A missed opportunity to start treatment at the point of care
A patient and dietitian agreed the next step in their diabetes treatment, but no prescription could be issued because no GP was available to sign the paperwork.
Agreeing the treatment needed
Grace is a Highly Specialist Diabetes Dietitian working in a dietitian-led clinic for people with Type 2 diabetes.
At the first appointment, a patient’s blood sugar levels were above the healthy range. They were given advice on diet and lifestyle changes to help manage this, however, at a follow-up appointment, a repeat test showed that her blood sugar levels had increased further.
The dietitian discussed treatment options with the patient and explained that medication was now needed to help bring their diabetes under control. Together, they agreed that Metformin would be the most appropriate first treatment, and the patient was happy for the dietitian to prescribe.
A prescription that couldn't be issued
In order to prescribe for the patient, Grace needed to write a clinical management plan, and get it signed off by a doctor. In this case, there was no GP available in the surgery at the time of the appointment, which meant Grace was unable to prescribe.
Leaving clinic without treatment
“The patient was frustrated that no prescription was able to be issued at the time of appointment, and they would have to return back to the pharmacy at a later date.”
Although Grace had made a complete assessment of the patient’s needs, she needed to wait until a doctor who has not met the patient signs off her prescription.
Delays beyond the dietetic appointment
“If dietitians had independent prescribing right then a prescription of metformin could have been issued at the appointment. There would have been no delay in treatment and patient could have collected medication at the time of appointment.”
The patient was delayed in starting treatment, and had to make a second trip to the surgery once their medication was ready to collect their prescription.
Cases like this are common across services that rely on supplementary prescribing, where treatment can be delayed by the need for additional sign-off even after a patient has been assessed and a treatment plan agreed.
How independent prescribing would have changed this case
Independent prescribing would have enabled Grace to complete the patient's care in a single appointment, ensuring treatment could begin without waiting for another clinician's approval.
✅ Medication could have been prescribed during the appointment
✅ No delay in starting treatment
✅ No need for a second journey to collect medication
✅ Reduced workload for GP colleagues
✅ More seamless patient care in a dietitian-led service
