NHS Wales Shared Services Partnership

OBJECTIVES: To identify (1) the non-medical healthcare professionals in Wales qualified to prescribe medicines (including job title, employer, where the prescribing qualification is used, care setting and service provided); (2) the mode of prescribing used by these healthcare professionals, the frequency with which medicines are prescribed and the different ways in which the prescribing qualification is used; and (3) the safety and clinical governance systems within which these healthcare professionals practise. DESIGN: National questionnaire survey. SETTING: All three National Health Service (NHS) Trusts and seven Health Boards (HB) in Wales. PARTICIPANTS: Non-medical prescribers. RESULTS: 379 (63%) participants responded to the survey. Most of these prescribers (41.1%) were specialist nurses who work in a variety of healthcare settings (primarily in secondary care) within each HB/NHS Trust, and regularly use independent prescribing to prescribe for a broad range of conditions. Nearly a quarter of the sample (22%) reported that prior to undertaking the prescribing programme, they had completed master's level specialist training and 65.5% had 5 years qualified experience. Over half (55.8%) reported that there were plans to increase non-medical prescriber numbers within the team in which they worked. Only 7.1% reported they did not prescribe and the median number of items prescribed per week was between 21 and 30. Nearly all (87.8%) of the sample reported that they perceived prescribing to have ensured better use of their skills and 91.5% indicated that they believed it had improved the quality of care they were able to provide. CONCLUSION: Non-medical prescribing has been implemented across the whole of Wales; however, its uptake within HBs and NHS Trusts has been inconsistent, and it has not been considered across all services, particularly those in primary care. Opportunities therefore exist to share learning across organisations.

OBJECTIVE: To provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services. DESIGN: Classic e-Delphi survey. SETTING: National study in Wales. PARTICIPANTS: Pharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification. RESULTS: A total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences. CONCLUSION: Given the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals.

BackgroundPopulation-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level. ObjectiveTo evaluate the impact of COVID-19 on dispensing patterns of medications. MethodsRetrospective observational study using population-scale, individual-level dispensing records in Wales, UK. Total dispensed drug items for the population between 1st January 2016 and 31st December 2019 (3-years, pre-COVID-19) were compared to 2020 with follow up until 27th July 2021 (COVID-19 period). We compared trends across all years and British National Formulary (BNF) chapters and highlighted the trends in three major chapters for 2019-21: 1-Cardiovascular system (CVD); 2-Central Nervous System (CNS); 3-Immunological & Vaccine. We developed an interactive dashboard to enable monitoring of changes as the pandemic evolves. ResultAmongst all BNF chapters, 73,410,543 items were dispensed in 2020 compared to 74,121,180 items in 2019 demonstrating -0.96% relative decrease in 2020. Comparison of monthly patterns showed average difference (D) of -59,220 and average Relative Change (RC) of -0.74% between the number of dispensed items in 2020 and 2019. Maximum RC was observed in March 2020 (D= +1,224,909 and RC= +20.62%), followed by second peak in June 2020 (D= +257,920, RC= +4.50%). A third peak was observed in September 2020 (D= +264,138, RC= +4.35%). Large increases in March 2020 were observed for CVD and CNS medications across all age groups. The Immunological and Vaccine products dropped to very low levels across all age groups and all months (including the March dispensing peak). ConclusionsReconfiguration of routine clinical services during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes.

