Patient Group Directions - Ensuring Safe and Effective Practice

Patient group directions (PGDs) are defined by the MHRA as "written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment". In simpler terms, a PGD is a document which enables clinically trained health professionals to bypass the medicine act and supply specific POM medicines without a prescription. In laymans terms this means a pharmacist or nurse can supply medicines like Viagra, Propecia or certain vaccines to patients without the need for a doctor.

POMs, prescription only medicines are prescription only for a reason, this is so that they are not open to abuse and that they are used for their clinical, licensed purpose. The prescriber is the legal "gate keeper" to the medicine and no other health professional can supply them. However, in recent years, more and more classes of health care professional have been able to prescribe them. This first started with the expansion of the dentist formulary, then with nurse independent and supplementary prescribing and relevantly recently, pharmacist prescribing. The NHS opened the gates to new prescribers in response to the growing amount of prescriptions needed each year and a diminishing supply of doctors.

However, if nearly any healthcare professional can use PGDs, what safe guards are in place to make sure that that clinician is of a competent standard? There are multiple safe guards in place in the private (non-NHS domain).

1. Firstly, the Quality Care Commission (CQC) who regulate all PGD related activity make sure that the private medical agency providing the PGDs conform to certain standards such as patient confidentiality, audit requirements and safety protocols.
2. The company supplying the PGDs also needs a GMC registered doctor and a GPhC registered pharmacist to sign each PGD certifying their safety and fitness of purpose.
3. All PGDs have inclusion and exclusion criteria which safe guard vulnerable patients from treatment. For instance, authorised clinicians using a Lariam (Malaria) PGD need to check whether the patient has any past history of epilepsy. If epilepsy is present the patient will be excluded from treatment and referred to a doctor.

In all, PGDs are an excellent tool for the NHS to meet key objectives such as better access to medicines without compromising patient safety. From a patient perspective, it enables them to get the medicines when they need them most and not be restricted to "Emergency Supply" protocol from pharmacies.