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'Unnecessary and inappropriate' PGDs should be stopped, urges Nice

Practice Commissioners should consider alternatives to PGDs, according to Nice, which claims lack of funding and staff commitment has hampered independent prescribing and led to an overuse

Nice has called for an end to "unnecessary and inappropriate" patient group directions (PGD) and urged commissioners to consider alternatives such as independent prescribing.


Lack of funding and staff commitment had hampered independent prescribing and led to the overuse of PGDs, the body argued in draft guidance released this week.


Nice said PGDs could be appropriate when patients needed urgent, unscheduled care or where medicines followed a predictable pattern

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The guidance advised commissioners to only use PGDs, which allow health professionals to supply a specific medicine without the need for a prescription, in "limited situations" where they improved patient care and did not compromise safety.


The advisory body also warned against including certain medicines in PGDs, including antibiotics.


Antimicrobials should only be used in "exceptional circumstances" where they were clinically essential and didn't jeopardise moves to combat antibiotics resistance, Nice said. In these cases, it recommended the involvement of a microbiology specialist in developing the PGD.


Commissioners should also steer clear of PGDs for managing complex long-term conditions such as diabetes, or for medicines that needed frequent dosage adjustments such as warfarin, or frequent or complex monitoring such as immunosupressants, the guidance warned.


But it acknowledged that the format could be appropriate when patients needed urgent, unscheduled care, or where medicines use followed a predictable pattern, such as contraception. Nice also gave its backing to the use of PGDs in emergency hormonal contraception and immunisation.


In addition, Nice listed a number of other situations where PGDs should be used with caution, such as black triangle medicines, controlled drugs or the supply of a range of medicines.


The "judicious" use of PGDs supported patient choice and access to care without compromising quality, Pharmacy Voice told C+D.


"There have been many benefits to date: for example, the supply of emergency hormonal contraception through pharmacies under PGD arrangements has helped prevent unplanned pregnancies," a spokesperson said.


The NPA agreed earlier this year to remove trimethoprim, doxycycline and ciprofloxacin from its PGD service, which it developed with Day Lewis, after the Department of Health raised concerns about antibiotics being included in the scheme.


The consultation on Nice's draft guidance will run until April 29 with the amended guidance expected to be published in June.



Is Nice right to restrict the range of PGDs?

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