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New GPC Guidance on the use of Patient Specific Directions and Patient Group Directions.

In response to regulatory changes,  the GPC has issued updated guidance on the use of Patient Specific Directions (PSDs) and Patient Group Directions (PGDs) clearing up the confusion about the circumstances of their use, who can write them and who can approve them.

Nurses or other registered healthcare professionals (HCPs) who are not prescribers can only administer or supply prescription only medicines (POMs) if one of three instructions are in place:

1. A signed prescription.
2. A patient specific direction.
3. A patient group direction.

There are a few exceptions to this including emergency situations.

Generally in practice the administration of a POM by a non-prescribing HCP is under a PSD. It is important to note that this can be a verbal instruction. Whether written or verbal it relates to a particular patient and the instructions must be clear. A PSD can be for a signed list of patients, such as for an immunisation or a travel clinic. There is no requirement for the instructions to be defined as a PSD in the notes.

Patient Group Directions

This is an authorised, written instruction for the supply and/or administration of medicines by named health care professionals, which does not include Health Care Assistants (HCAs), to groups of patients who meet the criteria specified in the PGD. Nurse led travel, immunisation or family planning clinics are examples of where a PGD would be used giving the non-prescriber the right to prescribe or administer POMs. This right to be applicable only to situations where the assessment and treatment follows clearly predictable and predefined patterns.

The guidance gives the particulars that must be included in a PGD, who can write them (the practice can but must include a senior doctor and a pharmacist)) and who can authorise them: the CCG, the Local Authority and NHSE only.

A PGD can only be signed off by the appropriate authorising body: the CCG, the Local Authority or NHS England. The regulations do not require these bodies to write the PGD. One of the important roles of your local LMC here is to ensure that the authorisation is not inappropriately obstructed. Your LMC will also support you by providing advice to practices seeking to write their own PGD and ensuring that CCGs do not unreasonably withdraw PGDs or allow them to go out of date without renewal.

Contact Londonwide LMCs for support.

Last updated : 17 Feb 2016

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