Each day over the next week I’ll post up an abstract for a paper being presented by a member of the Critical Physiotherapy Network at the In Sickness and In Health conference in Mallorca in June 2015. (You can find more information on the conference here.)
Physiotherapist non-medical prescribing: A policy of transforming community services, service integration and the primacy of orthopaedic surgery
By Nicky Wilson, Pope, C. Roberts, L. and Crouch, R.
Purpose & Background
The UK non-medical prescribing policy programme is a key component of workforce modernisation and reconfiguration, seen as essential to meet rising healthcare demands. Rights to prescribe medicines now extend to a range of healthcare professionals, including Physiotherapists, who can act as supplementary and independent prescribers. It is anticipated that this will deliver quicker access to treatments and result in improved health outcomes for patients, though there is limited research evaluating this.
In this paper we explore the enactment of non-medical prescribing by a group of physiotherapists assessing and managing patients with musculoskeletal disorders within one locality in the English NHS. The introduction of non-medical prescribing in this context occurred against a backdrop of significant service re-organization, including shifts between primary and secondary care provision (associated with wider NHS reforms). Drawing on Foucault’s conceptualization of governmentality, underpinned by interest in the relationship between professions and their work jurisdictions, we examine the microphysics of power and shifting discourses influencing and reproducing physiotherapist non-medical prescribing.
Data was collected using ethnographic methods including: observations of five non-medical prescribing physiotherapists in clinical practice, analysis of locality NHS policy and operational documents and semi-structured interviews with the participating physiotherapists and other healthcare professionals involved in the policy and practice of non-medical prescribing.
Externally imposed targets, for example an 18-week Consultant-led Referral to Treatment metric, are key rationalities shaping non-medical prescribing by these physiotherapists. Service reconfiguration has engendered a dominant discursive framework of biomedicine (within which orthopaedic surgery is given primacy) which has heavily influenced prescribing. Discursive shifts are challenging established professional practices and producing tensions in professional relationships.