Patient Group Directions (PGDs)
Legal frameworks that authorise qualified healthcare professionals to supply and administer specific medicines to defined patient groups without an individual prescription.
What it is
About Patient Group Directions (PGDs)
A Patient Group Direction (PGD) is a written instruction for the supply or administration of a licensed medicine (or a limited range of unlicensed medicines) to a defined group of patients, signed by a doctor or dentist and a pharmacist and authorised by the employing organisation. PGDs allow certain registered healthcare professionals — nurses, paramedics, pharmacists, physiotherapists, radiographers, and others — to supply or administer a specified medicine to patients who meet defined clinical criteria, without requiring an individual prescription for each patient. They are the legal mechanism that enables NHS vaccination programmes (flu vaccine, COVID-19 vaccine), sexual health clinic contraceptive provision, emergency hormonal contraception in community pharmacies, and many other service models where it would be impractical or inefficient to generate an individual prescription for each patient encounter. For a Clinical Pharmacist or Nurse operating under a PGD, understanding the document itself is a legal and professional competency. The PGD specifies exactly which patients are included (inclusion criteria), which are excluded (contraindications and exclusion criteria), the dose, route, and frequency, the maximum dose, the advice to give to the patient, and the record-keeping requirements. Operating outside the PGD — supplying a medicine to a patient who meets an exclusion criterion, or supplying a different dose than specified — is not covered by the PGD and may expose the practitioner to professional and legal liability. Clinical Pharmacists who develop and maintain PGDs for their organisation must understand the regulatory framework (Human Medicines Regulations 2012) and the NHS England PGD guidance.
What you can do with it
Capabilities
Work under an influenza vaccination PGD in a community pharmacy setting — screening each patient against the inclusion criteria (aged 65+ or in a clinical risk group), checking the exclusion criteria (history of anaphylaxis to egg protein, previous severe reaction to influenza vaccine), confirming the correct vaccine lot number and expiry date, administering the correct dose and route, and completing the patient record and vaccine register as specified in the PGD
Develop a new PGD for an emergency contraception service in a community pharmacy — drafting the clinical criteria, dose and administration instructions, exclusion list, and patient information requirements in line with the NICE PGD template, submitting it for sign-off by the pharmacist and medical signatory, and having it authorised by the pharmacy's organisation before any patient is treated under it
Conduct a PGD competency assessment for a newly appointed nurse practitioner — verifying that the nurse's registration is current on the NMC register, confirming they have completed the relevant clinical training for the medicines covered by the PGD, and documenting the competency sign-off in the individual practitioner authorisation register as required by the PGD governance framework
Review an expired PGD before renewal — checking whether the licensed indications for the medicine have changed since the PGD was written, confirming that the inclusion/exclusion criteria still reflect current NICE or professional guidance, updating the medical and pharmacist signatories if the previous signatories have left the organisation, and resubmitting for organisational authorisation before the expiry date
Identify a patient who does not meet the PGD criteria during a vaccination clinic — recognising that the patient has a history of allergy to a PGD component that appears on the exclusion list, explaining to the patient that they cannot receive the medicine under the PGD today, documenting the encounter and the reason for exclusion, and referring them to their GP for an individual prescription assessment
How to learn it
Learning Resources
NICE PGD guidance (nice.org.uk/guidance/mpg2) — free; the authoritative guidance on PGD development, operation, and governance; essential reading for any healthcare professional who works under or is involved in developing PGDs
NHS England national PGD programme resources — free; national template PGDs for vaccination programmes, sexual health, and other national services; available through the NHS England website and through the National PGD Repository
RPS (Royal Pharmaceutical Society) PGD resources — free for members; guidance on the pharmacist's role in PGD development and sign-off, including the governance questions a pharmacist should ask before signing a PGD
CPPE (Centre for Pharmacy Postgraduate Education — cppe.ac.uk) — free for NHS pharmacists; e-learning module on patient group directions covering the legal framework, development process, and operation under a PGD; the module includes case scenarios of correct and incorrect PGD use
Pro Tip
The most common governance failure with PGDs is practitioners operating under an expired or insufficiently authorised document. Check three things before every patient encounter under a PGD: that the PGD expiry date has not passed, that your personal authorisation to operate under the PGD has been documented by your organisation, and that your professional registration is current. Operating under an expired PGD or without individual practitioner authorisation provides no legal protection — the encounter is treated as unlicensed prescribing.
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