Abstract Background/Aims Biologic therapies have revolutionised the treatment of inflammatory and autoimmune rheumatic diseases. However, their administration - often through hospital-based infusion suites - creates logistical challenges for service providers and patients. As a result, subcutaneous biologics are increasingly being delivered to patients by private ‘Homecare’ companies. As highlighted in a recent Government inquiry, Homecare services are often subject to delays in prescribing, pharmacy processing and drug delivery. Patients receiving treatment via these pathways typically have significant disease burden, and treatment delays increase the risk of relapse or progression. This quality improvement project aimed to improve Homecare prescribing in the Rheumatology department at Sandwell and West Birmingham NHS Trust. Methods Three audit loops were conducted: baseline, early and late post-intervention; each included all patients with a Homecare prescription in a 2-week window. For each patient, we calculated the time taken to process their prescription by a) the Rheumatology department and b) the hospital pharmacy. From this, the total processing time and delay in prescription compared to the estimated due date were calculated. Data were non-normally distributed and analysed using the Mann-Whitney U test. The project was registered locally and patient data were held securely. Results Pre-intervention, prescriptions took on average 56 days to process, largely due to departmental delays (Table 1). As a result, a Biologics Coordinator was appointed to organise monitoring blood tests, triage requests from Homecare companies and chase prescriptions. While no benefit in patient delay was seen in loop two (p = 0.20), there was an improvement in delay of 11 days from the first to third loop (p 0.00001). This came despite slower pharmacy processing of prescriptions. Conclusion Significant delays in Homecare biologic prescribing create the potential for under-treatment of patients. Through a targeted intervention, the Rheumatology department has effectively reduced prescribing delays in the space of a year. While this has meaningfully improved service quality, the potential benefits have been negated by slower pharmacy processing. This highlights the need for a system-wide approach, and future work alongside pharmacy colleagues is needed to understand the challenges they face. Disclosure I.G. Raza: None. D. Stanley: None. A. Tabassum: None. J. Reynolds: None.
Raza et al. (2026) studied this question.