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Medicine entitlements

Laws control the sale, supply, administration and prescribing of medicines

The Medicines and Healthcare Products Regulatory Agency (MHRA) is responsible for regulating medicines, medical devices and blood components for transfusion in the UK.

Registrants must follow the law relevant to their practice, including keeping within the medicines entitlements for their profession.

Check the medicines entitlements of our registered professions

Sale, supply and administration

Local arrangements can be made to allow health and care professionals who are not prescribers to supply or administer medicines. 

The different methods or “mechanisms” that enable this are:

  • Patient specific directions (PSDs)
  • Patient group directions (PGDs)
  • Legal exemptions

These mechanisms are not the same as prescribing.

Registrants must have the proper skills, knowledge and experience before acting under any mechanism and should follow policies set by their employer.

PSDs and PGDs

  • What is a PSD?

    A PSD is a written and signed instruction, given by a a doctor, dentist, or non-medical prescriber to another professional to supply and/or administer medicine(s) to a named person. The person must have been individually assessed by the prescriber.

    This instruction may be written in a service user's notes or, in a hospital, on their medicine chart. A PSD can be for a list of named service users who have been individually assessed. A PSD for supply of medicines is a prescription form.

    Who can supply or administer medicines under a PSD?

    There are no legal restrictions around who can supply or administer medicines following a PSD.

    Read the NHS Specialist Pharmacy Service Questions and Answers about PSDs for more information.

  • What is a PGD?

    A PGD is a written instruction for the supply and/or administration of medicines to certain groups of patients, by certain named health professionals.

    PGDs can be useful in routine care pathways such as immunisation programmes.

    A PGD must be authorised by a clinical commissioning group (CCG), local authority, NHS trust or foundation trust, NHS England or Public Health England.

    Who can supply or administer medicines under a PGD?

    Which professions can administer medicines under a PGD is set out in law. Check the medicines entitlements of our registered professions.

    Read NICE guidance for developing, authorising, using and updating PGDs

  • All of our registered professions can administer under a PSD if they have the skills, knowledge and experience to do so. Only some of our professions can administer under a PGD.

    We do not annotate our Register to show that a registrant can supply or administer medicines under a PSD or PGD.

    Some registrants will gain the skills, knowledge and experience to supply and / or administer medicines through their pre-registration education and training. This will be reflected in the standards of proficiency for that profession. 

    Registrants that are not trained in the supply and / or administration of medicines when they register with us must gain the relevant skills, knowledge and experience through continued professional development.

     

‘Exemptions’ are exceptions to the general rules on selling, supplying and/or administering medicines for some groups of healthcare professionals.

Click on the tabs to read about exemptions for the professions we regulate.

A chiropodist / podiatrist may sell, supply and administer certain medicines in the course of their professional practice. 

To do so, they must have successfully completed approved education and training in these areas and have the relevant annotation(s) (marks) on our Register.

Medicines

A list of medicines included in this exemption is available on the MHRA website.

Annotations

  • Prescription only medicines – administration (POM-A)

Allows registrants to administer certain prescription only medicines (POMs). They cannot mix medicines and must use pre-combined preparations if required.

  • Prescription only medicines – sale / supply (POM-S)

Allows registrants to sell and supply certain POMs, pharmacy (P) medicines and all General Sale List (GSL) medicines.

Read our FAQs to understand POMs, P and GSL medicines.

These annotations were renamed in 2016 and were previously called 'local anaesthetics' and 'prescription only medicines'. You can read more about this in our FAQs.

 

An orthoptist may sell and supply certain medicines in the course of their professional practice.

They must have successfully completed approved education and training in this area and have an annotation (mark) on our Register

Medicines

Trained and annotated orthoptists may sell all pharmacy (P) medicines, all General Sale List (GSL) and the following prescription only medicines (POMs) in the form of eye drops and ointments for topical use:

  • Atropine,
  • Cyclopentolate,
  • Tropicamide,
  • Lidocaine with fluorescein,
  • Oxybuprocaine,
  • Proxymetacaine,
  • Tetracaine,
  • Chloramphenicol,
  • Fusidic acid

Read our FAQs to understand POMs, P and GSL medicines.

