Royal Lancaster Infirmary

By Dr John Halsey, Consultant Rheumatologist, Royal Lancaster Infirmary

The multiprofessional team

When the first rheumatologist was appointed to the Royal Lancaster Infirmary in 1982 he was informed by the then hospital manager that there were no additional resources to support his appointment. Since then a comprehensive service has been established with a purpose- built department, a multi-professional team including specialist nurses, physiotherapist, occupational therapist, podiatrist, pharmacist, three consultants, two specialist registrars and an osteoporosis service with a DEXA scanner.
 
                         

During this time the department has strived to, innovate and develop patient-centred compassionate care and, keep up to date with the changing pattern of service delivery and also the major advances in the management of rheumatoid arthritis (RA), particularly with the advent of anti-TNF therapy which, for many of our patients, has been a life changing experience. In an attempt to improve services a high priority has been given to the whole area of communication, which has taken place with patients, GPs, the rheumatology team and other providers of musculoskeletal services including orthopaedic services and the pain management team.

Working with patients

Following two highly successful half-day meetings we are now planning a further meeting which will explore ways patients can help themselves and live with the consequences of RA. The aim of our last meeting was to increase knowledge and awareness about RA, to encourage a positive attitude and to review advances in treatment. There were excellent contributions from local patients and also Ailsa Bosworth, who spoke about NRAS, and Alice Peterson, who spoke about "A Will to Win". Expert patients have made invaluable contributions to the monthly early arthritis clinic where newly diagnosed patients meet all members of the team and over three hours are informed about RA, treatment and self-help options and phone helpline details.

Patients receiving anti-TNF therapy attend a special clinic where they are seen by both the supervising consultant and nurse specialist.

Dr John Halsey and the teamMorecambe Bay is one of the pilot sites for the Arthritis and Musculoskeletal Alliance (ARMA) local network project which brings together clinicians, service users and presses for the implementation of national policies including ARMA’s Standards of Care. There is also an important lobbying role for this network in improving services following the recent publication of The Musculoskeletal Services Framework by the Department of Health.

We have also enjoyed two highly successful nights out when 200 patients and carers have been guests of the department for productions of "Anything Goes" and "Kiss me Kate" at a local theatre. These events were funded from some national awards the team had won and interestingly the contributions we received from grateful patients exceeded the ticket costs and have been passed on to NRAS, Arthritis Research Campaign and Arthritis Care.

Working with primary care

Members of the teamTo assist in communications with local GPs the consultants and nurse regularly visit local practices to provide updates on patient management. GPs are invited to attend a monthly clinic to gain experience in injection techniques and a quarterly newsletter is sent out in paper and electronic form to all GPs and practices providing departmental news, topical reviews, treatment and research advances. Management guidelines and pathways have been developed in collaboration with primary care and other musculoskeletal service providers to ensure that patients are referred to the right specialist and seen in the right place at the right time. One of the department’s award winning innovations has been the establishment of an electronic advice service which enables GPs to obtain prompt e-mail advice on patient management which has been very successful in reducing unnecessary referrals to busy hospital clinics. The essential blood test monitoring of disease modifying therapy, such as methotrexate, is performed in GPs’ surgeries according to national guidelines. This is far more convenient for patients and saves travelling to the outpatient clinic for these tests to be performed where parking is always difficult! All patients are provided with education, information literature and a shared care monitoring booklet in which the results of these tests are recorded.

		Team meetings The whole rheumatology team meets weekly for an educational teaching session with contributions from all members on clinical cases, research projects and audit and there are also highly informative presentations from the senior pharmacist and pain management team. The team enjoy regular social events, an annual garden and Christmas party and some members have just returned from a long weekend in Budapest! These team building events and focus on communication have contributed to the team being awarded Hospital Doctor rheumatology team of the year in 2002 and also winning a Wyeth innovation award in 2004.