P076 Paediatric rheumatology prescribing data: findings and recommendations from the Getting it Right First Time (GIRFT) report

Abstract Background/Aims The 2025 paediatric rheumatology Getting It Right First Time (GIRFT) review in England aimed to identify unwarranted variation in timely access to commissioned and non-commissioned medicines for children and young people with autoimmune rheumatic diseases Methods National prescribing data forpaediatric rheumatology from April 2023 to March 2024 were obtained via the NHSEngland-commissioned Rx-Info system, with utilisation expressed using theDefined Daily Dose (DDD) metric. Complementary data were obtained from theBlueteq system, capturing medicines supported through Managed Access Funds inaccordance with NICE and NHS England recommendations, covering April 2022 toMarch 2024 and stratified by indication. To preserve confidentiality, data fromproviders with fewer than ten approvals per medicine per year were suppressed.National prescribing patterns were contextualised using local data collectedthrough self-reported questionnaires and detailed discussions conducted duringGIRFT peer review meetings between November 2024 and April 2025. Results Sixteen commissionedspecialist paediatric rheumatology providers (hubs), together with their network hospitals (spokes), participated in the review. Seven hubs uploaded usable data to Rx-Info. DDDdata demonstrated substantial variation in medicine consumption between hubs, reflecting differences in patient populations, but did not permit directcomparison of actual use, including timing, indication, or per-patient dosing.Peer review identified factors limiting pharmacy data extraction, includinginaccurate cost-centre attribution, absence of standard operating procedures, and failure to map prescribers to specialty. Blueteq approvals for commonlyused biologics showed that 20 providers (16 hubs and four spokes) completed tenor more approvals per year. Fifteen hubs reported access to commissionedmedicines within four weeks of the decision to treat. Nonetheless, 11 (69%)raised concerns about delays in first-dose administration, citing homecaredelivery and nurse-led training. Nine hubs (56%) reported a dedicatedspecialist pharmacist within the paediatric rheumatology team, with a meanwhole time equivalent of 0.6 (range 0.2-1.4). All hubs reported switching to, or between, cost-effective biosimilar medicines. However, the timeliness andappropriateness of switching, including transition to child-appropriate or mostcost-effective formulations, could not be assessed. Peer review suggested delayswere exacerbated by staffing pressures, particularly in trusts without anembedded pharmacist. Conclusion The paediatric rheumatologyGIRFT review provides a first opportunity to evaluate prescribing practicesusing national datasets. All hubs regularly initiated biologics, with fournon-commissioned trusts completing additional approvals. The mechanisms bywhich non-commissioned trusts prescribe high-cost medicines remain unclear, potentially indicating inequities in access. Variability in paediatric dosinglimits the utility of the DDD metric, and the absence of clinically meaningfuldatasets restricts opportunities for detailed between-centre comparison andlearning. Inconsistent provision of dedicated pharmacy support represents afurther safety and efficiency concern. GIRFT recommends the development andenhancement of paediatric rheumatology prescribing datasets incorporatingrelevant metrics to inform best practice and optimise cost-effective care. Disclosure G. Cleary: Honoraria; SOBI, Pfizer. O. Aragon: None. K. Hartley: None. S. Olson: None. R. Sandler: None. F. McErlane: None.