A pan-London approach to patient group directions in sexual health services: from aspiration to reality

A patient group direction (PGD) is a legal mechanism1 that allows the supply and/or administration of a specified medicine or medicines, by named authorised health professionals, to a well-defined group of patients requiring treatment for the condition described in the PGD without the need for a prescription or an instruction from a prescriber. Using a PGD is not a form of prescribing.2 Whilst prescribing remains the preferred option for the majority of care,2 sexual health services have been dependent on this legal mechanism to supply and administer medicines in the absence of timely access to a prescriber for many years. For example, medicines may be supplied by registered nurses or pharmacists to people attending for contraception or for other unscheduled care in a sexual health clinic or in a community pharmacy for a discrete treatment episode, such as emergency contraception or treatment for chlamydia. Whilst nurses and pharmacists may now train to become independent non-medical prescribers in their own right, many services still rely on PGDs to deliver the service. Prior to 2011, contraceptive and sexual health service providers in London developed their own PGDs. It became apparent from discussions with lead nurses and doctors within the services that there were problems due to the many different versions being used and the human resource needed to develop/review PGDs on a regular basis. There was a risk of inconsistent standards of care and risks associated with practice where nurses employed in more than one organisation had to work to different PGDs. At that time, it was calculated that there were at least 30 versions of each PGD. …