Medicines Management

For a list of frequently asked questions and answers about the use of medicines in clinical imaging and radiotherapy, please view the: Medicines FAQs

The Allied Health Professions (AHP) Medicines project

This ongoing project was set up to consider extension to supply, administration and prescribing responsibilities for AHPs and to date the following has been achieved:

1. Independent prescribing by therapeutic radiographers

2. Supplementary prescribing by dietitians
3. Use of exemptions by orthoptists.

These are in addition to the previous existing AHP medicines mechanisms;

1. Independent prescribing by physiotherapists and podiatrists
2. Supplementary prescribing by diagnostic and therapeutic radiographers

Still to be achieved:
Independent prescribing for diagnostic radiographers

In 2021, NHSE and SoR presented the case to the Commission on Human Medicines to recommend that diagnostic radiographers be included in the Human Medicines Regulations as independent prescribers. The Commission supported the proposal to permit advanced practitioner diagnostic radiographers to independently prescribe to patients.  This was formally reported in the summary minutes published in August 2022. As of August 2024, we are still waiting to hear about the next steps.

For the latest update on ongoing research into the effectiveness of therapeutic radiographer independent prescribing, please see the information here, including a newsletter of latest activity.

Prescribing Now Campaign #PrescribingNow

In 2021, the Society of Radiographers joined the Royal College of Speech and Language Therapists, the British Dietetic Association, the Royal College of Occupational Therapists, and the British and Irish Orthoptic Society, calling on the UK Government to extend independent prescribing responsibilities to our professions.

Extending these responsibilities to us where it is safe and appropriate to do so within the scope of our professional practice will: 

• deliver better and more timely patient care 
• reduce pressure on other healthcare professionals, including GPs 
• support our professional development as healthcare professionals 

The #PrescribingNow campaign builds on our collective influencing work during the passage of the Medicines and Medical Devices Act (2021). It is supported by the British Association of Prosthetists and Orthotists as prosthetists and orthotists will be seeking independent prescribing responsibilities in the future. 

As part of the campaign, we are: 

• Writing to the Secretary of State for Health and Social Care 
• Writing to all MPs and members of the House of Lords 
• Providing the facility for individual AHPs and others to email their MPs 

More information, including how you can support the campaign, is accessible on the dedicated #PrescribingNow webpage. 

Update from the Prescribing Now coalition | August 2024

Supply, administration and prescribing of medicines by radiographers

Medicines include contrast agents as well as medicines that might be given before, during or after a diagnostic imaging procedure or during the treatment period for radiotherapy patients.

The law currently states that radiographers are allowed to supply and/or administer medicines using patient specific directions (PSDs) or patient group directions (PGDs). Both diagnostic and therapeutic radiographers can train to become supplementary prescribers and therapeutic radiographers can train to become independent prescribers.

Patient specific directions

A Patient Specific Direction (PSD) is the traditional written instruction, signed by a doctor, dentist, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.

Further information about the use of patient-specific directions in healthcare settings and a list of FAQs on this issue have been published.

Patient group directions

Patient group directions (PGDs) are written instructions for supplyingor administeringmedicines to patients, usually in planned circumstances. They require a significant amount of time and resources to develop and implement.

Radiographers can only supply and/or administer medicines under PGDs if doing so benefits the patient without compromising their safety.

PGDs should be developed by a multidisciplinary group that includes a doctor, a pharmacist, and a representative of the professional group expected to supply the medicines under the PGD. It’s good practice to involve local drug and therapeutics committees, area prescribing committees, and similar advisory bodies. Radiographers are among the health care professionals legally entitled to use PGDs.

Current information and resources should be reviewed before developing new or updating old PGDs. In 2018, SPS, NHS England, the Royal College of Radiologists (RCR), and the Society and College of Radiographers (SCoR) created a suite of PGD templates with the support of radiography experts working within NHS clinical practice. The templates have twice been updated for use in radiology services in NHS England commissioned services and are recommended by the SOR as reflecting best practice. The templates can be downloaded and adapted for local use from the 'Radiology'  section of the Specialist Pharmacy Services website.

• Sodium chloride 0.9% in multi injector devices
• Ioversol (e.g. Optiray®) contrast agent
• Gadoxetate disodium (Primovist®) contrast agent
• Gadoteridol (ProHance®) contrast agent
• Gadobenate dimeglumine (MultiHance®) contrast agent
• Gadoteric acid meglumine contrast agent
• Gadobutrol (Gadovist®) contrast agent
• Iodixanol (e.g. Visipaque®) contrast agent
• Iohexol (e.g. Omnipaque®) contrast agent
• Iopamidol (e.g. Niopam®) contrast agent
• Iomeprol (e.g. Iomeron®) contrast agent

A statement on the continued use of PGDs for contrast agents (updated in 2018).

