Patient Specific Directions (PSDs) and Patient Group Directions (PGDs)
Page Contents
Patient Specific Directions (PSDs)
Patient Group Directions (PGDs)
PSD for “Group” Administration e.g. Flu Vaccines
Patient Specific Directions (PSDs)
A Patient Specific Direction (PSD) is a written instruction or electronic authorisation from a prescriber to supply or administer a medicine. The prescriber remains legally accountable for this delegation.
A PSD is a direction to administer via a written instruction from a prescriber that indicates the intent for a medicine that has already been legally supplied, can be administered to an individual by a suitably trained and competent person.
If non-prescribing health care professionals are to administer a medicine on the instruction of a prescriber, the prescriber must be able to show that they have appropriate mechanisms in place to ensure that their practice meets statutory requirements. Since these mechanisms for supply and administration are statutory, the fact that a practice has followed them is mitigation to any ensuing liability.
The information required in a PSD for administration of a medicine at a minimum should include:
- Name of the individual and/or other individual identifiers including age if a child
- Name, form and strength of medicine (generic or brand name where appropriate)
- Route of administration
- Dose
- Frequency
- Date of treatment/number of doses/frequency/date treatment ends as applicable.
- Signature of prescriber and date PSD written.
PSDs are also often used in relation to the administration of vaccinations for named patients as well as Depo-Provera, B12 and Zoladex.
In some circumstances a signed prescription can be used as authorisation to administer. This is usually by prior agreement with specific providers and for specific circumstances. For example, some providers of District Nursing have made agreement that a Signed Prescription with specific directions can be used as authority to administer. This is to reduce the bureaucracy of completing separate administering charts by GPs when patients are housebound and reliant on community nurses to administer vaccines and injections at home. This will exclude controlled drugs used in end of life care, where an administration chart would be required.
Template PSD available for use if you wish.
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HCAs – Informed Consent
Please see our guidance page titled “UKSHA clarification on Health Care Support Workers & Informed Consent for Immunisation”
Patient Group Directions (PGDs)
A Patient Group Direction is a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition. PGDs allow a range of specified registered health care professionals to supply and/or administer a medicine directly to a patient with an identified clinical condition.
Please see below links to the regionally agreed PGD’s:
- PGDs in Hampshire and IOW (Wessex)
- PGDs in the South West(includes Dorset, BaNES, Swindon & Wiltshire)
The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.
PGDs are intended to improve patient care by enabling registered health professionals other than doctors/prescribers to supply and/or administer medicines to patients. Examples of where PGDs may be appropriate are services where assessment and treatment follows a clearly predictable pattern (eg immunisation, family planning).
In general practice they can be used to enable registered nurses to administer a prescription only medicine to a group of patients who fit the criteria specified in the PGD, for example, to administer vaccinations.
How long do you need to retain PGDs?
“PGD documentation includes master authorised (signed) copies of PGDs, lists of authorised practitioners and patient supply/administration records, including electronic records/agreements.
The same rules apply to PGD records as to all other patient records:
Clinical records:
- For adults all PGD documentation in an individual’s clinical record must be kept for eight years after the last entry.
- For children all PGD documentation in an individual’s clinical record must be kept until the child’s 25th birthday (or 26th birthday if the child was 17 when treatment ended) or for eight years after a child’s death.
- Where a PGD is for an implant in an adult then all documentation in an individual’s clinical record must be kept for 10 years. For example this would apply to contraceptive and sexual health PGDs for contraceptive implants or drug eluting coils.
Authorisation Records:
Staff authorisation records should be kept for 8 years after the expiry date of the PGD if the PGD relates to adults only (10 years if relates to an implant) and for 25 years after the expiry date of the PGD if the PGD relates to children.
Final Versions of PGDs:
- The final authorised copy of the PGD should be kept for 8 years after the expiry date of the PGD if the PGD relates to adults only (10 years if relates to an implant) and for 25 years after the expiry date of the PGD if the PGD relates to children.
- The main content of a PGD (i.e. an unauthorised final copy), which contains no patient identifiable information or staff authorisation records, may be retained by an organisation for up to 20 years for purposes of business planning/continuity if there is reason to do so (i.e. reference for future PGDs).”
BMA Guidance – Vaccinations and Medicines for Travel:
If a patient is attending a nurse appointment and requires an NHS vaccination for travel, the most straightforward solution would be for the nurse to be able to administer that vaccination under the authority of a PGD. The GPC would recommend in these circumstances that if a PGD is available and acceptable to the GP, it would be in the practice’s interest to have a PGD in place. However, an NHS PGD cannot be used for private immunisations so Rabies, Yellow Fever, Japanese B encephalitis, and Tic Borne encephalitis cannot be administered under an NHS PGD.
This also applies to supply of anti-malaria chemoprophylaxis or for any other drugs supplied privately (such as, for example, antibiotics, acetazolamide) in case of disease arising abroad. However English practices who, by definition, will be registered with the CQC, can write and sign off a private PGD for these private travel immunisations.
PSD for “Group” Administration e.g. Flu Vaccines
We do have to be mindful of the guidance around PGDs & PSDs and ensure we fulfil the recommendations.
What is a Group PSD?
