BT13 A remote nurse prescriber service: enhancing capacity for new patients and streamlining services to ensure high-quality patient care and satisfaction

Abstract Streamlining outpatient services and enhancing patient care has been a priority for the National Health Service (NHS) and private providers. ‘Getting It Right First Time’ states that stable patients can be reviewed remotely via phone or video, allowing face-to-face appointments to be kept for new patients [National Health Service. Guide to adopting remote consultations for people with skin conditions. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/B0502-setting-up-remote-consultation-services-for-people-with-skin-conditions.pdf (last accessed 4 March 2025)]. The costs for patients travelling to consultations, taking time off work and arranging responsibilities around appointments cause added anxiety and can be avoided if patients are stable on medications. Remote consultations also contribute to the NHS net zero pledge. Appointments are conducted in hospital settings and local general practitioner surgeries. Nurse prescribers work remotely and conduct isotretinoin services. A business plan was put forward for stable patients on systemic drugs and biologics to be reviewed once yearly by a consultant for a full-skin check. Psoriasis Area and Severity Index and Eczema Area and Severity Index would be scored twice yearly by nurse prescribers remotely. Nurses have 30 min per consultation, giving time for education, empathy and assessing skin via photos sent in prior to the appointment. This also provides time for patient-reported outcome measures (PROMs) to be completed. Nurses add value to the consultation by addressing health promotion using an evidenced-based methodology. Consultants are available for advice and guidance if needed. Audit results show that in the first year 1834 appointments were conducted with nurses. This ensures that freed consultant appointments can be utilized for new patients. Patient satisfaction is good and no complaints were reported. Walker et al. showed that for patients with chronic disease, remote appointments increased their disease-specific knowledge and improved self-management. However, they noted there was a lack of interpersonal contact (Walker RC, Tong A, Howard K, Palmer SC. Patient expectations and experiences of remote monitoring for chronic diseases: systematic review and thematic synthesis of qualitative studies. Int J Med Inform 2019; 124: 78–85). Patients reported they preferred the phone calls if their skin was stable, and were happy to send photos in and complete PROMS to obtain a new prescription. Utilizing the nurse prescribing team to implement this new initiative has enabled the company to accommodate an extra 1834 appointments. Costs are reduced as nurses work from home and no office space is needed. All of these aspects contribute to the success of the scheme and increase revenue while ensuring patient care is at the forefront of the initiative.