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Patient Group Direction — DFSRH MCQ

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EasyPatient Group DirectionDFSRH

A registered nurse in an NHS sexual and reproductive health clinic is individually trained, competent, named and authorised to use the current local patient group direction (PGD) for subcutaneous depot medroxyprogesterone acetate (SC-DMPA). A 32-year-old woman attends for a repeat injection. Following assessment, the nurse confirms that she meets every inclusion criterion, no exclusion criterion applies and she consents to treatment. Because the clinic is busy, the nurse proposes handing the prefilled injection to an experienced healthcare assistant who has been locally trained and assessed as competent in subcutaneous injection technique. The healthcare assistant is not a registered healthcare professional and is not authorised under the PGD. No prescription or patient-specific direction has been issued. Which is the most appropriate action?

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Correct answer: E — The nurse should personally administer the injection under the PGD

The nurse should personally administer the SC-DMPA injection. She is named and authorised to use the PGD, and the patient has been assessed as meeting its clinical criteria. However, authority conferred by a PGD cannot be transferred to another person. For an injectable medicine supplied under a PGD, administration must be undertaken by the authorised professional operating under the PGD or by the patient herself when self-administration is permitted. A is incorrect because completing or signing the PGD documentation does not authorise the healthcare assistant to administer the injection. B is a plausible near-miss because direct supervision may be appropriate when administration is authorised through another legal mechanism, but supervision does not permit delegation of a PGD function. C is incorrect because a generic organisational protocol cannot replace the required legal authority for administering a prescription-only injectable medicine. D is incorrect because a patient-specific direction must be issued prospectively by a prescriber; it cannot retrospectively legalise administration. If administration by the healthcare assistant were operationally necessary, an appropriate prescriber would first need to issue a valid patient-specific direction or prescription. In the circumstances described, immediate personal administration by the authorised nurse is the appropriate course.

Reference: Delegation of roles under a PGD (10 June 2026) — https://sps.nhs.uk/articles/delegation-of-roles-under-a-pgd/ Patient group directions: recommendations (27 March 2017) — https://www.nice.org.uk/guidance/mpg2/chapter/Recommendations