Annotation

  • Prescription only medicines – sale / supply (POM-S)

Standards

Orthoptists with this training must abide by our Standards for orthoptists using exemptions in legislation for the sale and supply of medicines.

A paramedic may administer certain medicines by injection on their own initiative for the immediate, necessary treatment of sick or injured people.

All paramedics are trained to adminsiter medicines under this exemption.

Medicines

A list of medicines included in this exemption is available on the MHRA website.

Annotation

We do not annotate our Register in relation to this exemption. 

Guidance

Practice Guidance for Paramedics for the Administration of Medicines under Exemptions from the College of Paramedics >

 

Some medicines can be injected by anyone to save a life

Prescribing

To be a prescriber means to have the legal authority to issue prescriptions. In practice, prescribing is a complex clinical skill.  

Only some of our registered professions can train to become prescribers.

Members of these professions must have successfully completed an approved education and training programme in prescribing and have an annotation (mark) on their record on the Register to prescribe.

There are two different types of prescribing available to allied health professionals.

Prescribing

  • What is independent prescribing?

    Independent prescribing is prescribing by a practitioner, who is responsible and accountable for the assessment of service users with undiagnosed or diagnosed conditions and for decisions about the clinical management required.

    An independent prescriber is able to prescribe on their own initiative any medicine within their scope of practice and relevant legislation.

    Who can become and independent prescriber?

    Check the medicines entitlements of our registered professions.

    Annotation

    • Independent prescribing (IP)

    Controlled drugs

    Independent prescribers cannot prescribe controlled drugs unless extra laws have been passed which allow their profession to do so.

    Independent chiropodist / podiatrist and physiotherapist prescribers may prescribe from a limited list of controlled drugs. 

    Prescribers must understand the legal framework that applies to their profession. See our FAQs for more information.

  • What is supplementary prescribing?

    Supplementary prescribing is a voluntary partnership between a doctor or dentist and a supplementary prescriber to prescribe within an agreed service user-specific clinical management plan (CMP).

    Once qualified a supplementary prescriber may prescribe any medicine within their clinical competence, within the limits of the CMP.

    Who can become a supplementary prescriber?

    Check the medicines entitlements of our registered professions.

    Annotation

    • Supplementary prescribing (SP)

    What is a Clinical Management Plan?

    A CMP is a written plan agreed between a doctor or dentist and a supplementary prescriber for the treatment of a named service user, with the knowledge and agreement of the service user and/or carer. The plan outlines the illnesses or conditions that may be treated by the supplementary prescriber, the types of medicines they may prescribe any limits to the strength or dose of medicines that they may prescribe.

    Controlled drugs

    Supplementary prescribers can prescribe controlled drugs only in accordance with a service user’s clinical management plan.

Regsitrants must keep within their scope of practice by only practising in the areas they have appropriate knowledge, skills and experience for

Frequently asked questions

  • Key pieces of legislation include:

     

    ·         The Medicines Act 1968

    ·         Misuse of Drugs Regulations 2001

    ·         The Human Medicines Regulations 2012

     

    Changes to medicines and prescribing law follow decisions by the Department of Health, Parliament and the devolved administrations.

  • Type of medicine Restrictions

    Prescription-only medicines

    (POMs)

    Can only be sold or supplied with a prescriotion from an appropriate practitioner (a doctor, dentist, or other independent or supplementary prescriber).

    Controlled drugs

    (CDs)

    Some prescription only medicines are subject to additional legal controls because they carry a higher risk of being misused or causing harm. These are referred to as ‘controlled drugs’ (CDs) and include medicines such as morphine, benzodiazepines and methadone.

