Implementation of Non-Medical Prescribing by Therapeutic Radiographers: Views of Prescribers and Service Managers in Devolved UK Health Systems

Abstract

Introduction: Workforce shortages and rising demand have increased interest in advanced practice (AP) and task redistribution in healthcare. In radiotherapy, non-medical prescribing by therapeutic radiographers (NMP-TRs) may improve medicines management and symptom control. However, adoption varies due to governance, leadership, culture and regulation. Differences in legislation, prescribing models and implementation timelines across Scotland, Wales and Northern Ireland (N.I.) create variable conditions for role enactment and sustainability. This study explored the experiences of NMP-TRs and radiotherapy managers regarding the implementation and impact of the role in Scotland, Wales and N.I. Methods: Semi-structured interviews were conducted with seven NMP-TRs and six radiotherapy service managers across Scotland, Wales and N.I. Data were analysed using reflexive thematic analysis, with interpretation using the Consolidated Framework for Implementation Research and Diffusion of Innovations theory as sensitising lenses. Results: Four overarching themes were identified: implementation and governance; preparation for the prescribing role; advantages and impact of NMP-TR; and disadvantages and constraints. NMP-TR was associated with medicines optimisation, continuity of care, delays in symptom management and service responsiveness. Prescribing authority supported professional autonomy, legitimacy and workforce retention. However, implementation was fragile and uneven, constrained by limited training capacity, banding and funding restrictions, legislative variability and reliance on prescriber cohorts. Professional identity work and emotional labour were prominent during transition into prescribing roles, particularly in early adopter sites. Conclusion: NMP-TR represents a workforce innovation capable of enhancing patient care and service efficiency. In devolved health systems, sustainable implementation depends on coordinated system level alignment across legislation, governance, leadership and organisational culture. Implications for practice: Successful integration of NMP-TR roles requires support beyond individual qualification, including governance, protected training capacity and clear pathways to strengthen sustainability and maximise impact.