Spotlight on a Rheumatology Unit - Bolton

13/01/09 : By Dr Sreekanth Vasireddy, Consultant Rheumatologist

Introduction Until 2005, Bolton had one specialist Rheumatology clinic per week delivered at the Royal Bolton Hospital (RBH) by a visiting consultant from Salford. From 2005 onwards, this visiting service ceased, and the new Department of Rheumatology took over the delivery of Rheumatology services to the entire borough of approximately 265,000.

Although the Department is uniquely based within a community care setting, we provide the full range of specialist rheumatology services expected of a District General Hospital Unit including inpatient care, and we maintain close working relationships with other specialist services within the PCT, other specialty departments in the local foundation hospital trust, and with tertiary units in the region.

Meet the Team

The clinical team is made up of three consultants (Dr Keatley Adams, Dr Sreekanth Vasireddy and Dr Anindita Paul), a GP with Special Interest, two junior doctors rotating through the unit at senior house officer level, four Advanced Rheumatology Practitioners (ARPs), one Specialist Nurse, an OPD sister, a dedicated Rheumatology Therapy team and a dedicated Health Care Assistant team.

Core Services:

Out patients and inpatients

With improved treatments lately, Rheumatology is now a predominantly outpatient service. Our department provides outpatient clinics every working day of the week at the LCH site and on four days a week at the RBH site. We use inpatient facilities as part of the Medical Directorate beds at RBH for any elective admissions, and the Bolton Community Unit (which is also sited at RBH) for short stay planned admissions such as planned intravenous therapies etc. The consultants also provide in patient cover on a weekly rota basis for any patients admitted via the emergency teams who require rheumatology input.

Biologics

Although this is a relatively young department, we have an active biologics programme for inflammatory arthritis patients with over a hundred patients already on anti TNF therapies. We have also recently started using MabThera (rituximab). Our two senior nurse practitioners, Lois Craddock (ARP) and Sharon Bradshaw (SpN), run their own weekly Biologics clinic lists with consultant support when necessary.

Imaging and other Investigations

We do the full range of routine and urgent imaging & pathology investigations for our patients in the Radiology & Pathology Departments at RBH, with instant access to PACS images on monitors in the clinics at LCH and RBH and high-resolution monitors in the consultants’ offices. In addition, we have rapid access MRI (for non-urgent imaging), and DXA in the PCT via independent sector providers with waiting times of less than 6 weeks for most patients.

AHP Clinics and Programmes

In addition to the Biologics clinics, two of our ARPs also have a weekly list each for an osteoporosis and a fibromyalgia clinic under consultant supervision. There is also a weekly Injection clinic list done by an ARP for joint injections. All the ARPs also have individual general rheumatology clinic lists where patients with stable inflammatory arthritis, polymyalgia and uncomplicated osteoporosis are followed up under consultant supervision.

Caring for People with Rheumatic Conditions:

Rheumatology Therapy Team

The therapy team consists of two senior physiotherapists, a senior occupational therapist, an advanced podiatrist, two part time counsellors, and three assistant therapists all of whom have weekly booked clinics. Services delivered include the standard treatments as well as acupuncture and Tai-Chi. Members of the therapy team and ARPs together deliver our Fibromyalgia and Osteoporosis management programmes (self management programmes delivered over five weeks) to patients with these conditions.

The ARPs and SpN also run the patient telephone advice line service on a rota basis. The dedicated room for this session has a computer with access to the department’s correspondence on-line (clinic letters etc), so that the response to each patient’s query is backed up by appropriate information in the absence of the actual case notes. On two audits, patients had high satisfaction rates with this service.

Patient Support Groups

The unit supports Bolton patient groups affiliated to the National Osteoporosis Society and the Fibromyalgia Association. In 2007, we also started the first NRAS patient group in the Greater Manchester, Lancashire and Merseyside areas.

Education and Research

We have a weekly education meeting for the whole multi-disciplinary team based on a planned annual programme. Both medical and non-medical members of the team contribute to the teaching covering a broad range of relevant topics. From 2008, we also have two trainee doctors at senior house officer level rotating through the unit. The unit also contributes to research and has been a recruiting centre for multi-centre studies in conditions such as inflammatory arthritis, Paget’s disease and osteoporosis.

Summary

A large proportion of our work involves looking after patients with chronic disorders. By doing away with traditional notions of primary and secondary care settings, our department delivers comprehensive specialist Rheumatology care across both community care and hospital settings in Bolton. Our main focus is on meeting patients’ needs, with the objective of achieving the best possible outcomes for our patients by providing access to the right personnel and latest treatments in a timely manner and in an appropriate environment.