E-learning for those required to develop and/or use PGDs

Supplementary prescribing

Supplementary prescribing is defined as a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient-specific clinical management plan (CMP) with the patient's agreement. Diagnostic and therapeutic radiographers can be supplementary prescribers.

Independent prescribing

Independent prescribers are responsible and accountable for assessing patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing. They assume full accountability for the prescribing decisions they make. They may instruct another person to administer the medicines under the terms of a PSD. An independent prescriber may be a medical prescriber (doctor/dentist only) or a non-medical independent prescriber (nurse, pharmacist, optometrist, physiotherapist, podiatrist or therapeutic radiographer). 

Therapeutic radiographers who are independent prescribers may prescribe controlled drugs. Legislation changed in 2023 to permit prescribing from a list of controlled drugs as follows:

• Tramadol by oral administration;
• Lorazepam by oral administration;
• Diazepam by oral administration;
• Morphine by oral administration or by injection;
• Oxycodone by oral administration; and
• Codeine by oral administration.

The Misuse of Drugs Regulations 2023 amendment implements the necessary changes to controlled drug legislation to achieve the policy intent, in accordance with the ACMD’s advice for therapeutic radiographer independent prescribers.

For a searchable list of HCPC approved supplementary and independent prescribing courses (including conversion courses) please check the HCPC website.

Curricular and practice guidance

Radiographers who are registered with the Health and Care Professions Council (HCPC) and have undergone and passed a validated course of education and training in either supplementary or independent prescribing are eligible to have their HCPC entry annotated to describe their status as a supplementary and/or independent prescriber. The HCPC sets Standards of Practice for Prescribers.

SoR|CoR provides practice guidance for radiographer prescribers: Practice Guidance for Radiographer Independent and/or Supplementary Prescribers (2nd Edition) on the policy and guidance document library

To qualify as a supplementary or independent  prescriber, radiographers have to successfully complete a course approved by HCPC, see the standards for education providers seeking HCPC programme approval and also The Outline Curriculum Framework for Education Programmes to Prepare Physiotherapists, Podiatrists and Therapeutic Radiographers as Independent/Supplementary Prescribers and to Prepare Dietitians and Diagnostic Radiographers as Supplementary Prescribers.

The Competency Framework for all Prescribers

This document defines the skills and knowledge for all prescribers including nurses, allied health professionals and doctors. Hazel Boyce is an advanced therapeutic radiographer and supplementary prescriber at Bristol Cancer Institute, working mainly in On Treatment Review. Hazel worked on the recent review and update of the 'Prescribing Competency Framework'.

Clinical Management Plans (CMPs):

See document download box below for examples of clinical management plans. which are used in supplementary prescribing

Assistant Practitioners and IV injecting

Only certain named registered and regulated health care professionals, such as radiographers, are allowed to use patient group directions. Non-registered practitioners are not allowed BY LAW to use patient group directions and so must not administer prescription only medicines (POM). Generally IV saline IS a POM although prefilled, single use syringes specifically intended for mechanical flushing of ports and catheters are classified as medical devices under the law and, in this case, assistant practitioners and other non-registered health care staff can use them. SCoR obviously expects all members to work competently and lawfully within their scope of practice and hence would not support an illegal practice and so flushing (which is, of course, administration) would not be covered by professional indemnity insurance unless the prefilled syringes (as described above) were in use.

Central venous catheter guidance

Guidance from the Intensive Care Society on the administration of contrast media using central venous catheters. Endorsed by: Royal College of Radiologists, Society of Radiographers and College of Radiographers.

Other links and useful resources

NHS Evidence (including access to BNF) has a search facility for authoritative, evidence-based information from hundreds of trustworthy and accredited sources.

Electronic Medicines Compendium (eMC) contains up to date, easily accessible information about most of the licensed medicines available for use in the UK. Includes patient information leaflets (PILs) and Summaries of Product Characteristics (SPCs). These include SPCs for contrast media.

Medicines & Healthcare products Regulatory Agency (MHRA) provides SPCs and PILs not on eMC and information about Yellow Card.

If you have any questions feel free to view the Medicines FAQs page to see if it has already been addressed. 

Alternatively, Sue Johnson is the professional lead on the safe use of medicines for the Society and College of Radiographers and will be able to answer your questions.