Transforming outpatient prescribing at Harrogate Foundation Trust

Overview

Hospital specialists prescribing medications directly during outpatient appointments has helped patients to get quicker and better access to medication. This in turn has reduced reliance on GPs to provide hospital prescriptions and increased primary care capacity to focus on more urgent work.

What the organisation faced

Harrogate Foundation Trust identified delays in patients accessing medication after outpatient appointments. Previously, specialists issued treatment advice notes or included prescribing instructions in letters to GPs, creating a delay of up to 14 days. Patients often visited GP surgeries immediately after hospital appointments expecting prescriptions, leading to frustration and complaints.

An audit revealed 42 prescription requests to one GP surgery in two weeks, and a patient survey showed delays of up to three weeks. This process placed significant administrative burden on primary care teams and highlighted the need for change. 

Improvement

The trust introduced a system where hospital specialists prescribed medications directly during outpatient appointments, enabling patients to collect prescriptions from the hospital pharmacy.  

The associate medical director and deputy medical director led engagement with consultants and specialists to adopt outpatient prescription pads. Support from the chief pharmacist was critical due to budget implications, and liaison with the outpatient pharmacy assured capacity for increased throughput. 

Strong leadership, collaboration across departments, and agreement on responsibilities through an interface agreement was essential for change to be successfully implemented. The trust aimed to improve patient satisfaction by ensuring timely access to medication while creating significant additional capacity in primary care for urgent work. 

Outcomes 

Patients received prescriptions in a timely manner from the recommending clinician, improving satisfaction and reducing complaints. Within three months, the outpatient pharmacy processed 50–100 additional prescriptions daily, and GP surgeries reported fewer requests and improved capacity for urgent work.

Prescription numbers increased by 1,000 per month, sustained beyond implementation. Although costs rose by approximately £20,000 monthly, the ICB supported this investment, recognising system-wide benefits including reduced administrative burden and lower drug tariffs in hospital pharmacies compared to community pharmacies.

Consultants and specialist prescribers in clinics were also impacted. They described previously needing to spend more time reviewing patients’ medication and handwriting prescriptions, particularly after telephone appointments. This was challenging given Harrogate Foundation Trust’s large and predominantly rural catchment area.   

Savings have come from reduced administrative tasks in general practice, fewer patient complaints, and lower drug tariffs for hospital pharmacies. Local GPs have praised the change, describing it as a dramatic and welcome improvement. Key successes included faster patient access to medication and reduced bureaucracy for GP teams.

Challenges remain, such as the lack of electronic prescribing in secondary care and reliance on non-prescribing specialists such as midwives, respiratory and diabetic nurse specialists. Patient group directions helped mitigate some issues, but future aspirations include implementing electronic prescribing and expanding independent prescribing among specialist nurses. 

Further information 

For more information on the work in this case study, contact: 

• Dr Catherine Dixon, associate medical director (primary care) at Harrogate Foundation Trust: catherine.dixon14@nhs.net
• Dr Sarah Sheliker, deputy medical director and consultant anaesthetist at Harrogate Foundation Trust: sarah.sherliker@nhs.net