Paramedic Prescribing

The current situation 
Paramedics have important medicines responsibilities.
All registered paramedics can:
• Give a range of injectable medicines listed in law
• Use medicines under Patient Group Directions (PGDs)
• Administer medicines under Patient-Specific Directions (PSDs)

Paramedic Independent Prescribers can also
• Prescribe most licensed medicines
• Prescribe five controlled drugs (incldi9ng morphine and midazolam) 
• Work in roles across urgent care, primacy care, community, and specialist services
There are now over 2,500 paramedic prescribers safely delivering care across the UK.

The issue
The problem is that older legislation has not kept up with modern paramedics practice, which creates avoidable barriers to delivering care. 

The 3 key barriers
1. Limited access to injectable medicines in prehospital care
Paramedics can only independently give injectable medicines that appear on a specific legal list.
Adding medicines to that list is slow and complicated. PGDs are helpful but can be bureaucratic and do not always suit fast-moving clinical situations. 
What this means in practice:
Delays, workarounds, and extra steps when patients need timely treatment. 

2. Student paramedics can’t give injectables during training
Unlike some other professions, student paramedics are not legally allowed to administer injectable medicines under supervision.
What this means:
Newly qualified paramedics may have less hands-on experience than they should, which is not ideal for confidence or preparedness. 

3. Paramedics prescribers have fewer prescribing rights than other professions
Nurses and pharmacists can prescribe all controlled drugs. Paramedics can only prescribe a small, fixed list, even when working in advanced or specialist roles.
Paramedics also can not prescribe unlicensed medicines where these are commonly used in specialist areas such as palliative care.

What this means:
Extra referrals, delays for patients, and duplicated work for other clinicians.

This is about fairness and patient care
All independent prescribers complete similar levels of education and governance, but paramedics have more restrictions than some other professions. 
The Royal College of Paramedics believes prescribing rights should be based on:
• Education
• Competence
• Governance
not professional background alone.

Our campaign
We are working with policy makers and regulators to call for:
• A simpler process to update the list of injectable medicines paramedics can prescribe
• Supervised medicines administration for student paramedics during training 
• Broader controlled drug prescribing rights for paramedic prescribers 
• The ability for paramedic prescribers to use unlicensed medicines when clinically appropriate
These changes are about removing unnecessary barriers, not lowering standards.

Why this matters to our members
Even if you are not a prescriber, these changes would:
• Support faster treatment for patients
• Reduce delays caused by paperwork and handovers
• Improve how prepared new paramedics are when they qualify
• Help paramedics work more effectively in GP practices, urgent care, community, and specialist roles
• Strengthen recognition of paramedics as autonomous clinicians 

Next steps
Legislative change takes time, but the profession is in a strong position:
• Paramedic prescribing is well established
• Safety and outcomes data are growing
• Paramedics are now embedded across the healthcare system
The College will continue representing members to make sure paramedics practice is properly understood and supported.