When to use a PGD

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

Helping to understand the circumstances when PGDs must not be used or are otherwise unsuitable as a mechanism for supply and/or administration

Considerations before starting

PGDs must only be used where there is no other suitable mechanism for the administration or supply of the medicine within the legislation.  Careful consideration should be given to opportunities within the care pathway to use a prescription or a written Patient Specific Direction and also consider the use of exemptions.

Patient Group Directions (NICE Guideline MPG2) (2017) states that you should consider investing in the training of additional non-medical prescribers to enable redesign of services if necessary.

Must not use a PGD

A PGD cannot be used in any of the following situations.

Abortifacients

PGDs cannot be used for the supply or administration of abortifacients (Abortion Act 1967)  Further information Supply and/or administration of abortifacients under Patient Group Directions

As part of training

PGDs cannot be used for training or as part of training.  Further information Use of Patient Group Directions by registered healthcare professionals undertaking training or competency assessment

Care homes and independent schools

PGDs cannot be used by or in care homes and independent schools providing healthcare entirely outside the NHS. An NHS body or local authority cannot authorise a care home or independent school to operate under a PGD for the supply or administration of medicines.

Controlled Drugs (CDs)

Not all controlled drugs can be supplied or administered under a PGD.  Further information Supply and/or administration of Controlled Drugs under a Patient Group Direction

Dose adjustments

A PGD cannot be used to make adjustments to the dose of a medication already in an individuals possession.  Further information Using a Patient Group Direction to adjust doses of medicines

Dressings or medical devices

PGDs can only be used for medicines with a UK Medicine Authorisation – medical devices and dressings so not have such authorisations and therefore cannot be supplied or administered under a PGD.

Health professionals not registered

Where the health professional is not eligible to use PGDs i.e. is not one of the registered health professionals listed in part 4 of the Human Medicines Regulations 2012. Further advice is available regarding profession and competence.

Mixing of medicines

When two or more licensed medicines are mixed together as this results in an unlicensed medicine – unlicensed medicines cannot be supplied or administered under a PGD.  Further detail Mixing of medicines and Patient Group Directions

Radiopharmaceuticals

PGDs cannot be used for the supply or administration of radiopharmaceuticals (Administration of Radioactive Substances Regulations 1978)

Unlicensed medicines

Where the medicine is unlicensed, i.e. it does not have a UK marketing authorisation (UKMA) or a temporary marketing authorisation under Regulation 174 of the HMR 2012 granted by the MHRA.

PGD not required

A PGD is not required and should not be used in any of the following situations.  A locally produced protocol or standard operating procedure should be used instead.  Further information When Patient Group Directions (PGDs) are not required

Administration of P or GSL medicines

The administration of a P or GSL medicine does not require a PGD.

Supply of GSL medicines

A PGD is not required for supply of a GSL medicine to an individual.

Emergency administration of parenteral medicines

Medicines listed in Schedule 19 of the Human Medicines Regulations (HMR) 2012 can be administered by any person in an emergency without the need for a prescription or PGD.

Profession exemptions

A PGD is not required if the registered health professional has authority to supply or administer a medicine in accordance with Human Medicines Regulations (HMR) 2012 in the course of their professional activity as listed within the Schedule 17 Human Medicines Regulations 2012

Unsuitable for a PGD

A PGD should not be used for the following situations.

Long-term condition management

For managing long-term conditions, such as hypertension or diabetes, or when uncertainty remains about the differential diagnosis.

Information is available on the use of PGDs to initiate treatment for long term conditions.

Medicines requiring frequent or complex monitoring

Where the medicines involved require frequent or complex monitoring e.g. anticoagulant or insulin. More information can be found in NICE Guideline MPG2, 2017, recommendation 1.1.11.

Special considerations

Follow the links for specific guidance on including the following medicines into a PGD:

Further information

More information can be found in: