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Medicines Governance Do Once Programme – National Patient Group Directions (PGDs)

The Medicines Governance Do Once Programme aims to develop a national system for organizational medicines governance, including standardized medicines policies, patient group directions, and other essential governance documents. This program is based on recommendations from the Carter 1 and Carter 2 reports and supports NHS England's Specialist Pharmacy Services and regional medicines optimization committees. The initial focus will be on developing PGDs, with plans to expand to other policies. Stakeholder engagement and collaboration with national guidance authors will be key in implementing this program.

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Medicines Governance Do Once Programme – National Patient Group Directions (PGDs)

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  1. Medicines Governance Do Once Programme – National Patient Group Directions(PGDs)

  2. Key Drivers Carter 1 report recommendations based around efficiency and productivity Carter 2 report: Recommendation 11 – Medicines and Pharmacy Optimisation states: NHS England’s Specialist Pharmacy Services and the regional medicines optimisation committees developing a national ‘do once’ system for organisational medicines governance, including national standardised medicines policies, patient group directions and other essential organisational governance documents during 2018/19. Medicines Value Programme NHS Long Term Plan

  3. Where to start? Paper to RMOC to agree the governance structure The MGDO Secretariat is accountable to the RMOC who will approve all output prior to release. Initial focus PGDs, then begin work on policies PGDs will be developed by Short Life Working Groups (SLWG) made up of nationally recognised subject matter experts (SMEs)

  4. Governance Structure

  5. Background work PHE immunisation PGD templates – introduced in 2013 Pan-London initiative (2011) – standardisation of PGDs for sexual health services Specialist Pharmacy Service scoping exercise of PGDs used for administration/supply of antimicrobials

  6. Background to abx PGD scoping • Scoping exercise undertaken to explore the extent to which PGDs are used to supply antimicrobials within NHS services and determine whether there are areas of duplication that would meet the principles of operational productivity and performance in the NHS. • Requests made to 44 NHS organisations between November 2017 and February 2018 – spread of organisation type and geography. • 22 organisations responded (acute, community and mental health trusts), 18 of whom used antimicrobial PGDs submitting a total of 199 PGDs.

  7. Variation • There was significant variation in the quality of PGDs across the organisations in the cohort • Examples included: • a single PGD for the supply and administration of ‘sexual health medication’ to treat multiple clinical conditions. • a PGD for multiple treatments is not in line with NICE guidance. • incomplete information relating to the antimicrobial agent such as strength and quantity to supply. • inclusion criteria made reference to internal organisation guidelines and therefore relied on the guidelines and PGD being updated simultaneously.

  8. Duplication • Across the responding 18 Trusts who had antimicrobial PGDs there were 199 PGDs for provision of antimicrobial therapy. • By removing duplication this could be reduced to 33. • Highlights the significant operational burden of PGDs.

  9. Work Plan Look at areas where PGDs are not required: Supply of medicines that are GSL Administration of GSL and P medicines Schedule 19 exemptions Schedule 17 exemptions for healthcare professionals Guidance Published here Initially the focus will be: Ambulance trusts Antimicrobials Reproductive and Sexual Health National guidance must be available

  10. How will it work? • Stakeholder engagement is key • Working with the authors of national guidance • We have established a process (published on our website) • Process well received by first SLWG (ambulance work stream) • Clinically signed but require authorisation by organisation as per HMR 2012

  11. Antimicrobial PGDs • Lower UTI – nitrofurantoin (SLWG in place) • Suspected meningococcal disease – benzylpenicillin • Sexual health – stakeholder meeting September

  12. Issues • Pack sizes • The use of PGDs in care pathways where a prescriber would be more appropriate The majority of clinical care should be provided on an individual, patient-specific basis, where a prescriber assesses the patient and then makes the decision to prescribe a medicine either for administration or for dispensing to a patient. • Surveillance data from PGDs • A back-up (delayed) prescription option dos not fit with the PGD requirement to supply or administer

  13. Questions? Find out more at: https://www.sps.nhs.uk/articles/medicines-governance-do-once-programme/

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