     

    Independent prescribers cannot prescribe CDs unless extra laws have been passed which allow their profession to do so.

     

    You can find a list of CDs commonly encountered in practice o n the Home Office website.

    Pharmacy medicines

    (P medicines)

    Can only be sold or supplied at registered pharmacies, under the supervision of a pharmacist.

    These medicines are typically kept behind the pharmacy counter. Examples include eye drops and emergency contraception.

    Some professions can sell or supply P medicines under exemptions.

    General sale list medicines

    (GSL medicines)

    Can be sold at a wider range of outlets, such as supermarkets, provided the premises are lockable and the medicines are pre-packed. Examples include cold and flu or hay fever medicines.

    Some professions can sell or supply general list medicines under exemptions.

  • The professions that can sell, supply, administer or prescribe medicines is set out in law. The law needs to change for new professions to access new medicines mechanisms.

    NHS England is working with professional bodies on behalf of the four countries of the UK to consider the supply, administration and prescribing of medicines by new professions. We support and assist NHS England in this process where possible.

    A number of steps must occur before a proposal leads to a change in the law:

    • A public consultation must be held
    • The Commission on Human Medicines (CHM) must recommend the change to Ministers
    • Ministers must decide to change the law
    • Changes to the law must be passed in Parliament
    • Changes must be made to NHS regulations in England, Scotland, Wales and Northern Ireland to give effect to the change in the law

    If proposals include controlled drugs, further steps must occu:

    • The Advisory Council for the Misuse of Drugs (ACMD) must recommend the change to the Home Office Ministers
    • Ministers must decide to change the law relating to controlled drugs in England, Scotland and Wales
    • Northern Irish legislation needs to be amended separately by the Department of Health in Northern Ireland.

    If you would like to lobby for changes to medicines and prescribing law, contact your professional body to support and develop the case of need for your profession.

    Find out more about NHS England's work on their website.

     

  • Independent prescribing

    Independent prescribers cannot prescribe controlled drugs unless extra laws have been passed which allow their profession to do so. 

    In England, Scotland and Wales, chiropodist / podiatrist and physiotherapist independent prescribers may prescribe from a limited list of controlled drugs for the treatment of organic disease or injury.

    The controlled drug must be prescribed to be administered by the specified method.

    The law in Northern Ireland has not yet been changed to allow this.

     Chiropodist / podiatrist

    • Diazepam by oral administration
    • Dihydrocodeine by oral administration
    • Lorazepam by oral administration
    • Temazepam by oral administration

    Physiotherapist

    • Diazepam by oral administration
    • Dihydrocodeine by oral administration
    • Fentanyl by transdermal administration
    • Lorazepam by oral administration
    • Morphine by oral administration or by injection
    • Oxycodone by oral administration
    • Temazepam by oral administration

    Supplementary prescribing

    Supplementary prescribers can prescribe controlled drugs, but only in accordance with a service user’s clinical management plan.

    Read the Home Office list of commonly encountered controlled drugs >

  • Registrants who are independent prescribers cannot prescribe unlicensed medicines. Only doctors, dentists, nurses and pharmacists are able to independently prescribe unlicensed medicines.

    Registrants who are supplementary prescribers can prescribe unlicensed medicines, but only in accordance with the patient's clinical management plan.  

     

  • The Royal Pharmaceutical Society (RPS) published a Competency Framework for all Prescribers in July 2016. It is an excellent resource for any prescriber regardless of their professional background. 

    NICE Medicines and prescribing centre provides a comprehensive suite of guidance, advice and support for delivering quality, safety and efficiency in the use of medicines. 

    The professional bodies of our prescribing professions also publish practice guidance, including:

    • The British Dietetic Association, here
    • The College of Paramedics, here
    • The Chartered Society of Physiotherapists, here
    • The College of Podiatry, here
    • The Society of Radiographers, here
Page updated on: 20/06/2018
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