PGD templates for commonly supplied/administered methods of contraception have been developed by an SPS led working group with support from the FSRH.

SPS and the Faculty of Sexual and Reproductive Health (FSRH), with the support of specialist stakeholders working within clinical practice, have produced PGD templates for contraception commonly supplied or administered within reproductive services.

The aim of these templates is to produce a consistent presentation which has been reviewed by specialists within reproductive health. They have ensured that the legislative and clinical parameters have been fully considered.

The PGD templates may require local adaptation to reflect local policies, commissioning arrangements etc – the areas of each PGD template requiring local adaptation are highlighted in blue throughout each PGD template.

The PGD templates contain advisory text (highlighted in yellow) intended to support the adoption of the PGD – all text in yellow highlight should be removed from final versions of the PGDs.

Each organisation using these PGD templates must ensure that it is clinically signed by a senior pharmacist, a senior doctor and any other professional group representatives involved in its use and that it is reviewed in line with the organisation’s PGD governance system. The organisation’s governance lead (or nominated deputy) must sign to authorise the PGD on behalf of the authorising organisation to ensure that this document meets legal requirements for a PGD. See SPS website or NICE guidance for further guidance on signatories.

It is intended that these templates will be reviewed and re-released prior to reaching their expiry date. If any relevant changes occur to the product SPC or other guidance then an earlier review will be undertaken. Any decision to locally extend a stated expiry date needs to be locally assessed and agreed as per the organisation’s local policy

The following PGD templates are available:

  • Supply and/or administration of levonorgestrel 1500micrograms tablet(s) for emergency contraception
  • Supply and/or administration of ulipristal acetate 30mg tablet for emergency contraception
  • Supply of a progestogen only contraceptive pill (POP)
  • Supply of a combined oral hormonal contraceptive (COC)
  • Supply of combined hormonal contraceptive transdermal patch
  • Supply of combined hormonal contraceptive vaginal ring
  • Supply and/or administration of subcutaneous medroxyprogesterone acetate (SC-DMPA) injection
  • Administration of intramuscular (IM) medroxyprogesterone acetate (DMPA) injection
  • Insertion of the Progestogen-Only Intra-Uterine System (IUS)
  • Insertion of etonogestrel (e.g. Nexplanon®) 68mg subdermal implant for contraception
  • Administration of lidocaine hydrochloride 1% injection to facilitate insertion and/or removal of subdermal etonogestrel (e.g. Nexplanon®) implant

Reflecting the current pandemic situation the CHC PGD templates listed above contain additional advice about undertaking remote consultations where clinical monitoring parameters (BMI and blood pressure) should be obtained prior to a supply being made and how this can be managed in practice in these exceptional circumstances.

SPS have also developed PGD templates for use in sexual health services which can be found at the link below.

The full national PGD template work plan can be found on the Medicines Do Once Programme page which can be found here.


Change history

  1. Implant PGD - minor additional wording in 'Special considerations' sections re possible complications or insertion
  1. Lidocaine PGD updated to clarify doses for removal/insertion and maximum doses reflecting FSRH 2021 guidance.
  1. CHC vaginal ring PGD updated to clarify composition of SyreniRing product
  1. IUS PGD updated due to product SPC change (Levosert ®)
  1. Published