BACKGROUND: In healthcare, there is increasing recognition of the importance of developing and testing strategies to scale effective interventions. The NHS long-term plan (2019) acknowledges that often a gold standard approach to a problem already exists somewhere within the NHS, however, it has not been replicated widely across the system. METHODS: We describe the approach and process measures for national scaling of PROMPT (Practical Obstetric Multi-Professional Training) across 12 obstetric-led maternity units in Wales. PROMPT is an evidence-based training package for local maternity staff, previously associated with improvements in maternal and neonatal outcomes, reduction in litigation related to preventable harm and improved safety culture. PROMPT has previously been disseminated internationally using a train-the-trainer model. However, this has been associated with variations in uptake, fidelity and impact. In Wales, the project was supported by Welsh Government, and a structured scaling plan was developed, encompassing ongoing implementation support from a multi-professional team. RESULTS: PROMPT was successfully implemented in all obstetric led units in Wales, with 326 local PROMPT facilitators trained, and 82.5%-100% of maternity staff attended a local PROMPT course in the first 15 months of the project (January 2019-March 2020). All training courses included evidence-based authentic elements, and 93% of courses in the first year (100/107) were supported by a national implementation team, providing coaching, implementation support and quality assurance. CONCLUSIONS: Authentically scaling up complex interventions is a significant challenge. To replicate the improved outcomes demonstrated by PROMPT, intervention reach and fidelity must first be demonstrated.In this national scaling project, our scaling methodology led to the successful implementation of PROMPT across all health boards in Wales. Additionally, we demonstrated reduced variation in adoption, reach, timescale and intervention fidelity between maternity units with varying readiness for change, which had been difficult in two previous large-scale PROMPT implementation projects.

BACKGROUND: The paper-based consent pathway can be associated with missing information, error, and inadequate patient comprehension. Digital consent addresses some of these limitations. However, limited research has been conducted to understand relative costs and consequences associated with adopting digital consent pathways. The aim of this study was to compare the relative costs of digital consent pathways with paper-based consent pathways in UK National Health Service (NHS) clinical practice. METHOD: A micro-costing study was conducted from the UK NHS perspective. Multi-stakeholder involvement contributed to understanding how the paper-based consent pathway varies by department and hospital setting. Sensitivity analyses were conducted to identify the key cost drivers and scenario analyses explored the effect of consent timing and hospital digital readiness. Potential advantages and disadvantages of digital consent were also considered, such as possible impacts associated with consent-related litigation. RESULTS: The cost per consent episode is approximately £0.90 more expensive when completed on paper. The ordering or printing of paper consent forms, and the transportation of forms to storage and back to clinic are process steps that would not be necessary with digital consent. Sensitivity and scenario analyses indicated consultation duration had the greatest impact on the relative costs of both pathways. Per litigation claim prevented, an average of £201,590 could be saved. CONCLUSIONS: Digital consent is potentially cost saving for the NHS. Consent for elective procedures is recommended in advance of the day of surgery, and digital consent used in this scenario demonstrated the greatest savings. Consultation duration was estimated to have the greatest impact on the relative costs of both pathways, which should be a focus of further investigation.

There is increasing interest in developing dementia supportive communities world wide. Dementia RED (Respect Empathy Dignity) is a unique example from North Wales which is based on the twin concepts of people living with dementia as citizens in their community and developing 'bottom up' rather than 'top down' approaches to dementia supportive communities. Most people with dementia prefer to live at home thus making community connectivity key to maintaining healthy relationships and wellbeing. For those living with dementia, the community plays a pivotal role in providing value, meaning, purpose and acceptance. Building dementia supportive communities helps to raise awareness about dementia in the community through engagement and from identifying champions in the locality to voice issues. Dementia RED is an initiative and service which helps to develop such a philosophy in creating a dementia supportive community.

OBJECTIVES: This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor. DESIGN: Retrospective database analysis. SETTING: England and Wales. PARTICIPANTS: Individuals certified as SI or SSI. OUTCOME MEASURES: Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy. METHODS: Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment. RESULTS: In England, from 2010 to 2020, there was a small but significant reduction (p<0.001) in the overall rate of certifications for SI and SSI due to any cause, from 43.4 certifications per 100 000 people to 41.7 per 100 000 people. Conversely, in Wales, an initial decline was observed, with a decrease from 50.6 to 40.1 per 100 000 people from 2009/2010 to 2014/2015, respectively. This rate subsequently increased to 51.8 per 100 000 by 2019/2020; however, this was not statistically significant (p=0.087). Individuals in Wales had a 9% higher certification rate compared with those in England (1.09 (95% CI 1.07, 1.10)). For diabetic retinopathy, certifications in England significantly decreased from 72.8 to 41.3 per 100 000 people over the study period; in Wales, the certification rate initially declined from 82.3 to 47.1 per 100 000 by 2016/2017 before increasing to 55.5 per 100 000 in 2019/2020. Despite this fluctuation, there was a significant decrease in certifications due to diabetic retinopathy in Wales during the study period. CONCLUSIONS: The findings underscore the importance of understanding regional variations in certification rates, particularly in the context of diabetic retinopathy. Despite fluctuations in Wales, the overall reduction in certifications due to diabetic retinopathy in both regions suggests a critical need for ongoing public health initiatives aimed at preventing vision impairment linked to diabetes. However, to provide a true reflection of the burden of vision impairment and its various causes, ensuring that all eligible people are certified is a prerequisite. Continuing attempts to limit the incidence of vision impairment due to diabetic retinopathy remain a priority.

