P135 Survey of liver transplant referral unit experiences of their post-transplant immunosuppression medication provision service, five years post prescribing repatriation from an adult liver transplant centre

<h3>Introduction</h3> UK liver transplantation is a specialised service (SS) covered by a 2017 NHSE SS specification. This mandates the liver transplant centre (LTxC) is responsible for the life of the transplant, but day to day care can be transferred back to the liver transplant referring unit (LTxRU) at a suitable point. In 2013 NHSE mandated the move of immunosuppression (IS) provision for solid organ transplant from primary care back to secondary care in England. In 2019/20 the LTxC pharmacist undertook work to repatriate IS prescribing back to 5 of 12 LTxRU, representing 180 patients and 50% of the LTxC IS prescribing workload from LTxRU. Drivers for this work were patient safety, LTxC capacity and funding. <h3>Method</h3> A digital survey was sent to each of the LTxRUs where IS prescribing repatriation had occurred. <h3>Results</h3> Four LTxRU completed the survey. All four LTxRUs utilise homecare as their primary method of service provision. Units 1 and 2 have hepatology pharmacist NMP (non-medical prescribers) as primary prescribers for the service. No units have a CNS (clinical nurse specialist) NMP, unit 4 utilises a CNS to run the service with prescribing by hepatology doctors. Three units expressed slight concern with capacity to manage prescribing, unit 4 reported being somewhat concerned. All LTxRUs indicated the highest level of concern with managing the administrative workload, unit 4 expressing extreme concern, also reporting a moderate level of concern with respect to the safety, resilience and turn-around speed for urgent and routine requests. This unit indicated concern over lack of funding to CNS to run the service. Unit 2 indicated almost doubling patient numbers in the last 3 years with concern over funding to hepatology pharmacy team to deliver. Units 2 and 4 expressed some concern regarding their homecare providers. Unit 1 directly funds hepatology pharmacy NMP time to deliver their service, reporting least level of concern overall. Overall most aspects of service provision elicited a majority of response of no or slight concern from LTxRUs. <h3>Conclusion</h3> Repatriation of IS prescribing to LTxRUs is an appropriate care pathway to develop, providing care closer to home supporting NHS 10 year plan, providing opportunities to align service with local needs, and manage LTxC capacity. Challenges include distribution of financial resource to deliver service, challenges with Homecare providers, subject of a recent House of Lords review, and building in capacity for service growth.