Implementation of Hs21 Prescribing by Foyle Hospice Community Prescribers

Strategic Planning and Performance Group and Foyle Hospice

Project summary

The traditional primary care model for prescribing and supplying medicines is well established, with clear lines of accountability and defined budgetary arrangements. However, managing medicines at service interfaces remains less clear, particularly for patients receiving community-based hospice care. In these settings, Specialist Palliative Care (SPC) clinicians commonly make recommendations to prescribe that must be implemented by a GP, often leading to delays, duplication and inefficiencies. In some circumstances, a more direct prescribing model is both clinically appropriate and beneficial for patients.

To address this gap, a pathfinder initiative was introduced to allow SPC nurse and medical prescribers employed by a hospice to issue Health Service prescriptions (HS21, equivalent to FP10 in England) directly to patients living at home or in care homes. This removed the need for GPs to action prescribing recommendations, streamlining access to medicines. The primary objective was to improve timely access to prescription-only medicines for patients with SPC needs, while alleviating pressure on GP practices and out-of-hours (OOH) services.

A multidisciplinary Task and Finish (T&F) group was established to oversee the initiative, bringing together key stakeholders to develop governance and accountability arrangements. This included creation of a standard operating procedure, along with clear training and competency requirements for prescribers. Launched in Northern Ireland by the Strategic Planning and Performance Group in September 2024, the six-month pathfinder was supported by regular oversight meetings to monitor progress, resolve service delivery issues and ensure robust data collection.

The Medicines Optimisation and Innovation Centre (MOIC) conducted an independent evaluation of the initiative, applying its expertise in medicines optimisation, service development, research and data analysis to assess impact and effectiveness.

The evaluation demonstrated a range of positive outcomes. Patients experienced faster access to palliative medicines, supporting timely and effective symptom management, particularly at end of life. More responsive prescribing enabled quicker symptom review and safe titration of medications. Prescribing by hospice clinicians reduced reliance on GPs, district nursing and OOH services, and displaced prescribing activity from general practice, increasing GP capacity for other clinical priorities. Baseline data showed hospice staff previously needed a median of two GP contacts per prescription; this was eliminated under the new model, improving workflow efficiency. Robust governance arrangements were successfully implemented, staff reported improved time management and job satisfaction, and high levels of patient and family satisfaction were observed, supported by strong collaboration and professional autonomy.