Background: The prevalence of neovascular age-related macular degeneration (nAMD) continues to increase. Hospital Eye Services are operating above capacity, innovative solutions to minimise the high proportion of false negative referrals, improve the care pathway and increase capacity for those patients who need ongoing care are essential are essential. Methods: A two-phase retrospective longitudinal analysis of all patients referred and assessed for nAMD between; April 2019 to March 2020 (Phase 1) n=394, and April 2020 to March 2021 (Phase 2) n= 414, within Swansea Bay University Health Board (SBUHB). All patients with suspect nAMD were referred to the hospital based nAMD clinic in phase 1, and a community optometry nAMD decision making pathway in phase 2. All clinical records were reviewed, and data collated for subsequent analysis. Age, sex, date of referral, diagnosis, and treatment date were all recorded and analysed. Results: During phase 1, 104 new nAMD cases needing treatment were diagnosed with 85% (n=88) receiving treatment within 2 weeks of initial referral. During phase 2, 230 new nAMD cases requiring treatment were diagnosed with 94% (n=216) receiving treatment within 2 weeks of initial referral. Both the proportion of nAMD cases diagnosed (χ² = 70.8; p<0.001) and proportion of those treated within 2 weeks of initial diagnosis (χ² = 7.57; p<0.05) were significantly higher during phase 2. Conclusion: There are advantages to a community optometry nAMD decision-making pathway with regard to 1) decreasing the number of patients requiring HES attendance, 2) increasing the number of patients able to access treatment for nAMD within 2 weeks of initial referral 3) an increased rate of diagnosis confirmation of nAMD and 4) a decrease in the rate of false-positive referrals.

Research has shown that people with long-term mental health difficulties often suffer poor general health and are at risk of premature death. An audit in primary care showed that these patients had low rates of access to physical health screening and health promotion. Practices worked with colleagues in the community mental health team to encourage patients to attend for an annual check with a practice nurse. Outcomes are sent to the mental health team so that they can promote concordance with follow-up tests or treatment. Attendance rates have been high and unmet need has been revealed. Practice nurses and mental health staff are developing a better understanding of each others' roles.

OBJECTIVES: To better understand the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers, leading to recommendations for the prioritisation of personal protective equipment, testing, training and vaccination. DESIGN: Observational, longitudinal, national cohort study. SETTING: Our cohort were secondary care (hospital-based) healthcare workers employed by NHS Wales (United Kingdom) organisations from 1 April 2020 to 30 November 2020. PARTICIPANTS: We included 577,756 monthly observations among 77,587 healthcare workers. Using linked anonymised datasets, participants were grouped into 20 staff roles. Additionally, each role was deemed either patient-facing, non-patient-facing or undetermined. This was linked to individual demographic details and dates of positive SARS-CoV-2 PCR tests. MAIN OUTCOME MEASURES: We used univariable and multivariable logistic regression models to determine odds ratios (ORs) for the risk of a positive SARS-CoV-2 PCR test. RESULTS: Patient-facing healthcare workers were at the highest risk of SARS-CoV-2 infection with an adjusted OR (95% confidence interval [CI]) of 2.28 (95% CI 2.10-2.47). We found that after adjustment, foundation year doctors (OR 1.83 [95% CI 1.47-2.27]), healthcare support workers [OR 1.36 [95% CI 1.20-1.54]) and hospital nurses (OR 1.27 [95% CI 1.12-1.44]) were at the highest risk of infection among all staff groups. Younger healthcare workers and those living in more deprived areas were at a higher risk of infection. We also observed that infection rates varied over time and by organisation. CONCLUSIONS: These findings have important policy implications for the prioritisation of vaccination, testing, training and personal protective equipment provision for patient-facing roles and the higher risk staff groups.

