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At the heart of general practice since 1960

Patient group directions a help not a hinderance

Dr Nicholas Norwell, medicolegal adviser at the Medical Defence Union, explains the potential advantages of patient group directions

ntil August 2000, there was uncertainty and confusion about the interpretation of the Medicines Act 1968. It was not clear if nurses could legally administer drugs to patients who were not individually identified before presenting themselves for treatment. In 1968 nurses had little autonomy; the question of a nurse administering a drug 'on her own' ­ that is without a signed prescription from a doctor ­ did not arise.

The Medicines Act did not address the issues of nurses making decisions.

The introduction of patient group directions in Health Service Circular 2000/26 issued on August 9, 2000, and its attendant legislation, changed all that. Now, not only do nurses have the reassurance, the clarity and the certainty they are acting within the law when administering a drug under a direction, they are actively involved in drawing them up.

Nurses are able legally for the first time to administer, for example, childhood and travel immunisations or contraceptive medication to patients without the need for a prior prescription from a doctor.

Patient group directions arose from the Crown report published in 1998 which recommended clarification of the legal position. Each direction is a statement of which condition can be treated with what medication by whom ­ see right for the information in full.

Most clinical care is still provided on an individual basis and patient group directions should be reserved for limited situations where they offer an advantage for patient care.

The patient group direction is drawn up by the doctors, nurses and pharmacists who will implement it. It must be signed by a senior doctor and a senior pharmacist, both of whom should have been involved in developing it.

It must be authorised by the appropriate PCO. It must have an expiry date, after which it could be discarded or modified.

So, are there any problems? Well, it takes a certain amount

of effort to set up, but probably little more than in setting up any other in-house protocol. The clarity and certainty a patient group direction brings can reassure you, the nurse and your patients. Also there is no risk of prosecution for this reason

under the Medicines Act once a properly set-up direction is in place.

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