PrescQIPP

Transforming and improving legacy endoscopy prescribing pathways through collaborative Community Pharmacy and Secondary Care partnership (2025)

Nottingham University Hospitals NHS Trust, Nottingham and Nottinghamshire ICB, Community Pharmacy Nottingham

Project summary

Project overview: the project was initiated to address the increasing demand for endoscopy services through improvements in patient compliance and successful bowel preparation using community pharmacy support.

Current situation: Bowel preparation medication is supplied to patients from the endoscopy department, via the post, or sometimes through delivery by taxi. This process has not changed in the last 10-15 years. Patients not attending, unplanned discharge and failed procedures due to issues with bowel preparation remain higher than national targets, which increases pressure on the service and waiting times.

Even though written instructions are given about how to take it, issues such as patients not receiving bowel preparation on time and misunderstanding instructions have led to higher rates of failed procedures and a high level of non-attendance for scheduled appointments. For example, in 2022 endoscopy session utilisation in NUH could be as low as 50 per cent.

What we did: Through collaborative working we conducted a trial in the Nottingham City Place Based Partnership (PBP) area of our Integrated Care System (ICS). This involved the supply of bowel cleansing preparations by selected community pharmacies, who received training from the hospital and provided counselling and information to each patient.

Financial aspects: the trial was funded by the secondary care endoscopy department, with making the payment for specific costs associated with pharmacy services and contract management facilitated by the ICB.

Patient outcomes: the trial has shown promising results, with a significant percentage of patients successfully collecting their bowel preparation from pharmacies and receiving counselling, which has resulted in no failed procedures due to inadequate preparation. The quality of the bowel preparation was either ‘excellent’ or ‘good’ with no ‘inadequate’ or ‘poor’ bowel preparation, providing the patient with a significantly better-quality procedure, due to improved visibility.

Recommendations: Exploring the potential for regional rollout considering service level agreements and developing automated systems for better integration between community pharmacies and secondary care. This would ease pressure on the acute sector significantly by allowing the administration teams to focus on cancer and RTT pathways, whilst releasing time to care for the nursing and clinical teams, due to not being required to prescribe large volumes of medication. It would provide patients with local options to collect medication, at their own convenience, and have robust face to face support around the medication. Furthermore, through digital innovation, the acute provider can early identity patients that may not attend their procedure by tracking collection of the product.