From Mrs M. C. Allen, FRPharmS
SIR,—Jo Raffaitin's article on patient group directions and the law (PJ, December 9, p851) provides a clear and useful summary of the recent legislative changes.
However, it contains a small omission in that the changes, which apply to National Health Service bodies, etc, also apply to voluntary sector activities funded by the NHS. I have no idea of the scope of such voluntary sector activities in general, but am very aware that there are around 200 voluntary sector hospices receiving NHS funds for patient care and which are 100 per cent funded for medicines and pharmaceutical input.
In our hospice, we started drafting our PGDs for a small number of drugs some months ago in anticipation of the changes. The medical and nursing staff were aware that, although most patients' actual and anticipated medicine needs were provided for and prescribed as regular or prn use, there might be occasions, (usually out of hours) where an experienced specialist nurse might usefully initiate a specific medicine for a symptom with which she was familiar. PGDs provide a tight framework, supported with training, to introduce this safely in the hospice.
Some pharmacists have expressed the view that PGDs do not apply to hospices because they are registered under the Registered Homes Act as nursing homes, or because they are not part of the NHS. However, voluntary hospices differ from most homes eligible for Registered Home Act registration, first, because they are voluntary sector establishments and, second, because most, if not all, hospices employ at least one full time doctor, usually a specialist in palliative care.
I have checked with Colin Pearson at the NHS Executive in Leeds and he has confirmed that the provisions for PGDs do apply to voluntary sector hospices which receive NHS funding for medicines, but that they should be signed by someone representing the NHS funding agency (ie, the local health authority or primary care group or trust), in addition to the other required signatures.
Mary Allen Clinical Pharmacist, Hospice of St Francis, Berkhamsted, Hertfordshire