Injections of medicines including  intra and peri – articular injection therapies

 by HCPC registered Podiatrists with POM-A annotation

Qualified podiatrists who are awarded licences in POM-A (prescription only medicine- administration), as either part of their undergraduate degree or as stand-alone qualifications are given statutory permission to administer medicines by injection that they may lawfully access**. The POM-A licence also contains a specific permission to obtain (without the usually required prescription) :  a range of injectables which include various local anaesthetics, adrenaline (epinephrine) and the anti-inflammatory synthetic steroid methylprednisolone. This permission continues whilst said podiatrist remains on the statutory register of the Health and Care Professions Council, and ceases should they leave, or be removed from, the stated register.

Whilst so registered they can legally obtain**all of the medicines above, including the steroid, and administer** them, without further training or permission.

However, it is a requirement of safe and responsible practice that podiatrists with POM-A  must ensure that they a) have a full and detailed understanding of the pharmacology of said medicines including their pharmacokinetics and pharmacodynamics (essentially how the body affects the drugs and the drugs affect the body) and b) they have suitable medical indemnity insurance for use of the items above. In respect of the local anaesthetics, a) is included in the approved courses which grants POM-A ,  so b) is included in most malpractice policies. In respect of the licensed steroid however, the Institute requires the completion of an approved course which explains, in substantial detail, the action of when TO use, and perhaps even more importantly when NOT to use the permitted steroid.  By virtue of the holding of a POM-A licence it is clear that the holders are already trained and safe injectors and the simple techniques of safe administration will already be known, but nonetheless, these are specifically restated (with some practical tips and information pearls) during the course and delegates to the course will readily grasp the analogy between  local anaesthetics and steroids.

To this end, the Institute’s course is designed by, and taught by, highly qualified podiatrist independent prescribers and due to its carefully designed structure permits the Institute’s insurers to offer insurance cover to allow members who have successfully attended the Institute’s approved course to commence its use independently without requiring further permission or ‘mentoring’. **Prescription-only-medicines that usually require prescription by a recognised prescriber can, where defined by law, be made available to defined members of certain legally regulated professions under statutory ‘exemptions’ to the 1968 Medicines act and its numerous subsequent amendments. The exempted substances may be purchased at retail or wholesale from regulated pharmacies or other legal UK sources. Note that ‘administration’ in the context of the above must be within the professional activities of the aforesaid practitioner with the said ‘exemption’.  The exemption is not in law a ‘prescription’ and does not permit mixing of medicines,  nor does it permit the holder of said exemption to direct  others to mix and or administer them (a patient specific direction from a registered prescriber is required for directing others to mix/administer) The position of epinephrine is less well determined by the above, as this falls within the parameters applying to medicine identified as being within schedule 19 of the 1968 medicines act (and amendments) wherein its legal category is relaxed when used with the provable intent of saving or preserving life in an emergency situation.