College of Optometrists

Therapeutics/Prescribing

The Review of Prescribing, Supply and Administration of Medicines led by Dr June Crown and published in 1999 recommended that the legal authority to prescribe should be extended to certain non-medical groups. In July 2000 the NHS plan endorsed the Review’s recommendations. The key principles of the extension of prescribing responsibilities are:

• Patient safety is paramount
   
• Patients should benefit from faster access to care, including the medicines they need
   
• Making better use of the skills of a range of healthcare professionals

There are now several legal mechanisms by which an optometrist can prescribe, supply or administer medicines to patients:
 

• Independent Prescribing (IP)
• Supplementary Prescribing (SP)
• Medicines Act Exemptions
  • additional supply (AS)
  • entry level

Independent Prescribing, Supplementary Prescribing and Additional Supply Medicines Act exemptions, all require specialist training and registration with the General Optical Council before an optometrist can practise in these areas. Entry level Medicines Act exemptions can be practised by all registered optometrists. 

Independent Prescribing

Independent prescribers take responsibility for the clinical assessment of the patient, establishing a diagnosis and determining the clinical management required (including prescribing where necessary). Legislation to allow optometrists to train as independent prescribers came into force in June 2008.

Supplementary Prescribing

Supplementary prescribing is defined as ‘a voluntary partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient-specific clinical management plan with the patient’s agreement’. The plan sets out how much responsibility should be delegated and refers to a named patient and to the patient’s specific condition. Legislation to allow optometrists to train as supplementary prescribers came into force in June 2005.

Medicines Act Exemptions

There are exemptions granted to certain groups of health professionals from the restrictions imposed by the Medicines Act on the sale and supply of particular Prescription Only Medicines (POMs), Pharmacy (P) medicines and General sales list (GSL) medicines.

Entry Level

Exemptions from the general rules laid down in the Medicines Act are permitted for all registered optometrists. These allow optometrists to use various diagnostic drugs (including mydriatics, cycloplegics and local anaesthetics) and to use and supply specific therapeutic POMs, such as chloramphenicol and fusidic acid. Furthermore, legislation that came in to force in April 2005 also allows optometrists to sell GSL or P medicines. A recent survey of the scope of optometrist’s therapeutic practice commissioned by the College of Optometrists (Needle et al, 2008) indicated that significant numbers of practitioners were regularly managing common non sight-threatening conditions using this exemption route.

Additional Supply

Since June 2005, appropriately qualified optometrists have been able to access a further list of POM exemptions, termed ‘additional supply’. The rationale behind ‘Additional Supply’ Exemptions is to provide optometrists with access to medicines to allow them to manage a range of common non-sight threatening disorders including:

• infective conjunctivitis
• allergic conjunctivitis
• blepharitis
• dry eye
• superficial injury

These medicines can be sold or supplied by the optometrist directly to the patient in an emergency, or routinely obtained by the patient from the pharmacist, against a written order signed by the optometrist.