New models of prescribing: implementation of specialist palliative care prescribing in the community

Background/Aims People with life-limiting conditions often wish to have their palliative care needs met in the community. In Northern Ireland, the lack of an established process to enable prescribers working in these settings to issue a HS21 (health service) prescription to patients within their own home or care home can lead to delays in accessing medication. This service evaluation describes the implementation and assessment of a new model of prescribing, known as the pathfinder, that allowed direct community-based prescribing by medical and non-medical hospice prescribers. Methods The pathfinder was implemented in September 2024 for a 6-month trial period. Key data were collected at baseline, 3 months and 6 months, including prescribing activity, urgency and waiting times. Qualitative data were collected through focus groups and interviews, held with eight staff members at the participating hospice, including one medical and one non-medical prescriber. A stakeholder survey was distributed to those outside of the hospice who were involved in or affected by the project ( n =13) to collect additional perspectives. Results Baseline data showed multiple attempts being required to request prescriptions, with a 170-minute median waiting time from start of a homecare visit to a prescription being issued. At 6-months post implementation of the pathfinder, this had fallen to 30 minutes. Themes drawn from the qualitative data from hospice staff and other stakeholders included service enablers, barriers and challenges, outcome benefits, sustainability of the project and regional adoption Conclusions The revised model of care demonstrated a valuable role for both medical and non-medical prescribing to meet the specialist palliative care needs of patients in the community setting. Vital learning from the constraints and enablers of service delivery informed recommendations to support future prescribing sustainability, scale and regional adoption efforts. Implications for practice Key recommendations from this study include provision of sufficient training and resources for community-based prescribers, strengthening governance and accountability processes and increasing skill use of medical and non-medical prescribers in hospice settings.