× NICE uses cookies to make the site better.  Learn more
A-Z
Topics
Latest

Patient group directions

About

What is covered

This pathway covers the systems and processes to develop, authorise, use and update patient group directions. This pathway also covers governance arrangements with the aim of ensuring patients receive safe and appropriate care and timely access to medicines, in line with legislation.
A patient group direction is defined in Health Service Circular (HSC 2000/026) as 'Written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.'

Updates

Updates to this pathway

17 August 2015 Link to NICE pathway on antimicrobial stewardship added.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on systems and processes to develop, authorise, use, and update patient group directions in an interactive flowchart

What is covered

This pathway covers the systems and processes to develop, authorise, use and update patient group directions. This pathway also covers governance arrangements with the aim of ensuring patients receive safe and appropriate care and timely access to medicines, in line with legislation.
A patient group direction is defined in Health Service Circular (HSC 2000/026) as 'Written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.'

Updates

Updates to this pathway

17 August 2015 Link to NICE pathway on antimicrobial stewardship added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Patient group directions (2013) NICE guideline MPG2

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

NICE has produced resources to help implement its guidance on:

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

in most cases, the pack to be issued under a patient group direction will need to be labelled to reflect the dose exactly as authorised in the patient group direction, as if it were being dispensed against a prescription (separate requirements exist for prescription-only medicines (POMs) and for Pharmacy (P) and General Sales List (GSL) medicines); in practice, medicines supplied for use under a patient group direction are often in packs that are pre-labelled by a licensed manufacturing unit – these labels include all the standard labelling requirements, leaving a space on the pack for the patient's name, date of dispensing and address of the supplying service to be added at the time of supply, this is sometimes known as over-labelling
an organisation listed in the legislation that is legally able to authorise a patient group direction; the commissioning and/or provider organisation may be an authorising body (in the NHS in England, these organisations are clinical commissioning groups, local authorities, NHS trusts or NHS foundation trusts, special health authorities, and the NHS Commissioning Board)
licensed medicines that are intensively monitored and subject to special reporting arrangements for adverse events
supply and/or administration of a medicine must not be assigned or delegated to any other person under a patient group direction, regardless of their professional group or level of training; for example, if the medicine is to be administered under a patient group direction, such as influenza vaccination, this should be by the same health professional that assessed the patient under the patient group direction
healthcare-associated infections can develop either as a direct result of healthcare interventions, such as medical or surgical treatment, or from being in contact with a healthcare setting; the term covers a wide range of infections, including those caused by meticillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C. difficile) and Escherichia coli (E. coli)
a medicine that has a UK marketing authorisation
medicines that meet the standards of safety, quality and efficacy are granted a marketing authorisation (previously referred to as a 'product licence') (this authorisation covers all the main activities associated with the marketing of a medicine); in the UK, a marketing authorisation is granted by the Medicines and Healthcare products Regulatory Agency (MHRA)
Non-medical prescribers include independent prescribing by specially trained nurses, pharmacists and optometrists working within their clinical competence (legislation is being amended to extend independent prescribing responsibilities to specially trained podiatrists and physiotherapists) and supplementary prescribing by specially trained nurses, midwives, optometrists, pharmacists, physiotherapists, podiatrists and radiographers
using a UK licensed medicine outside the terms of its marketing authorisation, such as outside defined indications, doses or routes of administration, for example, when amitriptyline is used for neuropathic pain
a locally determined multidisciplinary group established for each individual patient group direction – the working group is responsible for developing the patient group direction and its subsequent review and updating; other names for the group may be used locally
a locally determined multidisciplinary group that considers proposals to develop a patient group direction to deliver a service; this group may also be involved at other stages of the process, depending on local arrangements (for example, the group may approve a final draft of the patient group direction before it is submitted for authorisation); other names for the group may be used locally and the group may be an existing local medicines decision-making group, such as the drug and therapeutics committee, or subgroup
written information on a licensed medicine that must contain certain numbered headings and information, such as the indication(s), recommended dose(s), contraindications, and special warnings and precautions for use

Paths in this pathway

Pathway created: December 2014 Last updated: November 2016

© NICE 2017

Recently viewed