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A step-wise guide to urgent supply under the new PGD
The following steps to using the urgent provision patient group
direction are adapted from a more detailed version produced by
NHS Scotland:
· Pharmacist interviews patient or representative to determine
eligibility for supply using PGD
· Pharmacist fills out CP(US) form with details of the patient,
pharmacist and patient’s GP
· Pharmacist adds details of medicines supplied, including drug
name, form, quantity and dosage instructions
· Medicine is labelled and supplied, and patient medication record
is annotated to indicate an urgent supply
· Patient or representative signs CP(US) form — normal NHS
prescription charges and exemptions apply
· Pharmacist explains that a second successive supply of medicine
is not allowed using the PGD
· Pharmacist stamps and endorses prescription
· Copy of CP(US) form is sent to patient’s doctor so that
patient’s medical record can be annotated
· CP(US) form is sent to Practitioner Services with normal prescription
bundle for processing |
Ask a community pharmacist what is the worst thing about GPs’ surgeries
closing on Saturdays and the answer will invariably be the increased
demand for emergency supplies. Bank holidays exacerbate the problem.
The example (PJ, 16 April, p441) of a pharmacist who received 143
requests for emergency supplies over the Easter bank holiday may be extreme but
there is little doubt that such supplies have increased since the start
of the new GP contract.
The current emergency supply regulations allow pharmacists to provide
patients with up to five days’ supply of their regular medicines.
This is a useful tool but one which is fraught with difficulties. Many
pharmacists resort to snipping a few days’ worth of tablets from
a patient pack and supplying that in advance of the prescription, dispensing
the remainder when the patient returns prescription in hand. Legalities
aside, this double-dispensing is time-consuming with no financial reward.
NHS Scotland has decided to tackle the problem. Its solution is a national
patient group direction (PGD) that allows pharmacists to provide patients
with the quantity of medicines they would normally get on a repeat prescription.
Bill Scott, chief pharmaceutical officer in Scotland, says: “This
initiative will allow pharmacists to provide continuing care, working
in partnership with their GP colleagues and help patients to get access
to the medicines they require during GMS out-of-hours periods. This is
yet another step towards closer working between GPs and community pharmacists.”
NHS24 will have overall responsibility for the PGD. Its national pharmaceutical
adviser, Harry McQuillan, comments: “Pharmacists will now have
the opportunity fully to utilise their professional skills in providing
continuity of pharmaceutical care to their patients who receive repeat
medicines under the auspices of the NHS in Scotland through participation
in this initiative.”
What the PGD involves
The PGD allows pharmacists to supply almost any medicine to a patient
who normally obtains repeat prescriptions for it. There are some exclusions:
mainly injectable drugs and medicines that are used only in acute situations,
plus most Controlled Drugs. But overall, the PGD includes nearly everything
in the BNF and the BNF for Children.
There are restrictions to how and when the PGD can be used. First,
it is only an option when a patient’s GP is unavailable, the surgery
is closed or an out-of-hours system is operating. Since it was developed
for NHS Scotland, the PGD can only be used for patients registered with
an NHS GP in Scotland. And the patient must have had the medicines before
on a repeat prescription. If his or her clinical condition has changed
since the most recent dispensing, then an urgent supply via the PGD would
be inappropriate. Patients cannot have two successive supplies using
the PGD: they must have a regular prescription from their GP in between.
Patients can be referred to a pharmacist for a supply using the PGD,
perhaps by NHS24, an out-of-hours service, a GP or an accident and emergency
department. But it will be the pharmacist’s responsibility to ensure
that it is an appropriate situation in which to use the PGD. As such,
it is important to remember that pharmacists are not obliged to make
a supply: it is down to an individual pharmacist’s professional
judgement. However, the consequences of not making a supply need to be
considered. Furthermore, having the urgent provision PGD in place does
not mean that the existing emergency supply route is no longer an option.
In some cases, it might be more appropriate. The PGD recognises this,
stating that if a pharmacist decides that use of the PGD is inappropriate,
then he or she should either make an emergency supply, recommend an over-the-counter
medicine or refer the patient to an out-of-hours service.
If the pharmacist decides to make a supply, the details will need to
be recorded on a new prescription form — a community pharmacy urgent
supply form, or CP(US). This form has multiple purposes. It provides
a standard way in which to communicate urgent supplies to the GP, is
submitted to Practitioner Services for payment and forms part of the
audit trail. The pharmacist will record the patient’s details,
community health index (CHI) number, the medicines dispensed (including
form, strength, dose and quantity) and details of the patient’s
GP on the CP(US) form.
Although overall responsibility for the urgent provision PGD lies with
NHS24, local implementation falls to NHS boards. Pharmacists will only
be allowed to use the PGD if they have been authorised to do so by their
local NHS boards. Making use of the PGD
Pharmacists have long called for access to patients’ medical records.
The decision to make an emergency supply is complicated by the fact that
pharmacists do not have this access: records provide proof that a patient
really is taking a particular medicine.
The PGD does not solve this problem. But most requests for “emergency
supplies” are from patients whom pharmacists know: those who visit
the pharmacy on Saturdays with tales of forgetting to order their repeat
or to collect the prescription from the surgery. The situation is so
common that many pharmacists think of these situations not as emergency
supplies but as “advances” on prescriptions. For these patients,
for whom a record of their regular medicines exists on the pharmacy computer,
the PGD comes into its own. A full supply can be given, the double-dispensing
of “advances” can be avoided, and pharmacists can gain recognition
for a professional out-of-hours service. If the patient is unknown then
some pharmacists will prefer to stick to a more limited emergency supply.
But there is little doubt that having the option of the urgent provision
PGD is a significant step forward for the practice of pharmacy in the
out-of-hours period. |
The
Pharmaceutical Journal