PGD and Independent Prescribing

Can independent prescriber nurses/pharmacists use PGDs in their daily practice?

In short no. PGDs should only be used in the absence of a prescriber, if the prescriber can write a prescription there should be no need for a PGD. However, as with most things in life, this issue is not so black and white. PGDs are generally used in primary care for those high volume, generally safe medicines which can be given to a well defined group of patients which is usually established via the Specific Product Characteristic (SPC) of the medicine. Whereas healthcare professionals who can prescribe, do not need a well defined group but base their decision on an individual basis i.e. writing a prescription is a type of Patient Specific Direction.

The only possible reason why a prescriber would use a PGD is that although they can prescribe any medicine, they can only prescribe within their own specialty. For instance, if a nurse prescribers specialty was diabetes you would assume that they could prescribe things like:

• Insulin  
• Oral hypoglycemics
• Needles
• Syringes
• etc

You would not expect them for instance to be trained to prescribe Emergency Hormonal Contraceptives (EHC) or Hair Loss medication as this would be outside of their scope of practice. In this case the prescriber is in limbo land on one hand they are excluded from using PGDs because they are a prescriber but they cannot prescribe the medicine as this is not in their scope of practice. The easiest answer to this is to undergo some sort of training as per best practice whether this is a course endorsed by the GPhC or NMC.

MASTA Pharmacy Travel Clinic

We have been contacted a lot recently about the new MASTA travel clinic sales team targeting community pharmacies to purchase their pharmacy travel clinic solution. We have drilled down into MASTA travel clinic costs and found its pretty expensive....

• £100 online training fee 
• £555 live training fee incl YF £18 per referred traveller ( MASTA take a further 320 consultation fee from the traveller) 
• £35 per month for the PGDs =£420 
• £11 per medical helpline consultation 
• Also you cannot benefit from the Sanofi discount scheme as you have to buy from MASTA wholesale

In practice, based on their minimum prediction: 

If you do a minimum of 4 travellers per week, over the year this is = 4 x £18 x 52 = £3744 

So with the initial costs involved in set up the Total cost of MASTA solution in year one is

£3744 + £100 + £555 + £420 = £4819 

+ extra expense of buying vaccines through MASTA 

+ expensive clinical support.

So pretty dear overall. Our solution for independent pharmacist run travel clinics costs, £2,000:

• You are completely independent but we help you with all of your marketing and online SEO
• You can buy from any supplier, we have negotiated discounts for you
• There are no hidden extra costs for consultations or clinical support

Patient Group Directives

A "Patient Group Directive" is a misnomer for a Patient Group Direction. Both sound very similar however, they are exactly the same. The is no such thing as a patient group directive only a patient group direction. If you type "Patient Group Directive" into Google it automatically corrects you in suggesting "patient group direction".

The answer you are looking for is that a patient group directive or PGD is a legal/clinical document which enables specifically trained pharmacist to supply prescription only medicines. PGDs are either in the Private or NHS sector. When they are in the NHS sector the are often accompanied by very specific training requirements set nationally by the NHS. In relation to private PGDs (i.e. Erectile Dysfunction PGDs) the training requirements are set by an Independent Medical Agency which has a multidisciplinary team which decides what training is required so that a medical professional (such as a pharmacist) can safely supply and / or administer PoMs.

Trimethoprim (Cystitis) PGD Warning

Pharmacy PGDs in the UK need to be created to extremely specific guidelines set out by the MHRA (2010). These guidelines allow for many different medicines to be available via PGDs, however, certain medicines are generally excluded, these include certain controlled drugs and antimicrobials/antibiotics in certain circumstances. The document recommends that PGDs for antibiotics /antimicrobials should only be drawn up if local microbiologist is involved. In general, private PGDs are national guidance, therefore, unless the authorising PGD body directly contacts a local microbiologist in every distinct area in the UK it would be against these recommendations...


"Particular caution should be exercised in any decision to draw up PGDs relating to antibiotics. Microbial resistance is a public health matter of major importance and great care should be taken to ensure that their inclusion in a direction is absolutely necessary and will not jeopardise strategies to combat increasing resistance. A local microbiologist should be involved in drawing up the PGD. The local Drug and Therapeutics Committee or Area Prescribing Committee, where they exist, should ensure that any such directions are consistent with local policies and subject to regular external audit.." - MHRA 2010


The problem here is who would be liable for this. If the MHRA were to step in, the PGD authorising body will probably mention that it is up to the pharmacy that is implementing the PGD to check with a local microbiologist...

Medicine Management for Patient Group Directions

Medicines management refers to the way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care. In relation to PGDs this means the management of the entire process of how a PGD is developed and implemented. At PatientGroupDirection we make sure before a PGD is created that there is a need for it in community pharmacy for access to that medicine then we look at the feasibility of its implementation. Factors we look at are safety, the cost of the drug and the end user cost. Safety is weighted as the most important factor in this followed by profitability.


Pharmacists are excellent medicine managers so we do not interfere with procurement, however, we do take note of national shortages of medicines such as the Orlistat outage in 2012. In response to this and at the request of our pharmacists we have post poned the renewal dates on many of our Olistat PGDs. These subscriptions will recommence once the shortage of orlistat has been overcomed.

