Patient Group Directions (PGD)

Patient Group Directions (PGDs) templates and guidance

This page provides information about Patient Group Directions (PGDs) and their use in clinical practice. Guidance, advisory documents, templates and resources can be accessed via the subheadings below.

PGD templates are available to support immunisation programmes, the antivirals for respiratory viruses programmes and components of the Clinical Community Pharmacy Service.

This page is to support NHS Wales Health Board colleagues to develop and authorise PGDs locally.

Any queries regarding the clinical content of these PGDs or advisory documents should be addressed to: welshmedicines.information@wales.nhs.uk


On this page
1. About PGDs
2. PGD templates for:

3. FAQs


Background

Patient Group Directions (PGDs) are written instructions for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.

National PGD templates produced by the Welsh Medicines Advice Service (WMAS) for NHS Wales, with input from relevant experts, such as Public Health Wales (PHW), are provided for Health Boards or NHS organisations to review, authorise and sign off locally according to their policies and governance procedures.

For the COVID-19 vaccine programme, WMAS will provide NHS Wales with template PGDs for local review, authorisation and sign off procedures.

Some of the PGD templates are provided by UK Health Security Agency (UKHSA) which can be used as a reference resource. Health Boards or NHS Organisations may use these to develop, produce and authorise their own PGDs according to local policies and governance procedures. We gratefully acknowledge UKHSA for permission to use their PGDs as reference resource. UKHSA do not allow the addition of local logos or adaptation to their PGDs.

An advisory document will only be provided by WMAS to support the UKHSA reference resource when there are policy differences in Wales. Governance and sign off of any PGD is the responsibility of each authorising organisation. Practitioners using authorised PGDs must be familiar with the relevant Summary of Product Characteristics (SmPC), Welsh policy and guidance, and national guidance, such as the relevant chapters of the Green Book for all immunisation PGDs.

Any queries regarding the clinical content of these PGDs or advisory documents should be addressed to: welshmedicines.information@wales.nhs.uk


PGD templates

Immunisations

These national PGD templates are not legal for use until adapted and authorised by the relevant Local Health Board.

Primary to pre-school age immunisations

School age immunisations

Adult immunisations

Individuals at increased risk

Seasonal influenza

COVID-19

Current national protocols

COVID-19 vaccine protocols for Wales

Seasonal influenza vaccine protocols for Wales

Antivirals

These national PGD templates are not legal for use until adapted and authorised by the relevant Local Health Board.

Chemical, Biological, Radiological and Nuclear (CBRN) hazards

These national PGD templates are not legal for use until adapted and authorised by the relevant Local Health Board.

Common Ailments Service (CAS)

The Common Ailments Service (CAS) is an NHS Wales clinical community pharmacy service for adults and children living in Wales. Patients can access advice and treatment for 26 conditions.

More information on the service can be found on its webpage. Below are PGD templates for pharmacists delivering the Common Ailment Service component of the Clinical Community Pharmacy Service. These PGDs are not legal or valid without authorisation by the Local Health Board in which they are operating.

PGD template Formulation Indication
Anusol® HCOintment and suppository Haemorrhoids
Azelastine hydrochloride 0.1%Nasal spray Allergic rhinitis
Benzoyl peroxide 5%Gel Acne vulgaris
Chloramphenicol 0.5%Eye drops Bacterial conjunctivitis
Chloramphenicol 1%Eye ointment Bacterial conjunctivitis
Clobetasone 0.05%Cream and ointment Dry skin
Clotrimazole 1% and 2%Cream Athlete's foot, fungal skin infection, nappy rash and vulvo-vaginal candidiasis
Clotrimazole 10%Vaginal cream Vulvo-vaginal candidiasis
Clotrimazole 500 mgVaginal pessary Vulvo-vaginal candidiasis
Docusate sodium 100 mgCapsule Constipation
Duac Once Daily®Gel Acne vulgaris
Fluconazole 150 mgCapsule Vulvo-vaginal candidiasis
Fluticasone furoate 27.5 micrograms per doseNasal spray Allergic rhinitis
Fluticasone propoionate 50 micrograms per doseNasal spray Allergic rhinitis
Hydrocortisone 1%Cream and ointment Athlete's foot, dry skin, intertrigo and nappy rash
Ibuprofen 10%Gel Acute lower back pain without radiculopathy
Lansoprazole 15 mg and 30 mgGastro-resistant capsule Dyspepsia and gastroprotection from NSAID treatment in lower back pain
Macrogol 3350Oral powder sachets Constipation
Mebendazole 100 mg and 100 mg per 5 mLChewable tablets and oral suspension Threadworm
Miconazole 2%Oral gel Oral candidiasis
Mometasone 50 micrograms per doseNasal spray Allergic rhinitis
Naproxen 250 mgGastro-resistant tablet Acute lower back pain without radiculopathy
Nystatin 100,000 units per mLOral suspension Oral candidiasis
Omeprazole 20 mgGastro-resistant capsule Dyspepsia and gastroprotection from NSAID treatment in lower back pain
Scheriproct®Ointment and suppository Haemorrhoids
Terbinafine 1%Cream Athlete's foot and fungal skin infection

Clinical Community Pharmacy Service

The Welsh Medicines Advice Service (WMAS) has developed these PGDs for local authorisation. To adopt these PGDs locally, please make sure that you open them in Adobe Acrobat.

These national PGD templates are not legal for use until adapted and authorised by the relevant Local Health Board.

Not found what you are looking for? If there isn’t an NHS Wales PGD template available, check the Specialist Pharmacy Service (SPS) website for their PGD templates.


FAQs

What are PGDs and PSDs and when should they be used?

