Demise of Pharmacy PGD

It is probably no surprise to you that PharmacyPGD.co.uk seems to have gone out of business. On the front page of their site it states:


We have done a little bit of research and pulled up some articles from the Chemist and Druggist, namely:

http://www.chemistanddruggist.co.uk/news/pharmacy-pgd-closes-down-reasons-beyond-control

In the article, it goes on to explain, not very much. Essentially, it seems like they have closed their doors due to unforeseen circumstance. In the wider community pharmacy arena there is much speculation on the topic.

Why Mike Bereza left PharmaDoctor

Mike Bereza, as you may know has now moved from PharmaDoctor to Voyager Medical. There were a number of reasons for this, but mainly Mike was looking to make a system which was more pharmacy focused, a system which empowers pharmacist to do more services other than just sell medicines. The internet is both a blessing and a curse, it opens doors to new exciting markets for pharmacists however, it increases liquidity and will inevitably lead to a collapse in drug prices. Mike as a community pharmacy contractor believes the best way forward is to diversify, hence Voyager Medical a community pharmacy service and online pharmacy enabler.

To date, at the new influenza pharmacy PGD provider we have now rebranded the Influenza Vaccine package as the Seasonal Vaccination Programme and we are working closely with Avicenna to bring pharmacists more services. If you would like to register as a user please go to our register page and we will get right back to you.

Watch this space for more developments.

Travel Vaccines Blacklisted on FP10

The PSNC has published an article saying that travel vaccines can no longer be prescribed on a FP10 form from pharmacy. This has already taken effect from January 2013.

http://www.nhsbsa.nhs.uk/PrescriptionServices/Documents/PrescriptionServices/Dispensing_Contractors_-_Issue_10_(v1).pdf

**Update after seeking confirmation from the PSNC this is only applicable to prescribing doctors.

Removal of Trimethoprim from PharmacyPGD

PharmacyPGD run by Red Box Healthcare have now officially removed their trimethoprim PGD from their pharmacy pgd offerings. This is in direct response to the DOH investigation of the NPA and the subsequent removal of their antibiotic PGDs. The exact quote is as follows:

"The Cystitis PGD has been suspended 05/01/2013 to new users as a precautionary measure in response to concerns about Pharmacists supplying antibiotics without prescription. Pharmacists who already have rights to use this PGD may continue to do so until their current rights expire. We will keep the situation under review. If the cystitis PGD becomes available again to new users or for renewal we will inform member Pharmacists by email."

Patientgroupdirection.com, PharmaDoct.co.uk and the National Patient Group Direction Association welcome this decision and believe all private PGD suppliers should follow suit. 

Erectile Dysfunction PGD - Zanifil Condoms

Running your own erectile dysfunction clinics using our Erectile Dysfunction PGD is great as you can help patients get what they need. The PGDs covers the most popular oral treatments - Sildenafil, Vardenafil and Tadalafil. Some of our members having been starting erectile dysfunction clinics where the pharmacist has protected time for patients who would like to access the service. But what else apart from the oral tablets can be recommended?

• Vacuum pumps - these are non prescription items which can offer a valuable alternative to pharmacological action.
• Zanifil Condoms - a new product from Durex, zanifil is very similar to sildenafil and is included as a gel inside of the condom. We have been in contact with Reckitt-Beckiser, however a release date has yet to be confirmed.
• Counselling and referrals - although our PGD has wide inclusion criteria if you feel that the patients ED symptoms are in part caused by obvious psychological reasons you should refer.

Overall, patients can now access a wider arrange of solutions from pharmacists using Pharmacy PGDs. In addition to ED, there are solutions to premature ejaculation such as STUD spray which can prolong ejaculation.

pgd travel clinic

To create a pgd travel clinic all you need to do is visit this Pharmacy PGD site. There is a package called Travel Core which enables pharmacies to create a travel clinic which is comparable to any travel clinic which a GP can create. Included PGDs:

Dip/tet/polio
Hep A + B
Rabies
Typhoid
MMR
Japanese Encephalitis
Cholera (Oral)
Meningitis, 
Oral antimalarial - tablets: Malarone Doxycycline, Lariam
Adrenaline for anaphylaxis.

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.

EllaOne vs Levonelle PGD

The attached image shows the efficacy of Levonelle vs EllaOne. EllaOne 24, 48, 72, 96, 120 hours after unprotected sex results in less pregnancies than its Levonelle counterpart. However, looking at UK GP prescribing data Levonelle is prescribed almost ten fold in respects to EllaOne. Why is this? Well it is to do with Cost. UK GPs believe that the cost involved in choosing Levonelle over EllaOne is significant enough to ignore this problem. In reality, the price difference is only £10, we beleive that most women would be willing to pay this price to avoid 3% which is nearly 1 in 20 extra unwanted pregnancies. The UK have one of the highest teen pregnancy rates in the world... Using an EHC PGD from this site EHC PGD, means pharmacists can give women that choice, instead of leaving it up to GPs.

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...

Travel PGD - New Slides

We have now updated all of our Travel PGD learning resources with new slides and lectures covering all aspects of travel health.

PGD Pharmacy Brochure

Would you like to see our brochure? We have sent it out to every pharmacy nationwide, however if you didnt get it or would like to pass one on, just click this link for our Pharmacy PGD brochure. It contains details of our flagship PGD store in Islington, London and shows how much revenue is generated over certain periods in the year.

How to get an authorised pharmacy PGD

To get an authorised Pharmacy PGD is very easy, all you need to do is follow these simple steps. By using a third party service such as this you will bypass the need to be CQC registered, which is an absolute nightmare!

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.

Preventive Measures of Patient Group Directions

The main preventive measures built into all PGDs are inclusion and exclusion criteria. Each PGD, by MHRA definition must have precisely worded exclusion and inclusion criteria as to protect the more vulnerable in society. An inclusion criteria means groups of patient who have certain attributes such as over 18 or have certain symptoms which can have treatment from a PGD authorised clinician. Conversely, exclusion criteria are the oposite, exclusion criteria specify attributes of patient which cannot be treated under the PGD. 

Inclusion / exclusion occurs in all PGDs, an example of which are heart conditions and Erectile Dysfunction PGDs. Sildenafil (Viagra) was originally created as a heart medicine, it was found during the clinical trials that patients often had an "embarrassing" side effect, prolonged erections. Sildenafil proved extremely useful as a male impotence drug, however if it was given to a patient with High Blood pressure or a patient taking a complicated heart medicine regime it may adversely interact with the patients condition. If Sildenafil were prescribed to a patient with heart complications it would require a specialist who know the exact ins and outs of the patients condition. As authorised clinicians who use PGDs can sometimes be inhibited by lack of patient information and do not have the specialist knowledge needed, patients with heart conditions are usually excluded from access to medicines via PGDs and referrals are made.

Inclusion / exclusion criteria are not infallible. There may be undiscovered categories of patients with certain medical conditions which would have a higher predisposition to side effects and should not take the drug. This is why PGDs are normally restricted to those drugs which have a long history of patient safety.

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.

Free PGD

We are still offering a free Hair Loss PGD to all pharmacists who register. This is for a limited time only so be quick!

UPDATE: The PGD will now only be available for the next 2 weeks so be quick, remember there is no obligation, all you need to do is register as a pharmacist.