Implementation of independent and supplementary prescribing by therapeutic radiographers across the devolved nations of the United Kingdom

Abstract

Introduction:
Non-medical prescribing (NMP) by therapeutic radiographers (TRs) has been promoted as a workforce innovation to improve access to medicines, enhance continuity of care and address service pressures within radiotherapy services. Despite increasing policy support, empirical evidence examining how NMP-TR roles are implemented, governed and sustained in practice, particularly within smaller and devolved health systems, remains limited.

Aim:
This study investigated the implementation and impact of NMP-TR roles across the devolved health systems of Scotland, Wales and Northern Ireland, with particular attention to everyday clinical practice, patient experience and interprofessional collaboration within a small-state context.

Methods:
A multi-phase mixed-methods design was employed. Phase 1 comprised a national survey examining the scope, governance arrangements and perceived impact of NMP-TR practice across the United Kingdom. Phase 2 involved semi-structured interviews with NMP-TRs and radiotherapy service managers to explore organisational, professional and policy influences on implementation. Phase 3 consisted of an embedded mixed-methods case study within two radiotherapy departments in Northern Ireland, integrating prescriber audit data, patient surveys and interviews with patients and multidisciplinary team members. Quantitative data were analysed descriptively and qualitative data using reflexive thematic analysis, with interpretation informed by the Consolidated Framework for Implementation Research and Diffusion of Innovations.

Results:
Phase 1 demonstrated substantial variation in NMP-TR role configuration, governance maturity and organisational support across UK radiotherapy services. Phase 2 findings indicated that successful implementation was strongly shaped by organisational readiness, leadership support, interprofessional trust and clarity of role boundaries, while challenges related to role transition, training access and workforce capacity persisted. Phase 3 findings showed that NMP-TRs were highly embedded in routine radiotherapy practice. Patient-reported data demonstrated high levels of satisfaction, confidence and acceptance of NMP-TR prescribing, with NMP-TR-led review associated with more comprehensive communication regarding medication safety and self-management.

Conclusion:
Taken together, the findings demonstrate that NMP-TR roles, when supported by robust governance, organisational infrastructure and effective interprofessional collaboration, deliver tangible benefits for patient experience and medicines optimisation while supporting workforce sustainability within radiotherapy services. These benefits are particularly pronounced within small health systems, where service resilience and role flexibility are critical.

Date of Award	Jun 2026
Original language	English
Supervisor	Sonyia McFadden (Supervisor), Ciara Hughes (Supervisor) & Nicola Carey (Supervisor)