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Background Following the rapid expansion in the use of checkpoint inhibitors (ICIs) there has been increasing concern regarding the immune related adverse everts (irAE) associated with their usage. Whilst the efficacy is unquestionable the demand the management of patients receiving ICIs is having on oncological services is increasing and challenging in its differences to more traditional systemic anticancer therapies. Methods The Clatterbridge Cancer Centre established an Immuno-oncology (IO) committee early in the usage of ICIs having recognised the need to have a dedicated service for the support and management of patients receiving ICIs. This included the establishment of a toxicity management service delivered a dedicated nursing team with clinician oversight alongside the development of standard operating procedures, supporting documentation, patient and educational resources. Results The service was implemented with the appointment of a lead immunotherapy nurse in August 2018 and a clinical nurse specialist in October 2018. These two nurses deliver the IO toxicity service with clinical support from two medical oncology consultants and a clinical fellow. Prior to the introduction of the service, between 2016-2018, there had been 8 fold increase in the admissions due to IO. Following the introduction of the service IO admission rates have fallen by 40% over the 7 month period the service has been in place compared to the preceding 7 month period (72 vs 120 admissions). Triage calls have fallen by 16.6% and face to face reviews reduced by 9.6%. This is despite a 20% (290 vs 240 patients) increase in the number of patients commencing on ICIs in the same periods. Development of toxicity team irAE outpatient management pathways for IV therapies and a immunosuppression monitoring service have also been established. Conclusions A dedicated immunotherapy toxicity service has reduced the acute admissions related to irAE and is starting to reduce the activity of oncology outpatient services despite ongoing increases in ICI indications, number of administrations and complexity of combination therapies. Legal entity responsible for the study The authors. Funding This study was completed in part by a clinical research fellow (ACOB) who is currently funded by a Medical Research Council fellowship part funded by a UCB pharma, Roche, Eli Lilly and Novartis collaborative. Disclosure A.C. Olsson-Brown: Honoraria (self), Research grant / Funding (self): Roche; Honoraria (self), Advisory / Consultancy: Bristol-Myers Squibb; Honoraria (self): MSD ; Research grant / Funding (self): UCB Pharma; Research grant / Funding (self): Novartis; Research grant / Funding (self): Eli Lilly. T. Guinan: Honoraria (self): Bristol-Myers Squibb. S. Chow: Honoraria (self): Novartis. R. Lord: Travel / Accommodation / Expenses: AstraZeneca. J.J. Sacco: Honoraria (self), Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: immunocore. All other authors have declared no conflicts of interest.