Andrew Eustace outlines the pros and cons of traditional owner-occupied tenures vs some alternative funding arrangements and how they have been used to improve the quality and flexibility of premises stock

Abstract Background Medication prescribing and dispensing often regarded as one of the most effective ways to manage and improve population health. Prescribed and dispensed medications can be monitored through data linkage for each patient. We hypothesised that changes in patient care resulting from COVID-19, changed the way patients access their prescribed medication. Objective To develop an efficient approach for evaluation of the impact of COVID-19 on drug dispensing patterns. Methods Retrospective observational study using national patient-level dispensing records in Wales-UK. Total dispensed drug items between 01-Jan-2016 and 31-Dec-2019 (counterfactual pre-COVID-19) were compared to 2020 (COVID-19 year). We compared trends of dispensed items in three main British National Formulary (BNF) sections(Cardiovascular system, Central Nervous System, Immunological &amp; Vaccine) using European Age-Standardized rates. We developed an online tool to enable monitoring of changes in dispensing as the pandemic evolves. Result Amongst all BNF chapters, 52,357,639 items were dispensed in 2020 compared to 49,747,141 items in 2019 demonstrating a relative increase of 5.25% in 2020(95%CI[5.21,5.29]). Comparison of monthly patterns of 2020 and 2019 dispensed items showed a notable difference between the total number of dispensed drug items each month, with an average difference (D) of +290,055 and average Relative Change (RC) of +5.52%. The greatest RC was observed in a substantial March-2020 increase (D=+1,501,242 and RC=+28%), followed by second peak in June (D=+565,004, RC=+10.97%). May was characterised by lower dispensing (D=-399,244, RC=-5.9%). Cardiovascular categories were characterised, across all age groups, by dramatic March-2020 increases, at the epidemic peak, followed by months of lower than expected dispensing, and gradual recovery by September. The Central Nervous System category was similar, but with only a short decline in May, and quicker recovery. A stand-out grouping was Immunological and Vaccine, which dropped to very low levels across all age groups, and all months (including the March dispensing peak). Conclusions Aberration in clinical service delivery during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes

BACKGROUND: Prescribing is the most common intervention made by healthcare professionals. Our study aimed to compare prescribing between general practitioner (GP) practices with the highest and lowest levels of deprivation. METHODS: The deprivation level of each GP practice was determined using data from the income domain of the Welsh Index of Multiple Deprivation and individual patient postcodes. We compared prescribing data between the highest and lowest deprivation quintiles for selected groups of medicines. The prescribing measures used were selected as the most appropriate to the specific medicine group being considered. Data were analysed across the period of April 2018-March 2023. RESULTS: For the medicine groups of statins, hypnotics and anxiolytics, and antidepressants, there was a statistically significantly higher level of prescribing in the highest deprivation quintile. For anticoagulants, there was no significant difference in prescribing between the different quintiles. For hormone replacement therapy, there was a significantly higher level of prescribing in the quintile of lowest deprivation. CONCLUSION: Our study shows variation in the prescribing of different medicine groups between the highest and lowest deprivation quintiles in Wales. Further investigation into this variation is required.

