Comparing independent prescribing to patient group direction use in a general practitioner out-of-hours service: a retrospective cross-sectional service evaluation

Abstract

Introduction: Global demand for healthcare is escalating, prompting exploration of innovative strategies to augment service capacity. Independent prescribing (IP) helps to address this challenge, allowing non-medical professionals to prescribe medication. Paramedics in the UK were granted prescribing privileges in 2018, yet uptake remains low. Despite qualitative evidence indicating that paramedic prescribing is beneficial, quantitative comparisons of medication provision between prescribers and non-prescribers are lacking. Paramedics provide patients with non-emergency medication by three different routes: IP, using a patient group direction (PGD) or with prescriber support.Advanced paramedic practitioners who are not qualified as independent prescribers, rotating through ambulance and general practitioner out-of-hours services, offered an opportunity to quantitatively compare medication supply.Methods: This study compares medication supply by three advanced paramedic practitioners using PGDs with three prescribing nurses in a Welsh general practitioner out-of-hours service. A cross-sectional design was employed to retrospectively review electronic patient clinical records between 1 December 2019 and 30 November 2020, including patients presenting with one of five generalised clinical conditions (urinary, soft tissue, respiratory, abdominal pain, ear). Descriptive analysis and non-parametric tests compared medications prescribed or supplied, how patients received medication and reasons for seeking prescriber support.Results: A total of 397 patient records were analysed. Paramedics supplied medications more frequently with prescriber support (68.2%) than via PGD (27.9%). Nurses predominantly prescribed medication independently (99.3%). Medication provision was comparable when paramedics had prescriber support. Reasons for paramedic support-seeking included having no PGD available (34.1%) and PGD being excluded from use (28.4%).Conclusions: Advanced paramedic practitioner medication supply using PGDs and prescriber support was comparable to that of prescribing nurse colleagues. However, autonomy restrictions highlight the need for paramedic prescribing in services where prescriber availability is limited. Further research evaluating the efficiency and cost-effectiveness of PGD use versus IP is necessary. Additionally, the qualitative benefits of IP, such as improved patient care and satisfaction, warrant due consideration when implementing future healthcare strategies.