Supported by the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research (OH BRC), the Treating Unmet Needs in Psychiatry TUNE-UP is run by Oxford Health NHS Foundation Trust’s (OHFT).
Clozapine remains the only evidence‑based treatment for people with treatment‑resistant schizophrenia, yet many patients face long delays in accessing it, often because initiation typically requires an inpatient stay.
For many, this represents a major barrier to effective treatment. The TUNE-UP service was established to address this challenge by providing a dedicated, community-based pathway delivered by specialist clinicians from OHFT, working in close partnership with the University of Oxford’s Department of Psychiatry. While the clinic supports a wide range of complex clinical needs in people with severe mental illness, including medication optimisation, physical health and metabolic risk, and treatment-related side-effects; improving access to clozapine has been a key early focus.
Published in BJPsych OPEN, the findings show the scale of the clinic’s impact. During the 12 months that TUNE-UP was in operation, community clozapine initiations increased more than six‑fold compared with periods when the service was not available. Patients supported by the clinic also experienced measurable improvements in their symptoms and day‑to‑day functioning.
The TUNE‑UP team provided intensive assessment, collaborative care planning and closely monitored community‑based titration allowing suitable patients to begin clozapine without the need for hospital admission. Alongside benefits for clozapine access, the service supports broader prescribing optimisation and physical health management in a population with high levels of unmet need. This approach gives patients greater choice and control over their care, reduces reliance on inpatient admission, and helps free up specialist beds.
Senior author Robert McCutcheon, Associate Professor of Psychiatry and Honorary Consultant Psychiatrist said:
This paper highlights what’s possible when academic insight and frontline clinical expertise are brought together. By developing a safe and effective community pathway for clozapine initiation — within a wider service focused on complex treatment optimisation — we’ve been able to reach patients who might otherwise face long delays or avoid treatment altogether. The results show that targeted, collaborative services can make a real difference for people living with severe mental illness, and we hope this model will inform similar approaches across the NHS.”
With clozapine still under-utilised nationally, the authors suggest that community-focused, specialist services like TUNE-UP could offer a scalable solution not only for improving access to clozapine, but also for addressing wider unmet clinical needs and improving long-term outcomes and patient experience.