A Patient Group Direction (PGD) is a written instruction for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.
The part of the definition of a PGD that states ‘patients who may not be individually identified before presenting for treatment’ should not be interpreted as indicating that they must not be identified. The intended meaning is that patients may/or may not be identified, depending on the circumstances. For example, repeat supply of contraception where patients may be known to the service from a previous episode of care.
Patient group directions (NICE guideline MPG2, 2017) states that the majority of clinical care should be provided on an individual, patient-specific basis. The supply and administration of medicines under PGDs should be reserved for those limited situations where this offers an advantage for patient care (without compromising patient safety), and where it is consistent with appropriate professional relationships and accountability.
PGDs allow specified health care professionals to supply and / or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.
Using a PGD is not a form of prescribing. The supply and/or administration of medicines under a PGD cannot be delegated .
Since PGDs were introduced in 2000, their use has been established appropriately in a number of circumstances where groups of patients who may not have been previously identified present to e.g. minor injury units and other first contact services. Use of PGDs has also been well established in services where assessment and treatment follows a clearly predictable pattern (e.g. NHS immunisation clinics and contraception and sexual health services).
In general, a PGD is not meant to be a long-term means of managing a patient’s clinical condition. This is best achieved by a health care professional prescribing for an individual patient on a one-to-one basis.
Organisations should have policies and processes in place to consider all aspects of medicines management for patients within the service or pathway. Before a service is designed or commissioned using PGDs and before a PGD is developed, you must ensure that PGDs are appropriate, legal and that relevant governance arrangements are in place.
Although PGD legislation, and thus the use of PGDs, has been around for many years, there are many complex issues relating to PGDs that must be considered as the organisational landscape of the commissioning and provision of healthcare has changed and continues to do so.
For more information about PGDs, legal requirements and national guidance, see To PGD or not to PGD