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Use of patient group directions threatened

By Lilian Anekwe

GPs could see a huge increase in workload if the UK drug regulator acts on proposals to ban the use of patient group directions.

The MHRA’s review has been sparked by concerns that PGDs are being misused and that scrapping PCTs may mean they may no longer be legal in their current form.

The agency is inviting views on ‘the positive and negative aspects of PGDs generally and whether they are worth retaining in their present form’ but insists they will only be kept if there are ‘good reasons’ to do so.

One of its concerns is that PGDs are being used to ‘cope with shortages of staff with prescribing qualifications …. and may be an obstacle to non-medical prescribers attaining independent prescribing qualifications’.

There are also concerns they are being increasingly used to ‘manage planned care, as distinct from unannounced clinical need, and no longer meet the original intention that they should be reserved for those limited situations where this offers a distinct advantage for patient care.’

But the overhaul of NHS structures outlined in the White Paper has also led to worries they will no longer be legal in their current form.

‘It is also unclear who will be legally responsible for authorising PGDs once PCTs are abolished, and so the MHRA is inviting views on whether GP consortia, as the commissioning body, should have responsibility for monitoring them.’

The consultation also seeks views on whether to amend current legislation governing patient specific directions (PSDs), which currently allow medicines to be administered to an individual in a hospital or health centre, so PSDs could no longer be used in health centres – including GP practices.

It also appears to rule out any future use of PGDs to prescribe travel vaccinations or other medicines ‘that are not provided at NHS expense’.

Dr Andrew Green, a GP in Hull and a member of the GPC clinical and prescribing subcommittee, told Pulse the group would be submitting a response to the MHRA.

‘Patient group directions are useful and it’s vital that they – or a mechanism like them – are retained. They provide a legal framework to hand over work to other qualified practice staff.

‘Not only would we like to see them retained but we would also like to see amendments made to allow them to be used for private medicines like travel vaccinations, and to healthcare assistants, as it would be useful to include them in some of the work we do around flu vaccination.’

Flu vaccination is a common use of patient group directions Problems with PGDs

• ‘Development of PGDs can be time consuming and are perceived as bureaucratic.’
• ‘With the organisational changes being proposed for the NHS, we have concerns that, without amendment, the legislation will not support the use of PGDs in future.’
• ‘Who should be required to authorise PGDs? Should it be the commissioning body as they will have responsibility for monitoring the services provided?’
• ‘We take the view that there is no reason for an NHS body to take responsibility for authorising provision of a private service within the surgery.’

Source: MHRA Review of medicines legislation: informal consultation on the provisions for patient group directions and other matters, 22 October