Description

The main objective of the study is to quantify the extent of development and use of Patient Group Directions (PGDs) for immunisation and identify any perceived challenges posed to the working relationships between doctors and nurses.

Through a postal questionnaire survey in Health Districts in Greater Manchester and London Regions, all 50 District Immunisation Coordinators (DICs) in the two Regions were approached.

Most districts (94%) had PGDs for childhood immunisation. PGDs for adult (43%) and travel immunisation (39%) were less common. A shared PGD for all staff groups was more commonly used (61%) than one for individual staff. DICs reported playing a leading role in their preparation with GPs and other Primary Health Care staff much less likely to be involved. The Department of Health Green Book on immunisation was the main source for the preparation of PGDs in just under two thirds of districts. Most respondents said that DoH prepared PGDs would be valuable. Concerns about legal issues (including informed consent) were raised by a third of respondents: the credibility of nurse immunisers and role uncertainty were less frequently reported issues. The need for training to support the use of PGDs was reported by over a third of respondents.

PGDs are now required for any nurse administering medicines (including vaccines) not directly prescribed by a medical practitioner. Whilst PGDs for childhood immunisation have been developed in most districts, they are less available for travel and adult immunisation programmes. Additional research is required to determine how extensively they have been implemented at primary care level and further clarify interprofessional issues.