Summary

This page explains what a Patient Group Direction (PGD) is how they are used in clinical practice.

Definitions and guidance

A Patient Group Direction (PGD) is a written instruction for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.

May or may not be identified means an individual can either be known to the service/have an appointment (e.g. a baby immunisation clinic) or not be known in advance of presenting at a service (e.g. a walk in centre).

PGDs are not a form of prescribing. PGDs allow health care professionals specified within the legislation to supply and/or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.

The supply and/or administration of medicines under a PGD cannot be delegated – the whole episode of care must be undertaken by the health care practitioner operating under the PGD.

Organisations should have policies and processes in place to consider all aspects of medicines management for patients within the service or pathway. Before a service is designed or commissioned using PGDs and before a PGD is developed, you must ensure that PGDs are appropriate, legal, and that relevant governance arrangements are in place.

NICE Guidance

NICE guideline MPG2 (2017) Patient Group Directions gives guidance on when to use a PGD, stating that the majority of clinical care should be provided on an individual, patient-specific basis. The supply and administration of medicines under PGDs should be reserved for those limited situations where this offers an advantage for patient care without compromising patient safety, and where it is consistent with appropriate professional relationships and accountability.

Appropriate PGD use

When a PGD can be used

Examples include:

• Seasonal and other types of vaccination.
• For groups of patients who have not previously presented to e.g. minor injury units and other first contact services.
• In well established services where assessment and treatment follows a clearly predictable pattern (e.g. NHS immunisation clinics and contraception and sexual health services).

When a PGD cannot not be used

Examples include:

• For long-term management of a patient’s clinical condition such as in chronic or long-term conditions
• For medical devices
• For supply or administration of radiopharmaceuticals (Administration of Radioactive Substances Regulations 1978)
• For supply or administration of dressings and medical devices
• For supply or administer abortifacients (Abortion Act 1967)
• For training or as part of training
• For unlicensed medicines
• Where there is delegation of responsibility to supply or administer the medicine
• When two or more licensed medicines are mixed together as this results in an unlicensed medicine