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It is essential that the therapy radiographer recognizes when to refer the patient on to the doctor, so they need to differentiate between tumour- and treatment-related signs and symptoms. It is not known how widespread the use of PGDs is within the therapy community, but an unpublished national survey of radiotherapy service managers indicated that radiographers were involved in the administration of medicines using PGDs. In accordance with national advice, the survey revealed that more than half of them had been trained in-house while the remainder had attended a university-based post-registration programme. The care of patients in pre-treatment (for example contrast-based X-ray examinations) also offers scope for the use of PGDs similar to those for diagnostic radiographers, but again it is not known how widespread this is. The philosophy of supplementary prescribing is well suited to the management of therapy patients. Cancer is a chronic condition and it is highly feasible to set up a CMP between the independent prescriber and supplementary prescriber (therapy radiographer).

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Meanwhile, in for the Department of Health recommended two types of prescriber: the independent prescriber who would be responsible for assessment of patients with undiagnosed conditions and for decisions about clinical management required, including prescription; the dependent prescriber who would be responsible for the continuing care of patients already assessed by the independent prescriber, which may include prescribing. Over the next few years, following the Health and Social Care Act prescribing by nurses and pharmacists was introduced. After much consultation with the medical, pharmacy and nursing professions and the Department of Health and the Medicines Control Agency as well as meetings of the Committee on Safety of Medicines and the Medicines Commission, amendments were made to the legislation to allow nurses and pharmacists to become supplementary prescribers as from April A similar process occurred with the podiatry, physiotherapy and radiography professions and led to changes to the NHS Regulations in April prescribing to these professions. Extended formulary nurse prescribing was discontinued in nurse independent prescribing.

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Unless already covered by exemptions to the Medicines Act, there are two ways of achieving this: by PGD or by patient specific directions. In essence, a PGD allows a range of specified health care professionals, including podiatrists, to supply andor administer a medicine directly to a patient with an identified clinical condition without them necessarily seeing a medical prescriber.

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This could provide timely and appropriate access to treatment for chronic disease management. A community physiotherapist treating a patient in a remote location who is not responding well to medicines prescribed by a consultant could, under a CMP, alter dosages for that patients benefit.

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