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.

PatientGroupDirection.com & Incaplex announce Partnership and New Travel Core PGD Plus

PatientGroupDirection.com & Incaplex announce Partnership and New Travel Core PGD Plus

PatientGroupDirection.com, the UK's most innovative provider of clinical administration services and Incaplex, the company behind the market leading travel clinic management software - Inca Clinic, are delighted to announce a new partnership to provide the first turn-key solution for Travel Clinic services to UK pharmacies.

The service will include all 13 of PatientGroupDirection.com’s PGDs, that are CQC registered and provide pharmacists with the necessary training and expertise to administer and supply a wide range of travel medications and vaccines.  Travel Core PGD Plus, will also include Inca Clinic’s highly innovative online Travel Clinic management service to provide pharmacists with the most compelling PGD product on the market.

The CQC registered service enables pharmacists to reduce their dependency on NHS services. The 13 medications and vaccine PGDs in Travel Core PGD Plus are specifically selected and enable pharmacies to provide a comprehensive Travel Clinic service.

Inca Clinic is a complete patient management application for travel clinic service providers. Built on the worlds leading online application platform Salesforce.com. You just need a web browser to run Inca Clinic. The application is compliant with NHS IG and numerous requirements laid down by the CQC.

Previously both services, if purchased separately, would have cost over £3000 per annum.  However, this new partnership will enable Pharmacies to launch the complete service from as little as £2100 for the first year, a fraction of the potential profit that can be gained through diversification into this space by independent and community pharmacies.  Pharmacies can trial the Inca Clinic today by signing up for a free 15 day trial. Existing PatientGroupDirection.com can also available of special pricing structure; contact Incaplex for more details.

Tom Matchett, Business Development Director for PatientGroupDirection.com commented:

“We have been impressed with the usability, depth and functionality of the Inca Clinic software and recognised how useful this service could be to our clients in maximizing the profit potential of Travel Clinic service operations.  As a Customer Relationship Management tool, it also offers many benefits to traditional practices both from a business and clinical perspective”.

Richard  Boyd, CEO of Incaplex commented:

“Our two services fit hand in glove, after undergoing going the extensive training provided by PatientGroupDirection.com, Inca Clinic enables pharmacies to quickly grow and manage their travel vaccine service while working within their specific PGD. Together our companies offer the most comprehensive and cost effective service on the market.”

Travel Core PGD + Package Includes

·         PGDs for Dip/tet/polio, Hep A, Hep B, Typhoid, Rabies, Cholera (Oral), MMR, Meningitis ACWY, Jap Encephalitis, Malarone, Doxycycline, Lariam, Adrenaline - Anaphylaxis.

·         Comprehensive training, online and practical assessments. 

·         Inca Clinic, a best of breed online PMR solution to enable pharmacies to manage, monitor and support their Travel Clinic business' throughout the entire process.

·         Only £2100 + VAT (Save £900!)

For further information about this press release please contact:

Tom.Matchett@patientgroupdirection.com

Marketing Director, Patientgroupdirection.com Tel: +44 7887 564021

-- Ends --

PatientGroupDirection.com Launches Innovative PGD Service In The UK

PatientGroupDirection.com is the brain child of community pharmacist and digital 
entrepreneur Mike Bereza.  For the past 2 years he has worked as the manager of a small 
independent called Douglas Pharmacy based in Islington, London. Mike has been offering
patients access to travel medicines and specific POMs via PGDs and the revenues gained 
have been exceptional. 

PatientgroupDirection can now offer a fully CQC authorised service to pharmacies 
nationwide.

There are a handful of providers offering a similar service however, they offer an 
incomplete selection of relatively expensive PGDs.  Some providers offer influenza 
immunisations but not malaria prophylaxis, others offer erectile dysfunction but not 
vaccinations. PatientGroupDirection.com can offer a complete centralised package of all 
PGDs, giving them the greatest variety, better value, exceptional training and support, 
guaranteed.

PGDs we offer include:

•Erectile dysfunction: Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis) - £50 pa.
•Smoking cessation: Varenicline (Champix) - £50 pa.
•Hair loss: Finasteride (Propecia) - £50 pa.
•Anti malarials: Malarone, Mefloquine (Lariam), Doxycycline - £100 pa.
•Shingles: Zoster vaccine to protect 50yo+ patients from shingles - £150 pa.
•Flu jab: Influenza vaccination with free Hepatitis B PGD - £250 (NPA £360 pa!)
•Travel clinic: Typhoid, Rabies, MMR, DTP, Meningitis, Japanese Encephalitis, Cholera, Hepatitis 
A + B, Combined Vaccines - have a look at our case study and price list!
•Bespoke PGDs: We can create and authorise any suitable PGD just contact us.


If clients are interested in more than one PGD, we  can offer group discounts for 
subscriptions with multiple PGDs.

Our pharmacist created training resources fulfil all guidance as set out by the 
TRAVAX/HPA and have been created as to be as straight forward as possible. There is 
minimal paperwork and most of a pharmacies go live in less than 2 weeks from the initial 
subscription.

Please have a look at our site or call us on 020 8150 7199 to find out more about a 
significant new opportunity in the UK pharmacy sector.