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Patient Group Directions


Our work to review Patient Group Directions ensured an immunisation programme in the West Midlands continued without interruption.


Patient Group Directions (PGDs) are written instructions that allow health professionals to supply and/or administer specific medicines to a pre-defined group of patients, usually in planned circumstances. They offer multiple benefits to patients, including providing equity in the availability and quality of services, reducing delays in treatment and improving access to medicines. They are often used for immunisation programmes.

In April 2013, Clinical Commissioning Groups (CCGs) took over responsibility for immunisation PGDs from Primary Care Trusts (PCTs). At the same time, the commissioning of sexual health services transferred from PCTs to local authorities. Four CCGs in Birmingham, Solihull and Wolverhampton found that some of the immunisation PGDs were going to expire shortly. Four local authorities in the West Midlands faced similar problems with some of the sexual health PGDs. To ensure that the immunisation programme could continue without interruption, the PGDs needed to be reviewed urgently.


The four CCGs and four local authorities turned to NHS Midlands and Lancashire Commissioning Support Unit (CSU) for help in solving these problems. The CSU has a multidisciplinary group made up of experienced pharmacists, nurses, a doctor and a microbiologist, who develop and review PGDs. They use a robust process, which follows legislative requirements and good practice.

PGDs take a significant amount of time and resources to develop or review. However, we completed the review of the first set of PGDs – 15 in total – within four months. At the end of the whole process, we had reviewed and/or developed 50 across the eight client organisations. This included updating sexual health PGDs for GPs and pharmacists and creating a new PGD for stop smoking services for Birmingham City Council.

In addition, we supported some of our clients with:

  • Training nurses and community pharmacists on the principles of PGDs
  • Validating community pharmacists using PGDs for emergency hormonal contraception.


Our clients were very happy with our robust process and quick turnaround time. As a result of our work, patients continued to receive all the services that needed PGDs – including routine immunisations, travel vaccinations and sexual health – with no disruption.

We continue to support our clients with PGDs. For example, the CCGs were so pleased with our previous work that they recently asked us to review their travel vaccination PGDs.

We were very pleased with the work the CSU carried out for us. The team provided a work plan detailing when PGDs would be completed and the level of work required. They met all deadlines and kept us up to date regularly with progress of the work. The CSU also provided us with excellent advice and guidance in relation to PGDs in general. Staff were knowledgeable and approachable – great to work with.
Jennifer Finch, Contracts and Quality Officer, Birmingham Public Health

The training and support provided by the CSU were second to none. I felt fully informed all the way up to, and including, the evening itself. I look forward to more successful sessions in the future.
Keren Hodgson, Project Co-ordinator, Brook Black Country Chlamydia Screening Programme  


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