P001 A pharmacist-based flexible approach to workforce enhancement to support implementation of National Institute for Health and Care Excellence Technology Appraisal 715, biologics in moderate rheumatoid arthritis
Authors: Butler Stephanie 
Published: April 2023

Background/Aims

The National Institute for Health and Care Excellence Technology Appraisal 715; biologics for treating moderate rheumatoid arthritis was published in July 2021. Previously biologics have only been approved for patients with severe disease.

The National Health Service is legally obliged to provide treatments recommended in technology appraisals, yet they do not attract funding for medicines or workforce enhancement. Technology Appraisal 715 is expected to expand the eligible patient cohort posing a significant challenge for the rheumatology team already operating under considerable strain. Without workforce investment clinic capacity would need to be cut for clinicians to manage the additional workload. This would result in greater delays for clinic appointments, already above national targets for new and follow up patients. The specialist pharmacist, an established member of the rheumatology team, is ideally placed to provide further flexible working roles within the team, addressing workforce issues.

The aim here was to quantify additional workload associated with technology appraisal 715 and explore potential staffing models for implementation and delivery.

Methods

An audit of current practice was undertaken. Audit results were used to populate the modelling tool published with the technology appraisal and calculate predicted increase in workload. Three staffing models were developed and critiqued to manage this increase. A business case ranking these models in order of cost effectiveness was submitted to Trust management.

Results

University Hospitals Sussex rheumatology managed a cohort of around 1500 rheumatoid arthritis patients before publication of appraisal 715 with a growth rate of 14% a year since 2011. A majority of homecare prescribing was undertaken by the current specialist pharmacist and one registrar. Screening and prescribing a prescription took an average of 7 minutes. The team process around 120 prescriptions a week (approximately 14 hours work or two working days). The technology appraisal tool predicted an increase of up to 50% in the eligible patient cohort over 5 years. Increased workload was expected in the following areas; prescribing, pre-biologic and post-biologic clinics, Blueteq management, homecare and general administration workload. The staffing model of one band 8a pharmacist prescriber, one admin band 3 and half an admin band 4 (for Blueteq) was identified as most cost effective. A business case recommending this model was approved by both the Trust and commissioners.

Conclusion

Rheumatology teams face a growing workload and patient waiting times are increasing. Difficulties in recruitment of clinicians has been highlighted nationally. Pharmacists skilled in managing patients with acute and chronic diseases can acquire specialist competencies allowing them to take on non-traditional roles. Barriers separating professions need to be questioned as pharmacists are ideally placed to help manage increasing workload demands, including that of prescribing and implementation of technology appraisal 715.

Disclosure

S. Butler: Consultancies; Abbvie, Galapagos, Janssen.