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Cancer is a chronic condition and it is highly feasible to set up a CMP between the independent prescriber and supplementary prescriber (therapy radiographer). In many respects, supplementary prescribing is better than PGDs and the values of this mechanism with respect to toxicity management are indicated below: PGDs are inflexible, being restricted to specific medicines at specific doses. Doses cannot be altered and medication cannot be changed to an alternative medicine (within a specific PGD); PGDs require regular updating in accordance with Trust policies, and the associated processes can be labour intensive; supplementary prescribing allows therapy radiographers to have broad professional latitude within their competence in the medicines they prescribe and the amount they administer. This allows for more responsive and individualized care and management.

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This could provide timely and appropriate access to treatment for chronic disease management. A community physiotherapist treating a patient in a remote location who is not responding well to medicines prescribed by a consultant could, under a CMP, alter dosages for that patients benefit. Specialist knowledge allows the physiotherapist to explain to patients in these situations how to take their medication for best effect and could help improve compliance. A GP or a consultant, whichever is relevant, would have to be involved in the initial development of a CMP and review process so that physiotherapist could prescribe medication as appropriate for individual patients. Extended scope practitioners are clinical physiotherapy specialists with extended roles who see patients referred for assessment, clinical diagnosis and management.

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