Using appropriate legal mechanisms for the administration of COVID-19 vaccines

Jo Jenkins, Specialist Pharmacist (Patient Group Directions) SPS Medicines Use and Safety Division Published

Using an appropriate legal mechanism to administer COVID-19 vaccines is important. Common clarifications will be updated here regularly based on user feedback.

Introduction

All injectable medicines are Prescription Only Medicines (POM). Therefore they must be prescribed prior to administration or administered under an alternative legal mechanism.
Our remit as part of the programme is to make available to health care professionals in England information and advice to inform local decision making as part of the pharmaceutical oversight required by the vaccination programme.
Below we signpost to resources on these various alternative legal mechanisms, and also outline common points of clarification concerning their use for COVID-19 vaccination. This page should be read in conjunction with NHS England’s Summary of the legal mechanisms for administering the COVID-19 vaccine(s).
Our points of clarification are based on feedback. If you have further issues you feel we should address get in touch so we can update the page.

Option 1: National Protocol

This is the primary mechanism for the majority of deployment models. It can be used by a single registered healthcare professional undertaking all stages of the vaccination process, or by up to four registered or non-registered persons undertaking different stages. It has been introduced specifically to support the vaccination programme and is a new legal mechanism following amendment of the Medicines Regulations.

Hence, the protocol allows a wider range of suitably trained and competent persons to deliver the vaccination programme. The operational stages of activity that can be undertaken by registered and non-registered persons, are detailed in:

Common national protocol clarifications

Local authorisation

The National Protocols do not require local authorisation.

Option 2: National Patient Group Direction (PGD)

This mechanism fits the deployment method where a single registered healthcare professional undertakes the entire process. The registered HCP must be listed in the Patient Group Directions: Who can use them guidance from gov.uk.

Under a PGD all stages must be undertaken by the same registered healthcare professional; if any part of the process is undertaken by another person, then the National Protocol should be used and not the PGD.

For the national COVID-19 vaccine PGD, refer to NHS England’s:

You can find more background information about PGDs in our guide An introduction to PGDs: definitions and examples

Common PGD clarifications

Delegation

Delegation of responsibilities to another healthcare professional is not permissible. All aspects of use covered by the PGD including clinical assessment, reconstitution, preparation, administration, and record keeping must be undertaken only by the same registered healthcare professional working under this direction.
See our guide Delegation of supply under a PGD.

Local authorisation

The national PGDs do not require local authorisation.

Doctors, dentists, and PGDs

Doctors and dentists cannot work under a PGD. See our guide Doctors, dentists, and use of PGDs.

Option 3: Patient Specific Directions (PSDs)

Where an individual falls outside the inclusion criteria stated in the National Protocol or PGD, they need to be clinically assessed on an individual basis to receive vaccine by a prescriber. If this results in a decision to vaccinate, a PSD should be used.
For background on PSDs, refer to our guide Questions about Patient Specific Directions.
With specific reference to COVID-19 vaccination, NHS England has produced a PSD proforma in appendix B of NHS England’s Legal mechanisms for administration of the COVID-19 Vaccine(s).

Common PSD vaccination clarifications

Registered healthcare professionals that can write a PSD for COVID-19 vaccination.
In line with advice the advice contained in NHS England’s Summary of the legal mechanisms for administering the COVID-19 vaccine(s) only doctors, independent nurses or pharmacist prescribers can write PSDs for COVID-19 vaccinations. Other non-medical prescribers cannot prescribe unlicensed or medicines authorised under Regulation 174.

Use for health and social care staff

A PSD is a suitable mechanism to vaccinate health and social care staff. See also Questions about Patient Specific Directions.

Use at mass vaccination sites and in Primary Care Network (PCN) designated sites

A PSD is a suitable mechanism to vaccinate eligible individuals at mass vaccination sites and in PCN Designated Sites. See also Questions about Patient Specific Directions.

Use of a PSD including when the prescriber is working remotely

A PSD is a suitable mechanism for use by prescribers, including those working remotely, across PCN sites. However, the prescriber must:

  • accept their duty of care and professional and legal accountability—they should ensure that the person to whom they delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved.
  • the practitioner issuing the PSD remains responsible for the care delivered under it and should be contactable should issues arise.
  • be mindful that the delivery model may require Regulation 3A The Human Medicines (Coronavirus) (Further Amendments) Regulations 2020 to be met (i.e. where the vaccine is not prepared and administered by the same person acting under the PSD).

Other mechanisms: Written Instructions

Common written instruction clarifications

Vaccinating health and social care staff using a written instruction

A written instruction is not the correct mechanism for the provision of COVID-19 vaccination to health and social care staff.
This is because all COVID-19 vaccination is part of the nationally commissioned vaccination programme and is not being provided as an Occupational Health Service (OHS). Therefore the mechanism for health and social care staff vaccination will be via the national protocol or national PGD.