Non-medical prescribing in Australasia and the UK: the case of podiatry

Abstract

Background: the last decade has witnessed a rapid transformation in the role boundaries of the allied health
professions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategy
of health care ‘modernisation’ has encompassed calls for the redrawing of professional boundaries and identities,
linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domain
of medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped to
meet the challenges posed by changing demographic, social and political contexts. The prescribing of medicines
by non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects these
changes.

Methods: using a range of key primary documentary sources derived from published material in the public
domain and unpublished material in private possession, this paper traces the development of contemporary UK
and Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sources
include material from legislative, health policy, regulatory and professional bodies (including both State and Federal
sources in Australia).

Results: tracing a chronological, comparative, socio-historical account of the emergence and development of
‘prescribing’ in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reforms
on the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled with
demands for workforce flexibility and role transfer within a climate of demographic, economic and social change
has enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply,
administration and prescription of medicines.

Conclusion: as a challenge to medical dominance, these changes, although driven by wider healthcare policy,
have met with resistance. As anticipated in the theory of medical dominance, inter-professional jurisdictional
disputes centred on the right to access, administer, supply and prescribe medicines act as obstacles to workforce
change. Nevertheless, the broader policy agenda continues to ensure workforce redesign in which podiatry has
assumed wider roles and responsibilities in prescribing.

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