Paramedics as supplementary prescribers in managing stage 1 hypertension
Jack Gillies, Matthew HilditchBackground:
Supplementary prescribing enables registered health professionals to prescribe medicines within an agreed clinical management plan (CMP), in partnership with an independent prescriber. In primary care, this model supports safe, patient-centred prescribing while promoting multidisciplinary working. Reflective practice is recognised by the Royal Pharmaceutical Society as essential for developing prescribing competence, particularly for non-medical prescribers such as paramedics.
Aims:
This case study aims to analyse and critically evaluate a supplementary prescribing episode from a paramedic's perspective, demonstrating safe and effective prescribing practice within a primary care setting and evidencing achievement of the module learning outcomes.
Methods:
A reflective case study methodology was used to examine the assessment, diagnosis and management of a 56-year-old male presenting with suspected hypertension. Clinical assessment, home blood pressure monitoring, shared decision-making and development of a CMP were undertaken in accordance with local Integrated Care Board and National Institute for Health and Care Excellence guidelines. Prescribing decisions were made collaboratively between the paramedic, supervising GP and patient.
Findings:
Stage 1 hypertension was confirmed following 7 days of home blood pressure monitoring. A CMP was agreed and implemented, enabling the paramedic to initiate treatment with the angiotensin-converting enzyme inhibitor ramipril. The patient demonstrated significant improvement in blood pressure control within 2 weeks, alongside positive lifestyle modifications, with no reported adverse effects. Blood results remained within normal ranges, and escalation within the CMP was not required.
Conclusion:
This case highlights the effective use of supplementary prescribing supported by a clearly defined CMP, demonstrating safe clinical practice and improved patient outcomes. The findings reinforce the value of supplementary prescribing in primary care while suggesting its potential remains underutilised.