Consultation proposes wider prescribing powers for physiotherapists

The government has launched a consultation on proposals that would allow physiotherapist independent prescribers to prescribe a broader range of controlled drugs, as part of a wider plan to ease pressure on NHS services and improve access to medicines.

The consultation covers four professional groups: paramedics, physiotherapists, operating department practitioners and diagnostic radiographers.

For physiotherapists, the suggested changes would extend the current list of seven controlled drugs they are legally allowed to prescribe (temazepam, lorazepam, diazepam, dihydrocodeine tartrate, morphine sulfate, fentanyl and oxycodone hydrochloride), adding four further medicines commonly used in pain management:

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• codeine phosphate;
• tramadol hydrochloride;
• pregabalin;
• and gabapentin.

Physiotherapists were previously able to prescribe tramadol, gabapentin and pregabalin, but lost this authority when tramadol was reclassified as a Schedule 3 controlled drug in 2014, and pregabalin and gabapentin were added to Schedule 3 in 2019.

The Department of Health and Social Care (DHSC) believes these restrictions have contributed to treatment delays, fragmented care and unnecessary demand on GPs and other prescribers.

With physiotherapists working in multidisciplinary primary care settings, including GP practices, alongside clinical pharmacists, the proposals aim to support more efficient service delivery and reduce the need for patients to attend additional appointments to access prescribed pain relief.

According to the consultation, the changes would also ‘make best use of physiotherapist independent prescribers' clinical expertise’ and enhance job satisfaction by enabling professionals to work more effectively within their full scope of practice.

The broader consultation also proposes extending the list of medicines that paramedics can administer in emergency situations, enabling operating department practitioners to supply and administer medicines using patient group directions, and permitting diagnostic radiographers to train as independent prescribers.

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Any changes would require amendments to the Human Medicines Regulations 2012 and the Misuse of Drugs Regulations across all four UK nations. The consultation applies across England, Wales, Scotland and Northern Ireland.

The consultation comes as all newly registered pharmacists will qualify as independent prescribers from 2026.

In August 2023, the government launched a pathfinder project to test different models of pharmacist independent prescribing, backed by £12m funding.

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A year later, NHS England announced it was rolling out a national clinical system that would allow community pharmacists to generate prescriptions via the NHS Electronic Prescription Service (EPS) and enable pathfinder sites to 'start delivering their clinical services'.

In May this year, NHS England revealed that community pharmacist prescribing pathfinders had delivered more than 17,000 consultations.