Information about Patient Group Directions (PGDs) and Patient Specific Directions (PSDs) can be found on the Specialist Pharmacy Service (SPS) website:

[reviewed 07 Aug 23]

Can a Health Care Support Worker (HCSW) administer the nasal live attenuated influenza vaccine (LAIV) to a child once it has been supplied to the child by a registered nurse under a Patient Group Direction (PGD)?

Yes.  A registered healthcare professional can supply non-injectable medicines under a PGD and give these to the patient for self-administration or for administration by another person e.g. HCSW.

This means that a HCSW could administer a live intranasal flu vaccine (LAIV) to a child to whom the vaccine has been supplied by a registered healthcare professional under a PGD. The law requires that the administration of the supplied medicine is in accordance with the PGD, which needs to specify that the medicine is supplied for subsequent administration by another person (or for self-administration).

Injectable vaccines cannot be supplied in this way so a patient cannot be provided with inactivated flu, shingles and/or pneumococcal vaccine under a PGD or given to a HCSW for administration. All injectable vaccines administered by a HCSW must be under a Patient Specific Direction (PSD).

HCSWs must be appropriately trained and competent, work in compliance with legislation and have appropriate level of support from a registered healthcare professional.

[updated 07 Aug 23]

Vaccines should always be stored in accordance with the manufacturers licence. If the cold chain has been compromised and a vaccine is exposed to warmer or colder temperatures than recommended, the vaccine will fall outside the specifications of its product licence.

Depending on how long the vaccine has been outside the cold chain, the temperatures reached, and based on additional stability studies the product remains a licensed product but any subsequent use will be considered “off-label”.

Unlicensed medicines cannot be supplied or administered under a PGD, but off-label medicines can be included provided that there is documented evidence to support its inclusion. Risk assessments must be made on a case by case basis taking account of the time out of the cold chain, and temperatures reached, additionally reference to the manufacturer and/or via local Medicines Advice teams will be required to determine whether off-label use of a specific vaccine under these circumstances is appropriate.

At an organisational level, consider the stock levels to be wasted and impact on implementation of the national immunisation programme. Generally, these types of assessments are not consistent with the principles of inclusion in Patient Group Directions and are best managed on an incident case-by-case basis.

PHW have produced an advisory document on ordering, storage and handling of vaccines. The UKHSA vaccine incident guidance provides advice for healthcare professionals on responding to a cold chain breach or compromised storage event.

A leaflet describing the circumstances of off-label use of vaccines due to cold chain breaches has been produced as a brief guide for parents ‘The use of vaccines that have been temporarily stored outside the recommended temperature range’.

[updated 14 Aug 23]

Can a Patient Group Direction (PGD) be used by registered health professionals to administer vaccines as part of immunisation competency and assessment training?

The NICE Patient Group Directions Medicines Practice Guideline [MPG2] states that PGDs are not suitable for health professionals who are undergoing relevant training, for example, for administering intramuscular injections.

PGDs should only be used by fully trained and competent health professionals.

Further information is available from the NHS Specialist Pharmacy Service:

[updated 08 Aug 23]

Are UKHSA Patient Group Direction (PGD) templates suitable for use as a resource in Wales?

Yes, health boards are able to use UKHSA’s PGD templates as a reference resource when developing their own PGDs. The UKHSA clinical signatures do not apply in Wales.

Governance and sign off for any PGD is the responsibility of the authorising organisation in Wales.

Where policy differs from England, an advisory document for Wales will be provided jointly by the Welsh Medicines Advice Service (WMAS) and Public Health Wales.

[updated 08 Aug 23]

UK guidance
Wales guidance

Some of these links are only accessible on an NHS Wales networked device:

Welsh Policy and Guidance as provided by Welsh Government, including Welsh Health Circulars (WHCs), Written Statements and Chief health professional letters

Public Health Wales A-Z Vaccination Information


Change history

10 Jun 24

Mebendazole PGD for CAS updated.

04 Jun 24

Pertussis vaccination PGD and accompanying advisory document updated

28 Mar 24

Molnupiravir PGD retired and mpox vaccine PGD updated.

29 Feb 24

Advisory document for pneumococcal conjugate vaccine (PCV) PGD added.

18 Dec 23

Shingles vaccine advisory documents for Shingrix and Zostavax updated.

08 Nov 23

Link to SPS PGD templates page added.

10 Oct 23

Hepatitis A vaccine, hepatitis B vaccine and hepatitis A/B vaccine PGDs updated.

06 Oct 23

COVID-19 mRNA vaccine PGDs for children aged 6 months to 4 years, and children aged 5 to 11 years added.

29 Sep 23

CBRN PGDs added. COVID-19 mRNA vaccine for adults and children over 12 years updated.

26 Sep 23

Antivirals PGD section added. COVID-19 vaccine national protocols updated.

18 Sep 23

CAS PGDs added.

15 Sep 23

COVID-19 mRNA vaccine for adults and children over 12 years PGD added.

06 Sep 23

Smallpox PGD template updated. Banner relating to transition of immunisation PGDs from PHW site removed as all content now on WMAS.

05 Sep 23

IIV and Comirnaty BA4.5 PGDs added. Links to influenza national protocols updated.

23 Aug 23

Zostavax advisory document added

17 Aug 23

Shingrix advisory document added

16 Aug 23

Background and FAQs added. Remaining immunisation PGDs added. CCPS template and guidance added.

14 Aug 23

Pertussis PGD and advisory document added.

28 Jul 23

LAIV PGD and advisory document added.

14 Jul 23

HPV school immunisations and GBMSM PGDs added.

10 Jul 23

Published.

Cymraeg