Dr Charles Sears discusses the new legislation and guidance on drawing up patient group directions

On receiving HSC 2000/026 Patient Group Directions (England Only), I was not quite sure how it would affect my practice.

The NHS Executive were able to furnish me with a copy of HSC 1998/ 051, and an enclosed Report on the Supply and Administration of Medicines under Group Protocols5 which form the backdrop for the current guidance.

The thrust of the argument is that the majority of patient care is better given on an individual patient-specific basis, but there are a limited number of occasions where the supply and administration of medications under patient group directions (PGDs, formerly known as group protocols) offer an advantage, without compromising patient safety.

The circular points out that any current or new PGD should comply with the new legal requirements (see box below). These cover NHS bodies, including general medical practice, walk-in centres and NHS-run family planning clinics. The private and voluntary sector will be covered by further legislation.

The sort of activities to which PGDs apply are those carried out by many practice nurses, after training and with the support of reference books, etc, but frequently without written, comprehensive protocols. The report pointed out that the standards that apply in these circumstances may vary considerably, from place to place and occasion to occasion.

It is recommended that PGDs be developed at a local level, with a senior doctor and pharmacist involved in their creation. They should be signed by them and authorised by the HA, SHA, NHS trust, and PCT or PCG. It is suggested that clinical governance leads are well placed to do this. A representative of the profession carrying out the PGD should also be involved in its creation.

There are a number of areas to which PGDs apply, and one of immediate importance in general practice is the administration by nurses of vaccinations of various types.These are covered well by the green book, and a PGD would not countermand those recommendations, but augment them.

The development of PGDs locally is time-consuming and laborious, but there is a very helpful website,1 set up by the Salford Royal Hospitals Trust and the NW Regional NHS Executive, which carries examples of PGDs from around the country. It also demonstrates the way in which a PGD may be created and presented.

Certainly a written protocol to cover such procedures makes sense, but I hope we will not end up requiring more protocols merely to allow us the time to develop PGDs!

Legal requirements for all patient group directions
The name of the business to which the direction applies
The date the direction comes into force and the date it expires
A description of the medicine(s) to which the direction applies
Class of health professional who may supply or administer the medicine
Signature of a doctor or dentist, as appropriate, and a pharmacist
Signature by an appropriate health organisation
The clinical condition or situation to which the direction applies
A description of those patients excluded from treatment under the direction
A description of the circumstances in which further advice should be sought from a doctor (or dentist, as appropriate) and arrangements for referral
Details of appropriate dosage and maximum total dosage, quantity, pharmaceutical form and strength, route and frequency of administration, and minimum or maximum period over which the medicine should be administered
Relevant warnings, including potential adverse reactions
Details of any necessary follow-up action and the circumstances; a statement of the records to be kept for audit purposes

  1. http://www.groupprotocols.org.uk/

Guidelines in Practice, October 2000, Volume 3
© 2000 MGP Ltd
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