The meeting of an individual's healthcare needs is traditionally undertaken by a doctor using a process of assessment, diagnosis and review, which may also include the prescribing of appropriate medication. This is a typical outline of a general management plan, particularly with regard to chronic healthcare needs. Today this concept of care is gradually changing owing to the evolution and development of professional roles - healthcare professionals other than doctors are now able to manage patients independently by utilising their clinical skills and knowledge and expertise in order to make effective interventions and safe decisions about patient care. This can be demonstrated within the realm of sexual health, where in the past ten years nursing roles have developed to meet the ever-changing needs of those attending sexual health clinics, including the development of the roles of Nurse Consultants and Nurse Practitioners/Specialist Nurses. Facilitation of these role progressions into independent practice and autonomy has been aided by the use of patient group directions (formerly known as group protocols) and the ability to undertake independent and supplementary prescribing. The use of patient group directions in particular has greatly enhanced patient care within sexual health and has led to many innovative services, particularly in Outreach settings, for instance hepatitis A and B vaccinations for gay and bisexual men.

This chapter will now present an overview of the development of patient group directions in relation to legislation and application to practice, as well as discussing independent and supplementary prescribing, including the required knowledge and competencies.

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