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The Pharmaceutical Journal
Vol 268 No 7181 p45-49
19 January 2002

PGDs to be extended beyond the NHS

Patient group directions will be available to cover work in police custody suites

Patient group directions, which are currently restricted to health professionals working in the National Health Service, are to be extended to private, charitable and voluntary sector hospitals and to prisons, police custody suites and the defence medical services. Care homes are excluded from the proposed extension.

Consultation letter MLX 278 (PDF* 45K), issued by the Medicines Control Agency on 9 January says that the criteria for PGDs in the new sectors will largely be the same as for NHS PGDs. The differences lie in the final authorising signatory for the body taking legal responsibility in each case.

For prisons, this will be the prison governor (in England and Wales), the director of rehabilitation and care (Scotland) or director of services (Northern Ireland). In the case of police forces, the chief constable or a representative of the chief constable's office will have to sign. PGDs developed for use in the medical services of the three armed forces will need to be approved on behalf of the relevant single service medical director general or agency chief executive.

Police and prison nurses to use PGDs

Police and police custody suites have been included in proposals to extend the use of patient group directions beyond the National Health Service because the two services want to employ nurses to provide some health care rather than rely on contracted GPs and external NHS resources.

A Medicines Control Agency spokeswoman said that the standard of health care provided to police detainees and also to victims of crime was a matter of general concern to the Government. In England and Wales, there was a momentum within the police service to employ nurses in some custody suites, although none were yet in post, and for them to work under PGDs to supplement arrangements with police surgeons (contracted GPs).

The prison service also has plans to employ nurses and for them to be able to work under PGDs. Pharmacists are already employed by the prison service and will be eligible for inclusion in PGDs.

Both services sought inclusion in PGD arrangements introduced in 2000 (PJ, 12 August 2000, p219) but were excluded because of difficulties in identifying who should sign PGDs on behalf of the organisation legally responsible for providing the service. Defence medical services, which have been included in the latest proposals, were excluded in 2000 for the same reason.

The proposal for final authorisation of PGDs in independent hospitals and clinics is that they should be signed off by the person registered as running the hospital under the Care Standards Act 2000 and the local manager registered under Regulations arising from the Act. If more than one person is registered, each will have sign the PGD.

There is likely to be a separate consultation by the Home Office about a proposal to allow non-injectable Schedule 4 and 5 Controlled Drugs, with the exclusion of anabolic steroids, to be included in PGDs. It is also possible that specialist nurses working in accident and emergency departments and coronary care units will be allowed to use diamorphine under PGDs. The Advisory Council on the Misuse of Drugs has agreed in principle to the changes, but the timescale has not been decided.

In addition to views on the proposals, the MCA is seeking answers to four specific questions. They are: how should clinical governance operate in the independent sector; should external bodies, such as local prescribing committees be involved; how should pharmacist input be achieved if none are employed by the organisation; and how should microbiological advice be given in respect of antibiotics?

Comments can be sent to Anne Ryan, 16-42, MCA, Market Towers, 1 Nine Elms Lane, London SW8 5NQ (e-mail ann.ryan@mca.gov.uk) until 10 April.

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