When I sat the final pharmacology paper of my undergraduate degree in 2001 I pretty much thought that would be my last experience of intensively studying that subject matter. I very much loved my time as a pharmacology student; I loved the subject, the detailed study of cells and how to target them in life and disease. But, I always knew I wanted to work with people. Life as a pharmacologist would be life in a lab and/or academia, and although investigating new drugs and beginning their trials would help people, I wanted a job where I would interact and help people every day.
I was very lucky to secure a place on the Human Nutrition and Dietetic PG Dip, and that was the start of my journey in dietetics. The well used pharmacology textbooks were placed in the back of a cupboard. However, the my old uni days continued to hold relevance in my new studies and then in my job. I always felt comfortable explaining how an anti-emetic worked, how an anti-depressant contributed to constipation or why the timing of an anti-spasmodic was important, and I could always saw benefit when patients shared this understanding. So I never, ever regretted my long route into dietetics.
I have to admit I wasn’t very aware of when Non Medical Prescribing rights started to change for dietitians until I attended a department study day in 2017. I instantly thought the idea made sense, and although the application within our roles might be tricky I was sold and I knew right away I wanted to become a non-medical prescriber. But, the misconceptions were already there within dietitians. Why would we want to prescribe? That’s a Dr job! We don’t get paid enough! Dr’s on the cheap! I felt like the odd one out actually putting myself forward for the course; but hopefully we have now put these negative thoughts aside.
Dietitians make excellent prescribers when diet and medication is a blended therapeutic area such as in IBS, diabetes, pancreatitis, and cow’s milk allergies, as we are the professionals that take the time to detail the diet history, food patterns, symptoms, influencing factors and personal preferences. In my experience the knowledge you gain as a prescriber, without even using your prescription pad, changes your day to day practice. The greater appreciation of polypharmacy, side effects, compliance, drug metabolism, pharmacokinetic and dynamics all help you to understand and support your patient’s health, and to consider the impact these have on nutritional status will enhance your dietetic care. We often can be the right person to make these decisions and to support models of person-centred care.
I had a nerve racking 14 month wait from being accepted on the NMP course at Glasgow Caledonian University and starting the course, as HCPC validation of the course took quite a while! I second guessed myself a great deal in that time but I knew I could cope with the pharmacology and put my focus on the other ‘unknown’ parts. I suppose I still couldn’t quite believe we were getting the opportunity as a profession to do this. So, when I started the course in September 2019 with 4 other willing, dietetic recruits I was relieved as it was finally coming to be a reality.
Then a new feeling of being completely overwhelmed took over and I will not lie, for the next 4 months I ate, slept and breathed NMP. However, returning to pharmacology and new subject areas including law, pharmacy practice, drug reactions, psychology of prescribing and concordance – I loved it! Much of the evidence required to pass all the Royal Pharmaceutical Society competencies is demonstrated through much of what we do already as experienced dietitians. This confirmed my belief that dietitians would have made good NMPs way back when the opportunity for AHPs started many years ago, and it is actually pretty frustrating we are almost last to the party.
All five of us from NHS Greater Glasgow and Clyde passed the course and were soon joined by a dietitian from NHS Forth Valley and two from NHS Highland. At my last count we had 13 qualified NMP dietitians in Scotland and 14 more are currently on courses. To help provide peer support, share practice, audit our prescribing practices and collect data for our professional case to independent prescribing, I started our Scottish NMP Dietetic Network. We come together every 3 months and are open to NMP students. Those who are just thinking about venturing into NMP can also pop in and listen to our meeting or get in touch for a chat.
Now two and half years into my prescribing journey, I find myself supervising two student NMP dietitians as part of the new Royal Pharmaceutical Society NMP training framework. It has been a challenge to set up so quickly, but it is already proving effective in supporting and nurturing our students on their portfolio and competencies journey. It’s nice to help a newbie during that initial overwhelming stage, as I realise that evidence and opportunity is all around us which can help to reduce the pressure of the unknown. That is a very, familiar journey to me.
Those old dusty pharmacology textbooks are still very much core books in the study of pharmacology. I have added some newer books to my collection now, but those oldies are no longer at the back of a cupboard. Instead they sit nicely on the shelf in my office. They have renewed purpose and they are now also shared across our department.
Laura Troiano is a Community Dietetic Team Lead, Gastro Clinical Specialist, ONS Service Manager, Accredited FODMAP RD and Supplementary Prescriber at NHS Forth Valley
Follow Laura on Twitter @RDTroiano