Allied Health Professionals and their developing roles
It's the start of a new beginning for me, developing the Allied Health Professions (AHPs) work stream in NHS LPP Medicines Optimisation and Pharmacy Procurement. AHPs is the collective name for various therapists (e.g. speech & language, physio, podiatry) that make up the 14 AHPs. I've learnt a lot about the contribution that these talented Health and Care Professionals (HCPs) can make in providing an array of interventions that often includes... not prescribing. This may be simply being more cautious with initiation of specific items or products (or considering deprescribing) where alternative therapies are available. Social prescribing is also a key adjunct to therapies. This is important for two reasons:
1) Patients appreciate the holistic approach with expert coaching to improve specific health concerns and goals, and if needed, the option of a prescription.
2) As the medicines bill gets bigger year on year, we need better alternatives to 'a pill for every ill' and to offer a range of treatments that better support self-care when possible.
AHPs counsel on their different therapeutic interventions, and the risks/benefits of each option, including potentially prescribing in an area they are a specialist in. The new GP contract, with additional roles for diverse AHPs, is a fantastic opportunity for patients to access these therapies easily. This also has the potential of taking the strain off our oversubscribed GPs, A&Es and hospitals.
What challenges await? Establishing where AHPs can add the most value and make the biggest difference will be interesting. Delivering a range of services via more AHPs in Primary Care Networks (PCNs) might need a shift to part-time working (or split posts), rotations, and flexibility in employment. Training of other HCPs in what we do and some degree of cross cover for other HCPs may also be required. Long arm (rather than direct) or multi-professional supervision to provide appropriate career development will be a must. For many AHPs working in more traditional settings this would be a significant shift, but one that can provide joy in work and increase our retention of valued staff. Deciding which further qualifications add the most value to patient care and career satisfaction is evolving. Understanding the different therapeutic areas that AHPs can offer (musculoskeletal is the obvious example) and then what qualifications are essential or desirable (First Contact Practitioners, Non-Medical Prescribers, Advanced Practice) will take time.
Here at the NHS London Procurement Partnership (NHS LPP), we will be looking at prescribing data and if and how medicines usage is affected by increased access to AHP therapists, both through their own prescribing and their wider effect on condition management. I have been developing our broader strategy around understanding this emerging area of practice, and how we can support the prescribing of medicines and borderline substances by AHPs. What will this look like? The main focus will be education and support, monitoring prescribing trends and any changes in wider practice, as well as continuing to promote the principles of Medicines Optimisation and the Medicines Value Programme.
Seeing how this is implemented and what innovative services are delivered is exciting. We know there is the potential to increase the quality of care for patients and improve prescribing practice in areas that AHPs excel in. Simultaneously, there may also be the potential to improve career opportunities for the AHP workforce.
We don't yet know, what exactly is possible. But it's going to be exciting!
Rebecca Fisher is AHP Prescribing Advisor for NHS LPP and is Education Lead for the Optimising Nutrition Prescribing Group of the BDA.Rebecca also works in dietetic clinical practice at the Royal Free eating disorders service. Research interests include intuitive eating and the mental health effects of restrictive diets.
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