏灵活性且难以更改。本文大部分数据源自作者作为 NHS 英格兰首席专业官员药品项目的足病代表所做的工作，特别是在 2017 年至 2021 年期间向人类药品委员会和药品滥用法咨询委员会提交的材料。它描述了一个复杂的过程，并强调了两个立法框架之间的错位，这可能会破坏现有的权利。
与受控药物相关的持续困难说明了当前足病供应、管理和处方权的问题性质。努力跟上药品定期的法律重新分类受到有限和缺乏灵活性的法律机制的限制，通过处方获得扩展访问的正式批准仍然是不可预测和复杂的。对于处方医生和非处方医生（非处方医生是指既不是补充性处方医生也不是独立处方医生，但享有某些药物的现有管理和供应权利的医生）来说，足病行业面临着对其获取药物能力的新挑战，以及实现其全部临床潜力的新挑战。
