Previously dental hygienists and therapists had only been able to administer such prescription only medicines (POMs) to patients on the basis of a Patient Specific Direction (PSD) or written instruction from an approved prescriber (a dentist or doctor) concerning a named patient or patients, who had been assessed by that prescriber.
However a change in the law in April which took effect from 1 June 2010 added these two groups of dental care professionals to the list of healthcare professionals able to administer medicines via a PGD. As a result, hygienists and therapists can supply or administer these treatments to a defined group of patients and are responsible for selecting patients who meet the criteria for treatment and for obtaining the necessary consent or authority to carry out the procedure.
The nature and effect of Patient Group Directions (PGDs) are well set out in guidance issued by the NHS National Prescribing Centre in December 2009. Section 3 explains the practicalities of producing, authorising and using a PGD, while section 4 has some frequently asked questions about their use. The guidance states that PGDs must legally include the following information:
- The name of the body to which the direction applies
- The date the direction comes into force and the date it expires
- A description of the medicine(s) to which the direction applies
- The clinical conditions covered by the direction
- A description of those patients excluded from treatment under the direction
- A description of the circumstances under which further advice should be sought from a doctor (or dentist, as appropriate) and arrangements for referral made
- Appropriate dosage and maximum total dosage, quantity, pharmaceutical form and strength, route and frequency of administration, and minimum or maximum period over which the medicine should be administered
- Relevant warnings, including potential adverse reactions
- Details of any follow-up action and the circumstances
- A statement of the records to be kept for audit purposes
A PGD must be signed by the senior professionals who are required to be involved in developing it and the authorising authority (usually the clinical governance lead) for the organisation in which it is being used, such as the Primary Care Organisation. PGDs should be formally reviewed and re-authorised every two years, and the expiry date must be included in the PGD itself.
The DDU considers that a PGD does not remove the requirement for a written treatment plan from a dentist for individual patients, as set out at paragraphs 2.1 to 2.7 of the GDC's Principles of Dental Team Working guidance. While the GDC's guidance does not stipulate what should be included in a treatment plan, we would suggest that if the dentist considers it appropriate for the patient to receive local analgesia or fluoride treatment if necessary, it would be prudent for this to be made clear.
Dental hygienists and therapists should be fully trained and competent to perform the procedure and are professionally accountable for their actions or omissions. They should also ensure they have adequate indemnity arrangements in place to cover the work they undertake.
Members with specific queries about PGDs can contact the DDU advice line for individual advice.
This page was correct at publication on 14/10/2013. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.