A first step towards prescribing by pharmacists was taken on March 13, when the Government announced that it was to consider legislation to allow pharmacists and other health professionals to issue repeat prescriptions and adjust doses as soon as there was Parliamentary time.
Responding to the second report of the Crown review on the prescribing, supply and administration of medicines (PJ, March 13, 1999, p346), Lord Philip Hunt (Parliamentary Under-Secretary of State for Health) said in a press statement that legislation would be considered for two areas. First was to allow dependent prescribing by health professionals, such as pharmacists, physiotherapists and chiropodists, where repeat prescriptions were issued or dose adjustments made. Secondly, this could be stepped up to independent prescribing, subject to satisfactory development of the first stage.
Lord Hunt also said that the Government had decided to take forward a recommendation in the first Crown report (PJ, April 25, 1998, p581) to clarify the law on the use of group protocols, under which locally approved nurses and members of other professions supply and administer medicines, eg, in minor injury units, accident and emergency walk-in centres, family planning clinics and for immunisation programmes.
He announced a six-week consultation period, with a view to having new Regulations in place by July.
Illustrating the sort of new prescribing that nurses might be allowed to undertake, Lord Hunt said that, currently, specialist asthma nurses could conduct lung check-ups and advise on exercise and diet, but could not prescribe inhalers.
"We will push forward now to start identifying the circumstances where nurses with the right training can prescribe from a wider list of medicines," the Minister said.
The consultation on group protocols, which the Government now wants to be called patient group directions (PGDs), is being undertaken by the Medicines Control Agency. Copies of the consultation document (MLX 260) can be found in the "what's new" section of the MCA website at www.open.gov.uk/mca/mcahome.
The proposal is to amend legislation, including the Medicines Act 1968 and the Prescription Only Medicines (Human Use) Order 1997 to allow patient group directions within the National Health Service only. Sale, supply and administration of medicines under PGDs is to be restricted to certain professionals working in specific "medical businesses" (see panel).

Proposed PGD prescribers

The Government proposes to allow prescribing under patient group directions by:

• Nurses
• Midwives
• Health visitors
• Pharmacists
• Optometrists
• Chiropodists
• Radiographers
• Orthoptists
• Physiotherapists
• Medical laboratory technicians
• Ambulance paramedics.

The "medical businesses" to which PGDs would be restricted are:

• Health authorities and special health authorities
• NHS and primary care trusts
• Medical and dental practices providing NHS services
• Bodies not run by the NHS, but providing treatment under arrangements made with health authorities or trusts.

MLX 260 says that a PGD is a specific written instruction for the supply and administration or administration of a named medicine in a specific clinical situation drawn up locally by doctors, pharmacists and other health professionals, signed by a doctor or dentist and approved by an appropriate health care body. It adds that PGDs must satisfy the Medicines Act requirement for medicines to be sold, supplied or administered on the directions of a practitioner, but that there is currently uncertainty about their legality where patients are not specified by name. The PGD scheme would be expected to overcome this. Controlled Drugs would be excluded from PGDs.
MLX260 also sets out particulars that would be required in a PGD (see panel).
A Department of Health spokeswoman confirmed that PGDs would apply to hospital pharmacists and to community pharmacists where they had suitable arrangements with health authorities.

Hospital pharmacists, and community pharmacists, too, will soon be able to prescribe under "patient group directions"

Particulars to be required for a lawful patient group direction

The Government has proposed 14 components that are to be required in patient group directions.

• The name of the business to which the direction applies
• Dates of coming into force and expiry
• Description of the medicine to which the direction applies
• Signature of a doctor or dentist, as appropriate
• Signature by an appropriate health organisation
• Clinical condition or situation to which the direction applies
• Clinical criteria under which the patient is eligible for treatment
• Exclusions from treatment under the direction
• Circumstances in which further advice should be sought from a doctor or dentist
• Details of applicable or maximum dosage, quantity, pharmaceutical form and strength, route of administration, frequency and duration of administration
• Relevant warnings
• Details of any necessary follow-up action
• Arrangements for referral for medical advice
• Record keeping arrangements

There is also a requirement that particulars concerning medicines must be consistent with the product's summary of product characteristics.