Northern Ireland lacks mechanisms to allow some prescribers working at interfaces between primary and secondary care to prescribe treatments directly to patients. This means that there may be duplication of work, with the original prescriber needing to work through the patient's GP to ensure that the required treatments are prescribed. The New Models of Prescribing (NMOP) project considered new transformative processes to allow prescribers to issue HS21 prescriptions directly to patients. It included 21 physiotherapist prescribers in the specialities of respiratory, lymphoedema, women's health, orthopaedic Integrated Clinical and Treatment Service (ICATS), Acute Care at Home and neurology. The project ran from November 2020 to June 2021 in two Health and Social Care Trusts. Prescribing was permitted where there was an urgent need for medication (within 72 hours of assessment), a requirement for titration/tapering of medicines with early review, or a need for specialised items.
Process maps were completed at baseline and end of pilot. Baseline and end-point audits captured capture medicines prescribed, de-prescribed and changed. Patient satisfaction was measured using questionnaires and stakeholder feedback was captured using Mentimeter®️ software
Results:
• Recurrent funding (£250k) was secured for Integrated Prescribing programme in NI due to the success of this and other NMOP projects
• NMOP are now established within business as usual arrangements for physiotherapist prescribers working in both Trusts
• An electronic treatment advice note was designed and is now utilised within other patient-facing services
• Governance processes have been implemented that can be transferred to other pathways
• 97% of patients were satisfied with their consultation and felt they received appropriate and sufficient information
• Prescribers achieved >80% compliance with NI Formulary drug choices
• 83% of stakeholders surveyed were happy for physiotherapist prescribing to continue
• 543 medicines were prescribed during the pilot
• Better time management was achieved due to improved clinic efficiency
• Excellent collaboration of stakeholders throughout the project
• Time taken prescribing lymphoedema garments reduced by 66% and savings were accrued:
o Fewer transcription errors in relation to garment prescribing could save £3.8k/prescriber per annum
o Reduced need for interim bandaging for lymphoedema patients due to quicker access to compression garments.
Learning will be taken forward in to new clinical areas and across the region.
