Patient Group Directions

From Practical Group Directions - A practical guide and framework of competencies for all professionals using patient group directions. Liverpool National Prescribing Centre, 2004. www.npc.co.uk... 

Patient Group Directions have been defined as ... 

Patient Group Directions have been specifically developed to allow first contact services to supply or administer medicines without the patient first needing to see a doctor or a dentist. A first contact service is a service that a patient would make contact with when seeking unscheduled care under the umbrella of the NHS and include ... 

Patient Group Directions are intended to help healthcare professionals to work in a more flexible manner and develop a more patient centred approach to medicines that is safe and effective. They are an extra layer of exemptions in addition to the long standing exemptions already in medicines legislation (e.g. the supply of medication to patients by chiropodists, optometrists, etc.). 

The use of Patient Group Directions means that designated healthcare professionals may supply (for example, an inhaler or tablets) or administer (for example, an injection) directly to a patient without the need for that patient to first obtain a prescription from a prescriber. Patient Group Directions are intended for shortterm, usually urgent, care it is not intended that they would be used to manage a patient s condition in the long term. 

Patient Group Directions are particularly suited to minor injuries as they often can be easily treated with medicines that could be provided by the first contact care team without... 

Healthcare professionals who work under Patient Group Directions do not need an additional formal qualification, unlike supplementary (see Section 3.2.4) or independent (see Section 3.2.5) prescribers. 

Scotland has introduced a system whereby Patient Group Directions can be used by pharmacists in the urgent supply of medicines or appliances. For specific details on the use of Patient Group Directions in the urgent supply of medicines or appliances to patients in Scotland, see Section 7.3. 

Patient Group Directions are drawn up by a group of professionals from different disciplines, including a senior doctor (or dentist), a senior pharmacist and a senior member of the profession working under the direction. 

Legislation states that Patient Group Directions must contain the following information ... 

The regulations state that the following health professionals may supply or administer medicines under a Patient Group Direction. It should be noted that these professionals may only work under the Patient Group Direction on an individually named basis ... 

Patient Group Directions are used in both the NHS and private sector. Organisations that may sell or supply/administer medicines under a Patient Group Direction are ... 

If a medicine is supplied using a Patient Group Direction under NHS guidelines, a prescription charge will be levied and if outside the NHS, a charge will be made but this will not be subject to VAT. 

Figure 3.1 contains a sample template for a Patient Group Direction, Figure 3.2 contains an example of a Patient Group Direction for the administration of fusidic acid cream/ointment 2% by a community pharmacist and Figure 3.3 contains an example of a Patient Group Direction for the administration of trimethoprim 200 mg tablets by community nurses for the management of patients with cystitis. 

Patient Group Direction for [Name of Drug] Name of body authorising the PGD ... 

Patient Group Direction for Fusidic acid Cream/Ointment 2%... 

Figure 3.2 An example of a Patient Group Direction for the administration of fusidic acid cream/ointment 2% by community pharmacists. (Continued overleaf.)...

Patient Group Direction for Trimethoprim Authorised by Anytown Primary Care Trust... 

Patient Group Directions for antimicrobials are drawn up with caution because of the issue of antimicrobial resistance. Any Patient Group Direction for antimicrobials must be consistent with local policies and should be regularly reviewed. 

GSL medicines do not require a Patient Group Direction nor do P medicines if supplied by a pharmacist, but in all other instances a Patient Group Direction would be required. 

In summary, Patient Group Directions contain two separate but linked sets of information. Primarily the information concerns the medicine but linked with this is the review and monitoring process. We could therefore split the Patient Group Direction as shown below. 

In occupational health schemes if the person supplying the prescription-only medicine to the patient is not a doctor then they must be a registered nurse acting on instructions provided by a registered doctor. The supply may be made under Patient Group Directions (see Section 3.4). The prescriber must make clear when the use of a prescription-only medicine would be permissible, and the supply would only be made under the terms of the occupational health scheme. 

Some controlled drugs can be supplied or administered via Patient Group Directions (PGD) (see Section 3.4). These are ... 

The urgent supply of medicines or appliances to patients via Patient Group Direction in Scotland... 

In Scotland another way of dealing with the urgent supply of medicines or appliances at the request of a patient, in addition to the emergency supply detailed in Section 7.2, has been implemented using a Patient Group Direction (for details of Patient Group Directions, see Section 3.4). 

The similarities continue with regard to when and why an urgent supply can be made under the Patient Group Direction. In order to use a Patient Group Direction the following criteria must be met ... 

As the Patient Group Direction applies solely to NHS patients in Scotland, the patient must be registered with a Scottish GP. 

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