Under the national programme

PGD templates are produced as part of the national Medicines Governance Do Once (MGDO) Programme. About the SPS Medicines Governance Do Once Programme contains further information.

Considerations

The MGDO Programme Board will determine the priority of developing new PGD templates. This decision is multifactorial and will reflect national requirements. Generally, PGD templates will be developed where there is currently significant national usage, the treatment follows nationally available guidance and no other suitable mechanism for the supply and/or administration of medicines exists.

The board will also determine which PGD templates are not suitable for national development. Here we outline conditions, clinical areas or medicines where PGD templates will not be developed and the rationale for these decisions.

The decisions made will be subject to regular review by the PGD short life working group as national guidance is revised or developed and this article will be updated regularly to reflect these reviews.

PGD templates not included

We list below the condition or clinical area where it has been decided a PGD template will not be included in the MGDO Programme and the reasons for this.

Dental infections

GPs generally do not manage dental infections, including prescribing antibiotics. More information is provided by the British Medical Association. Given this, it would be inappropriate for PGDs to be developed for dental infection management by non-dental healthcare professionals.

Lyme disease

NICE guidance is available to support treatment pathways but the condition is considered to be specialist and requires patient testing. The stakeholder group consider there would be opportunities within the patient pathway for antimicrobial therapy to be prescribed and therefore the treatment of Lyme disease under a PGD is not appropriate.

Sepsis

National PGDs have not been created for neutropenic and non-neutropenic sepsis as there is no national guidance to support antimicrobial choices. Local PGD production may be considered against local antimicrobial guidance and microbiological advice.

UTI in special groups

Urinary tract infections (UTIs) in catheterised patients, men and children are potentially complex clinical situations requiring clinical review and prescribing. The stakeholder group do not support the use of a PGD to manage urinary tract infections in this patient group.

Benzathine benzylpenicillin for syphilis

Use should be within prescriber-led services, therefore giving opportunities for the treatment to be prescribed and so a PGD would not be suitable.

MSK services

National guidance to support medication choices/doses for intra articular injections in MSK services is not currently available.  National guidance is required for SPS to develop PGD templates.

Isotretinoin for acne

A national PGD template for isotretinoin for acne will not be developed by SPS.

Use of a PGD is not recommended for the following reasons:

• There are no nationally published dosing guidelines for isotretinoin once it has been initiated. PGDs require clear dosing instructions and should only include dose ranges where an appropriate dose within the range can be determined against guidance.
• The use of a PGD for isotretinoin does not align with the MHRA agreed Risk Minimisation Measures (RMMs). PGDs legally only allow one healthcare professional to be involved in the entire process, meaning the independent pharmacist check would not be possible under a PGD. This independent pharmacist check is an essential RMM and is known to prevent harm. Medicines can only be supplied or administered under PGDs if there is an advantage for patient care, without compromising patient safety.

Ceftriaxone for bacterial meningitis or meningococcal disease

A national PGD template for ceftriaxone for strongly suspected bacterial meningitis or strongly suspected meningococcal disease has not been developed by SPS.

The decision not to draft a ceftriaxone PGD template is multi-factorial and follows discussion with healthcare professionals across the health system:

• there are concerns regarding the availability of ceftriaxone in the community, and this is acknowledged within the updated NICE guidance NG240
• ceftriaxone is not listed in the BNF’s Medical emergencies in the community list of medicines
• potential risk that the diluent used to prepare intramuscular ceftriaxone (lidocaine 1%) may be incorrectly chosen to dilute another powder for injection/infusion, especially in an emergency

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