“A written and authorised instruction to administer a medicine to a list of individually named patients where each patient on the list has been individually assessed by that prescriber. The prescriber must have adequate knowledge of the patient’s health and be satisfied that the medicine to be administered serves the individual needs of each patient on that list.
A written instruction applying to a group of patients where the patient/s are not individually identified i.e. a PSD could not state ‘All patients attending the practice’s ‘flu vaccine clinic on date dd/mm/yyyy’ but needs to be a list of all named patients due to attend the clinic who have been individually assessed by the prescriber as suitable for treatment and be signed and dated by a prescriber (this does not need to be completed for each entry but can be once for the entire list).” https://www.sps.nhs.uk/articles/questions-about-patient-specific-directions-psd/
What a GP needs to consider when signing a Group PSD:
If signing a group PSD you must have considered that each of the individuals on the list has been assessed as fit and appropriate to receive the vaccine. Traditionally, lists might have been prepared for a GP to simply sign. We would encourage practices to consider how lists of patients are collated, and ensure the practice has a process or pathway to ensure information has been shared with patients about their vaccine prior to running the clinics. This ensures the patient has been informed of information about their vaccine, and then at the clinic has an opportunity to speak to a registered health care professional should they have any questions about their vaccine
In addition, we would recommend that the following needs to be put in place;
The PSD must clearly identify which flu vaccine is to be administered under this specific PSD i.e. Quadrivalent or Trivalent as there should be a separate PSD for each vaccine. This may require practices organising separate clinics for administration of each vaccine.
The person signing the PSD must be satisfied that they are not aware of any contraindications to the patients on the list receiving the stated vaccine, as they are taking responsibility for making the clinical decision.
The person signing the PSD must be confident that they are signing that the person administering the vaccine is competent, has received training in administering the flu vaccines, is aware of the cold chain policy, clinically supervised and has attended annual up to date training around basic life support, management of anaphylaxis and use of the defibrillator.
There should be a record in the patients notes that the vaccine has been administered via a PSD. You would benefit from speaking to your IT person to add in a short cut key or SNOMED code.
The printed list of patients under the PSD should be retained for at least 2 years and preferably stored electronically.
As with all vaccines the patients name, DOB, type of vaccine, expiry date, vaccine code, method of immunisation and site of injection should be recorded in the patients notes together with patients consent to administration.
Vaccine Group Directive (VGD)
The National Protocol, which was introduced during the COVID-19 pandemic to give greater flexibility in terms of workforce to rapidly deploy vaccines at unprecedented scale was retired on 31st March 2026.
From 1st April, 2026, it has been replaced by the Vaccine Group Directive (VGD), which is a is a legal framework introduced in April 2026 allowing registered healthcare professionals to authorize the administration of specific vaccines (viral or bacterial) to individuals without a prescription. Unlike Patient Group Directions (PGDs), VGDs allow delegation of tasks like preparation and administration to trained staff.
The table below describes the comparison between the National Protocol, the new Vaccine Group Directive (VGD) and a Patient Group Directive (PGD)
There are some important, key differences between the National Protocol and the Vaccine Group Directive (VGD) which we have highlighted below:
- Reconstitution and dilution can no longer be delegated to someone other than the vaccinator – both elements must now be undertaken by the same person
- Only those registered Healthcare Professionals who are able to work under a PGD (as described in this list) can clinically assess & obtain consent under a VGD – this means that doctors and nursing associates cannot. (NAs can undertake this function if using a PSD as an alternative legal mechanism)
- Clinical supervision of non-registered Healthcare Professionals (including registered Nursing Associates) MUST be undertaken by the same list of registered health professionals who can clinically assess and obtain consent under a PGD – this means that doctors cannot undertake this task either before or during a clinic if using a VGD as the legal mechanism for the delivery of your vaccine clinic
- Use of the VGD does have the benefit of removing the need for a Patient Specific Direction (PSD) to be added to each patient record where non-registered Healthcare Professionals will be used in the service delivery, so if a practice can make the other elements work for them, this could potentially save a significant amount of time
**Important notice**
Practices who wish to use the VGD will need to wait for regional authorisation to be completed (like PGDs). IT IS NOT LEGAL UNTIL IT IS REGIONALLY AUTHORISED. DO NOT DOWNLOAD UKHSA TEMPLATE AND USE • Authorised VGD will be distributed to practice managers in the usual way using the PGD distribution list or downloaded from the usual web pages
You may find the following resources useful:
NHS England » COVID-19 vaccine (5 years and over) Vaccine Group Direction – links to the UKHSA template which is not legal until regionally authorised
When No PSD or PGD is Needed – Emergency Drug Exemptions
There are some specific exemptions from medicines legislation which may apply in limited circumstances e.g. administration of certain parenteral medicines such as adrenaline that can be administered in an emergency without the directions of a prescriber.
Additional Resources
- Podcasts – PM Webinar 26th November dedicated session on HCA’s & consent
- What exactly are PGDs & PSDs? And why are they important?
- Consent for a vaccine – who has to do this and how?
- Patient Group Direction use in Primary Care Networks
- BMAs guidance on Patient Group Directions (PGD) and Patient Specific Directions (PSD): Patient group and patient specific directions. Within this there are a number of frequently asked questions which practices may wish to review.