Rules allowing patients to by-pass doctors to gain prescription only medicines are not always following proper procedures according to NICE.

These rules – made under ‘patient groups direction’ - were introduced in 2000, with the aim of increasing access to prescription drugs while also promoting self-care.

It works by allowing healthcare professionals to provide medicines directly to groups of patients fitting the criteria laid out in the PGD, essentially by-passing the need for a GP, or other prescriber.

But in new draft guidance on the scheme, NICE is now saying this may not be the best or safest option for patients. It argues that allowing access to prescription-only medicines may not have been developed following the proper procedures, with some appearing to omit the requirement to gain agreement of an authorising body.

In its new guidance NICE says: “Even in some circumstances when it may be legally possible, the GDG [Guidelines Development Group] agreed that a PGD may not be the preferred and safest approach to individual situations of providing patients with the medicines they need.”

NICE calls for particular caution in decisions on PGDs covering anti-bacterials, stating their inclusion must not jeopardise strategies to combat increasing microbial resistance. And it stresses that, while correct dosing can be advised under a PGD, it is unsuitable for medicines requiring frequent individual dosing adjustments.

The Institute concludes by saying that authorising bodies must carefully weigh up whether or not a proposed PGD is appropriate – even if it would be legal to introduce it.