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Give GPs freedom to sign-off patient group directions, says BMA

Exclusive GPs should be given the freedom to widen the range of prescription-only medicines or vaccinations practice nurses are able supply to patients without sign-off from NHS managers, says the BMA in its official response to new rules on patient group directions (PGDs).

In its response to a consultation held by NICE, the BMA ‘strongly recommended’ GPs should be included in the bodies that can develop PGDs for supplying prescription-only medicines or vaccinations, in a move it said would allow practices to better respond to their patients’ needs.

It also recommended that GPs were not subject to new requirements for training before developing PGDs, and that certain medicines that require careful monitoring - such as salbutamol inhalers or erectile dysfunction treatments - are declared off-limits to PGDs.

The consultation comes after NICE noted that some PGDs have been developed without proper approval, and after controversial PGDs used in pharmacies saw them selling antibiotics and salbutamol inhalers over the counter, prompting the Department of Health to intervene.

NICE is currently developing new rules for the development and approval processes needed before a PGD is used, but the BMA said it was ‘disappointed’ that the proposed guidance was too onerous and complicated to follow.

Currently general practices have to ensure PGDs are counter-signed by a designated authorising body, such as a CCG, NHS trust or NHS England, but the BMA said it wished for this stipulation to be removed as it is for dentists and some private providers.

The BMA’s response states: ‘We strongly recommend that general practices are included in the bodies that can develop PGDs, especially given that even private healthcare organisations are now able to do so.’

Dr Bill Beeby, chair of the GPC clinical and prescribing subcommittee and a GP in Middlesborough, said GPs should be able to create and sign off new PGDs themselves, without getting the all-clear from anyone higher up.

Dr Beeby said it was partly about ‘levelling the playing field’, as GPs had less flexibility than pharmacies and other organisations working alongside general practice to develop appropriate PGDs for their populations.

He told Pulse: ‘I think that most of my colleagues would like to see a little more liberalisation of the rules on PGDs so it easier [for GPs] to create them, although there still has to be responsibility and governance.

‘We would like to make it clearer and it easier for GPs to do it – which would be better for patients as well. Things like holiday vaccinations are a good example where the world changes, but the PGD that’s written doesn’t.

‘Practices may want to be flexible and you don’t want be restricting [GPs], you want to be helping them to move forward and liberalising PGDs [in this way] would be good for the NHS,’ he added.

In addition to greater clarity on who can write PGDs, the BMA also calls for certain drugs and conditions to be exempt, where for instance the frequency of prescriptions needs to be closely monitored or investigations are needed before prescribing, such as with salbutamol inhalers and drugs for erectile dysfunction.

Dr Beeby said this was in response to the PGDs that had been used in pharmacies. He said: ‘Remember, the pharmacy [PGDs] are not about NHS supplies, they are about selling drugs to patients – there’s a difference. Most of those developed within the NHS are about simply facilitating patients getting hold of vaccines or [necessary treatments], which is not the same.

A NICE spokesperson said: ‘Following consultation on the draft guidance, the NICE project team and guidance development group review all eligible comments. The guidance is expected to publish later this month.’

Readers' comments (4)

  • Some practice nurses already issue scripts for any commonly used meds - including salbutamol - and are not discouraged by their gps who are happy to sign them without question. Personally as a non- prescriber, I'd rather have a PGD. It's an added pain to have to get a script to get a salbutamol inhaler to do yet another pointless spirometry with reversibility to diagnose asthma in a patient who is currently well.
    A Practice Nurse!

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  • GPs can write PSDs to facilitate their patients but PGDs are a legal document and can take anything up to 6 months or longer to perfect ( at quite a large expence).

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  • PSDs are specific to one patient only and takes up GP time. PGD's are a way for the non- prescribing nurse to initiate therapy for same day consultations, to speed up the treatment. I agree GPs should be able to write them, along with adequate clinical governance, safety nets etc;

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  • Many people consider that PGDs are essential for opportunistic vaccination, and that the ability to do opportunistic vaccination is essential to achieving the levels of vaccine uptake that are needed.

    While it can be quite tricky to get a PGD right - and they do have to be right - this is much less true if you are adapting a previously existing PGD. PHE has, for example, produced a template PGD for rotavirus vaccine, and I'm told it plans to produce PGDs for fluenz and shingles vaccination.

    Groups of practices or other bodies could produce template PGDs which could be adapted by individual practices.

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