A Rota de Arte Rupestre do Noroeste é um projeto que pretende explorar as potencialidades da arte rupestre do NW de Portugal enquanto recurso passível de desenvolvimento de uma prática turística sustentável.O NW português é uma área rica em arte rupestre de ar livre de cronologia pós-paleolítica, em especial do estilo designado de Arte Atlântica, específico da área. Além do seu inegável valor científico, o caráter estratégico deste recurso patrimonial deveria integrar programas de desenvolvimento e de organização do território.Para que tal se concretize há que colmatar carências ao nível da investigação, tais como a compilação e sistematização dos dados que promovam o avanço do conhecimento científico e, simultaneamente, propiciem discursos atrativos para o público em geral.O projeto tenciona aprofundar a investigação da arte rupestre segundo perspetivas arqueológicas e antropológicas, contribuir para salvaguardar este património arqueológico e promover a sua valorização na fachada ocidental no NW de Portugal, por forma a que se possa criar o produto turístico sustentável “Rota de Arte Rupestre do Noroeste”. Visa, ainda, rentabilizar o património “intangível” ligado a estes recursos, os recursos humanos das parcerias envolvidas no projeto – e incrementar o desenvolvimento sustentável do território abordado.Serão divulgadas as ações já materializadas e/ou em vias de materialização, bem como os resultados atingidos para diferentes áreas do NW.

Abstract Background Medication prescribing and dispensing often regarded as one of the most effective ways to manage and improve population health. Prescribed and dispensed medications can be monitored through data linkage for each patient. We hypothesised that changes in patient care resulting from COVID-19, changed the way patients access their prescribed medication. Objective To develop an efficient approach for evaluation of the impact of COVID-19 on drug dispensing patterns. Methods Retrospective observational study using national patient-level dispensing records in Wales-UK. Total dispensed drug items between 01-Jan-2016 and 31-Dec-2019 (counterfactual pre-COVID-19) were compared to 2020 (COVID-19 year). We compared trends of dispensed items in three main British National Formulary (BNF) sections(Cardiovascular system, Central Nervous System, Immunological &amp; Vaccine) using European Age-Standardized rates. We developed an online tool to enable monitoring of changes in dispensing as the pandemic evolves. Result Amongst all BNF chapters, 52,357,639 items were dispensed in 2020 compared to 49,747,141 items in 2019 demonstrating a relative increase of 5.25% in 2020(95%CI[5.21,5.29]). Comparison of monthly patterns of 2020 and 2019 dispensed items showed a notable difference between the total number of dispensed drug items each month, with an average difference (D) of +290,055 and average Relative Change (RC) of +5.52%. The greatest RC was observed in a substantial March-2020 increase (D=+1,501,242 and RC=+28%), followed by second peak in June (D=+565,004, RC=+10.97%). May was characterised by lower dispensing (D=-399,244, RC=-5.9%). Cardiovascular categories were characterised, across all age groups, by dramatic March-2020 increases, at the epidemic peak, followed by months of lower than expected dispensing, and gradual recovery by September. The Central Nervous System category was similar, but with only a short decline in May, and quicker recovery. A stand-out grouping was Immunological and Vaccine, which dropped to very low levels across all age groups, and all months (including the March dispensing peak). Conclusions Aberration in clinical service delivery during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes

BACKGROUND: The certificate of vision impairment has an important role in enabling access to support for people with vision impairment (VI) and the provision of epidemiological data regarding sight loss. However, the rates of certification may not accurately reflect the number of people living with certifiable VI. METHODS: Observational data from a national primary care low vision rehabilitation service between 1 April 2021 and 31 March 2022 were analysed. Descriptive statistics were used to describe the certification status of patients with certifiable VI. For patients with age-related macular degeneration (AMD) and best-corrected visual acuity of 6/60 or worse, logistic regression was undertaken to assess the effects of patient characteristics on certification status. RESULTS: For patients with AMD and certifiable levels of visual acuity, 41.00% (n = 426) were not certified. The reported certification was 60.09% (n = 256) and 58.24% (n = 357) for neovascular AMD and atrophic AMD, respectively. Existing patients of the service were 3.87 times more likely to be certified than new patients (OR 3.87, 95% CI 2.7-5.4). Increasing age (OR 1.02, 95% CI 1.004-1.038) and decreasing visual acuity (OR 0.62, 95% CI 0.50-0.78) were associated with an increased likelihood of certification. CONCLUSION: A significant number of patients live with certifiable vision impairment but do not access certification. Policy changes in Wales now enable patients with bilateral atrophic AMD to access certification within the primary care setting. Given the unmet need, consideration should be given to primary care certification in the rest of the UK, and in Wales, the potential to expand the scope of conditions.

