Identify and engage all relevant specialties (for our working group, these included infectious diseases, microbiology and virology, specialist clinical pharmacy, respiratory medicine, rheumatology, haematology, renal medicine, intensive care, paediatrics and obstetrics)

Clearly define the roles and objectives of the group, write a mission statement and set out your expected outputs

Define your membership and quorum

Establish a frequency for meetings

Obtain the medical director's approval and endorsement

Ensure there is a clear clinical governance structure and a defined position in the organisational flowchart

Establish reporting responsibilities (in our case this was directly to the medical director's office)

Set up processes for documentation, including a clear record of all referrals received and of clinical advice given by the group

Flatten hierarchies to encourage open and equal debate among all members of the group

Co-chairing of the group can be beneficial to provide a balanced view

Set a clear set of values to be followed during meeting (eg kind, expert, collaborative and aspirational)

Make sure guidelines are easily accessible on the hospital intranet

Provide easy-to-use flowcharts

Set up a simple referral system (form to be emailed or online referral)

Establish a 24/7 on-call rota for a responsive service (including essential pharmacy support to release drugs in stock within hours of original referral)

Establish collaborative partnerships with pharmaceutical companies for compassionate supply of drugs

Make sure all compassionate use request forms are completed and sent back to pharmaceutical companies

Carry out a daily check of pharmaceutical stock to replenish drug supplies