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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. Notwithstanding the above, therapy radiographers have yet to fully realize the importance of supplementary prescribing in their practice and until this is incorporated and evaluated it is likely that widespread uptake will be limited. Nonetheless, medicines that might be used to good effect using supplementary prescribing include: prophylactic anti-emetics for patients receiving high- and moderate-risk emetogenic radiotherapy; codeine phosphate for pain or diarrhoea; Entonox and micro enemas for brachytherapy patients. In addition, all medicines for toxicity management, as indicated earlier under PGDs, specifically: pain; constipation; diarrhoea; rectal symptoms; skin reactions; oral care; nausea and vomiting (metoclopramide tabletsIV injection, domperidone tablets suppositories, granisetron tabletsIV injection, dexamethasone tabletsIV injection). ( As with diagnostic radiography, this is likely to have specialist areas of application.

These are written directions made in favour of health care professionals and require the signature of a doctor and a pharmacist. Since podiatrists, dieticians, occupational therapists, orthoptists, paramedics, physiotherapists, prosthetists and orthotists, radiographers and speech and language therapists comprise the list of professionals able to supply medicinal products under PGDs. A PGD can include a variable dose range, so the health care professional can decide on a suitable dose for individual patients. PGDs should only be used where there is clear benefit for patients and by health care professionals with the necessary expertise and competence.

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