OBJECTIVES: To develop and validate a bilingual experience survey for use in any NHS healthcare setting, to support service improvement. DESIGN: A prospective mixed-methods study. SETTING: Any healthcare setting in NHS Wales including primary, secondary, urgent and planned care. PARTICIPANTS: An opportunistic sample of people with experience of using local healthcare services. Qualitative interviews and focus groups were held to develop a draft survey. These were followed by online data collection from a wide participant sample for statistical validation. The tool was translated and linguistically validated following recognised methods. Patient engagement leads were involved to ensure the tool met their needs. RESULTS: We conducted and analysed five focus groups and four interviews, consisting of 33 people in total. 12 draft questions were developed related to key aspects of patient experience. A series of online surveys were conducted to test the draft questions, with 769 responses received. Data were analysed to assess completion rates, intra-rater reliability, internal consistency and convergent validity. One question had both sub-par intrarater reliability and poor convergent validity, and despite attempts to improve the wording, it failed to meet minimum requirements of validity and was subsequently removed. The final validated People's Experience Survey (PES) was subsequently translated into Welsh and validated with service users. CONCLUSIONS: The PES is a reliable and valid tool, suitable for use in any healthcare setting. The robust processes that have been undertaken ensure that the questions included are available bilingually to collect reliable, meaningful data to support service improvement work.

Character education has become increasingly crucial in facing the complexity of challenges in the 21st century. Education serves as one of the fundamental pillars in shaping individual character and personality. Amidst the growing religious and cultural pluralism, values-based education becomes more relevant in cultivating a generation with global awareness and inclusive attitudes. The purpose of this research is to delve into the implementation of Living Values Education (LVE) approach that integrates character values with the principles of religious moderationtn the Madania educational environment. This study uses a type of qualitative research method with a case study approach. The findings indicate that Madania School adopts the Living Values Education (LVE) approach by integrating an understanding of religious moderation to create an inclusive, multicultural learning environment that focuses on character development. This approach engages educators as role models in applying character values and encourages students to internalize these values through various daily activities and interactions.

John Prendergast, a Decontamination Engineer working within the specialist team at NHS Wales Shared Services Partnership/Facilities Services, and Wayne Spencer, an independent consultant on decontamination and healthcare engineering issues, with high-level previous experience at the Department of Health and the Welsh Health Common Services Authority (now NHS Wales Shared Services Partnership), report on a recent study day held in Birmingham, and staged by The Central Sterilising Club, entitled 'Update on Decontamination Standards'.

Purpose Intimate partner violence (IPV) is an area of international concern across social, health and justice settings. Reducing such has been an ongoing part of government strategy in the UK. As well as putting in measures to protect victims, part of the strategy to reduce this problem is around working with perpetrators to reduce the risk they present to intimate partners. The purpose of this study is to identify the factors associated with male IPV perpetrators who screened into the offender personality disorder (OPD) pathway in Wales, and to identify the treatment needs of this cohort. Design/methodology/approach The authors analysed the formulation documents of 235 men who had committed IPV and who had been assessed as posing a high risk of harm to the public. All men had complex needs linked to their personality functioning. Thematic analysis was used to analyse the data. Findings Twenty-eight treatment needs were identified for this cohort, the most common of which were emotion dysregulation (identified in 96.2% of cases), relationship problems (93.6%) and substance misuse (90.2%). High levels of trauma and mental health problems were also identified. Practical implications Individuals who screened into the OPD pathway required support and intervention regarding emotional regulation/stabilisation, processing trauma, substance misuse and mental health. The authors emphasise the importance of individualised treatment based on collaborative assessment and formulation to determine the type of intervention needed, as well as the timing and sequencing of interventions. Approaching treatment in this way could help to maximise engagement, and the benefit obtained from work completed, including risk-reduction work. Originality/value The OPD pathway is a large-scale initiative that plays an important role in the justice system of England and Wales. To date, relatively little research has been published regarding the needs of the IPV perpetrators who are eligible for support from the OPD pathway. As well as this, there is currently somewhat limited research on the treatment needs of IPV perpetrators with difficulties linked to their complex personality presentations. This study aimed to address these gaps in the evidence base.