P070 Setting up a Nurse-Led Atopic Dermatitis (NuLAD) service

Abstract

Unlike the established psoriasis service supported by two part-time clinical nurse specialists (CNSs), our hospital lacked dedicated clinical nursing support for patients with atopic dermatitis (AD) requiring advanced therapies. This led to delayed time to treatment, avoidable hospital admissions, consultants performing administrative tasks, and a perception of suboptimal care among patients. We describe and evaluate our Nurse-Led Atopic Dermatitis (NuLAD) service, supported by a joint working agreement with LEO Pharma. Key developments included recruiting two part-time band 7 dermatology CNSs (including one experienced nurse prescriber), upskilling of the second CNS to practise autonomously conducting patient reviews following achieving clinical competency, and consultant clinic shadowing to ensure smooth patient transition. The role of the CNS includes reviewing baseline screening investigations, initiating and monitoring systemic and biologic therapies, conducting efficacy reviews and annual follow-ups, coordinating homecare prescriptions, delivering patient education, and providing ongoing support rather than being channelled via secretarial teams to consultants. NuLAD officially launched in June 2024 with both face-to-face and virtual clinics. It has since expanded to include two face-to-face clinics, two telephone clinics, a dedicated review clinic and a live patient helpline. Between June 2024 and April 2025 the service delivered £31 889 in cost savings through appropriate CNS-led follow-up and 1750 patient appointments. The consultant workload was reduced by 5–8.5 h per week across 10 consultants. The times from MDT decision to first contact and prescription reduced from 15 to 3 days and 35 to 19 days, respectively. Overall, 90% of surveyed patients would recommend the NuLAD service to other trusts. The NuLAD service has significantly improved efficiency, reduced costs and enhanced the quality of care for patients with AD. This model could be expanded across medical dermatology, including other conditions (e.g. hidradenitis suppurativa). To our knowledge, there is currently no established nurse-led AD biologics service within the region.