Guidance for OTs on patient group direction launched

College of Occupational Therapy launches guidance for OTs on administering medicines in specific circumstances

Published on 3rd April 2017

Guidance on patient group direction (PGD) which allows occupational therapists to supply and administer specified medicines in specific circumstances has been produced by the College of Occupational Therapists.

The College says that PGDs do have their limitations but when used appropriately, may improve patient experience, clinical effectiveness, reduce costs and provide more fulfilling roles for occupational therapists.

Once a PGD is in place, occupational therapists can treat the patient immediately without them having to wait to see a GP or district nurse. This not only speeds up care for the patient, it means other staff can be released to visit patients who are most in need of nursing or GP care.  

However, the COT is keen to provide guidance and information about PGDs for its members. As part of NHS England’s wider medicines optimisation agenda and with increased diversity in occupational therapy practice, more occupational therapists are becoming involved in medicines optimisation. As such it is important that occupational therapists understand their responsibilities.

Karin Bishop, Assistant Director - Professional Practice said: “Increasing the ability of occupational therapists to administer medicines has the potential to improve patient experience, clinical effectiveness, reduce costs and provide more fulfilling roles for occupational therapists. It is in the interests of patients and our members to raise knowledge and awareness of this legal mechanism as an option to supply and administer medicines.”

A Patient Group Direction (PGD) is a signed, written document supported by a legal framework that allows named, authorised and registered health professionals such as OTs to supply and administer specified medicine(s). The specified medicines are supplied/administered to a pre-defined group of patients with conditions described and detailed within the PGD. An authorised PGD within a service enables the named, authorised health professionals to supply and administer medicines without the requirement to consult a doctor or dentist.

The COT guidance for OTs outlines that there are a number of considerations prior to the PGD being developed:

-          The preferred way for a patient to receive a medicine is via a prescriber directly to a patient on a one-to-one basis. This might be by individual prescription dispensed by a pharmacist, or by a Patient Specific Direction (PSD).

-          PGDs should not be seen as a direct substitute for prescribing and there must be clear rationale and multi-disciplinary team (MDT) support with full adherence to relevant legislation and national and local guidelines.

-          Patient Safety evidence to support development of a PGD must demonstrate that it is safe, with improved outcomes, be clinically effective and cost effective. It should ensure patient choice and provide an optimum patient experience.

-          PGDs take a significant amount of time and resource to develop, implement and review. As such any organisation developing a PGD must make full consideration about whether it is the most appropriate option to deliver safe and timely care for patients. For this reason, occupational therapists must ensure that they adhere to any organisational PGD policies and procedures when embarking on this process.

-          MDT approach - PGDs should be developed by a multidisciplinary team and must be signed off by a doctor or dentist and a pharmacist.

-          Prior to developing a PGD, occupational therapists must obtain full agreement to do so within their organisation with key professionals who have the clinical and governance expertise (for example pharmacist leads) and authority to proceed, supported by a knowledge of the service where the PGD is to be delivered.

-          An MDT with extensive knowledge of national legislation, local procedure, governance and policies relating to PGD is essential.

-          Occupational therapists involved in PGDs from development to delivery must abide by the College of Occupational Therapists code of ethics and requirements under the HCPC.

The guidance says the COT strongly recommends the Quality PGDs - 7 stages to success resource as an essential reference source. The document clearly breaks down the seven steps needed in the PGD process cycle which are as follows:

Step 1 - Think about finding the safest route for patients to receive their medicines within the service or pathway

Step 2 - Think about the process, the people to involve and the medicine

Step 3 - Getting ready to write the PGD

Step 4 - Writing and agreeing the PGD for submission

Step 5 - Authorising the PGD

Step 6 - Getting ready to use the PGD

Step 7 - Monitoring and reviewing the PGD in practice

Support for the development of this guidance was provided by the NHS Specialist Pharmacy Service.  Angela Bussey NHS Specialist Pharmacy Service PGD Lead welcomed publication of the guide, she said: “I am delighted to have worked with the College of Occupational Therapists on this guidance. Its advice and signposting to key resources will undoubtedly be very useful for occupational  therapists when considering ways to  deliver better care for their patients and expand their clinical practice.”


If you are considering a PGD within your service or are going to be authorised to use a PGD in practice, you are advised to complete this e-learning to ensure that you have an understanding of the whole process and factors to consider.

You may also wish to have look at and complete the NICE PGD Competency Framework which is relevant to your needs.

Quality PGDs - 7 stages to success resource.



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