Spotlight on a Rheumatology Unit - Pennine MSK Partnership

		Introduction Pennine MSK PartnershipPennine MSK Partnership (PMSKP) is a unique NHS organisation, commissioned by Oldham PCT to provide a comprehensive service to the population of Oldham in Rheumatology, Orthopaedics and Chronic Pain. We have a primary care contract, but in the service, consultants and other specialist staff work along side primary care staff to provide integrated care for people who have inflammatory arthritis.

PMSKP launched in March 2006 developing from a successful “Tier 2” service in Rheumatology. The tier 2 service, simply screened GP referrals into secondary care, managing those patients in the community who did not need to see a Consultant Rheumatologist. However as PMSKP now has all the specialists working together we can now manage inflammatory patients completely in the community.

Referrals are received daily electronically and triaged to the appropriate clinician within 24 hours. Waiting time for assessments are 1-2 weeks and we have a help line and rapid assessment clinics for existing patients.

The Team There are three partners, Dr Alan Nye, From left: Dr Alan Nye, Ms Anne Browne and Dr Hugh Sturgess. Dr Hugh Sturgess and Ms Anne Browne, the two doctors are both GPs with a special interest in Rheumatology (GpwSI) and Anne is a Consultant nurse in Rheumatology. Pennine MSK Partnership directly employs a wide range of staff:

1 Business and Finance manager

2 Human Resource and office managers

2 nurse specialists in Rheumatology

1 specialist in occupational therapy

1 osteoporosis nurse specialist

There is also a full range of staff in the orthopaedic, chronic pain and office support.

The Main Office

Most of our staff work just work part time with us, either privately or as part of their NHS work. These include 14 Consultants working in the service covering Orthopaedics, Rheumatology and Liaison Psychiatry, 10 extended scope Physiotherapists, 1 Consultant Podiatric Surgeon, extended scope Podiatrists, nurse specialists in Cognitive Behavioural Therapy and chronic pain management. We have 84 clinics a week.
Staff work very closely with hospital consultant colleagues, and both formal and informal training takes place on a weekly basis. There is a strong commitment to personal development, with several of the staff completing Masters degrees/ modules/joint injection training.

		We have team building days twice a year and all staff have completed a strength deployment inventory, which focuses on understanding personal strengths in relation to others. Regular clinical supervision by the Consultants is planned for the whole clinical team. We hold regular training sessions for our local GPs in joint injection training.

The Rheumatology Service

This is a consultant led service providing assessment, treatment and long-term follow-up of all inflammatory arthritis and connective tissue disease, including a full range of joint injections and commencement of DMARDS.
We see patients within the service on average 2 weeks from referral, at initial assessment all necessary investigations are performed and any appropriate intervention for immediate pain relief given.

The patient will then see the Consultant Rheumatologist within 2 weeks and DMARDS are commenced following drug counseling with one of the nurse specialists. They are then seen on a regular basis (monthly initially) until the disease is well controlled. Access to advice and support is made available via the Nurse Helpline. The local GPs and the team share monitoring of the blood tests. This all takes place in a community setting, away from hospital outpatients.

An appointment is made for all patients with inflammatory arthritis with the specialist podiatrist for a base line foot assessment and advice on foot care.

Other members of the interdisciplinary team are involved in assessment within the first 6 months

As psychological distress can be a major problem for patients with inflammatory disease, we have a psychological medicine team within the service to fully assess and support the patient in terms of depression, anxiety or management of chronic pain. This helps to maximise the quality of life and minimise the impact of RA on their day-to-day life. Patients can self refer for joint injection therapy or reassessment at any point, with agreement from their own GP. This gives the patient greater control of their long term condition.

Future Developments

Within the next 12 months we will move some of the clinics into a brand new purpose built unit enabling all interdisciplinary team members to be at annual assessments on the same day. At this point we will have access to tabletop MRI, ultrasound and state of the art facilities. We will have day facilities available for patients requiring IV biologic therapies. We will be in a position to offer training for junior doctors and students from the allied health professions and nursing.

Summary

Patient satisfaction is very high in this community-based service. Satisfaction surveys have consistently shown that patients appreciate the quieter environment in a small community setting and found it much less intimidating than a large hospital.

The service is very responsive and change can occur quickly in response to need, as the management structure is very small and led by clinicians with many years experience of caring for patients with rheumatological diseases.

The long term aim is to have a fully integrated service with the local Acute Trust, the Mental Health Trust, Social Services and Pennine MSK Partnership and last but not least our Patients!