York Hospital Rheumatology Department

By Julie Green and Helen Bickerdike, Rheumatology Nurse Specialists, York Hospital

The Rheumatology service in York was initially developed under the guidance of Consultant Rheumatologist Dr Martin Iveson. Due to an increase in service need and continued advances in treatments for rheumatology patients the team has grown. It includes three full time and 2 part time consultants, one full time and one part time registrar and one senior house officer. We have three full time and one part time clinical nurse specialist, one part time research nurse and a clinical trials assistant. The rest of the multi-disciplinary team consist of 2 physiotherapists, one occupational therapist and an occupational therapist technical instructor. There are close links to musculoskeletal podiatry and orthopaedic appliances. We also have access to the support of a part time rheumatology pharmacist.

Currently, the York Teaching Hospital NHS Foundation Trust serves an urban and rural population of approximately 350,000 with clinics occurring at York Hospital and Selby War Memorial Hospital.

We aim to deliver the best possible care within the current constraints of the NHS. In addition to offering a comprehensive rheumatology service, which offers up-to-date research based care, we carry out separate clinics for connective tissue disease, ankylosing spondylitis, early arthritis and ultrasound. Our aim is to achieve remission of inflammatory diseases as quickly as possible, thus enabling patients to recover from their debilitating conditions with empowerment and dignity and maintain their independence. We very rarely admit patients to the wards, and with the support of the ‘Medical Elective Services’ department patients are able to attend as day cases for biologic and bisphosphonate infusions. We also give other treatments like joint injections to quickly settle acute flares of arthritis. The clinical nurse specialists run a ‘Rapid Access’ clinic every week, giving access to patients who may be having a flare or side effects to their therapies.

The nurse specialist role provides a comprehensive support service for patients including patient education around diagnoses, medication and self management in addition disease assessment and monitoring. Patients, carers and health professionals are able to seek information via the telephone advice line or email. Education and training is provided to hospital and community staff via training sessions and to regional and national colleagues via conference presentations. The nursing team has developed skills to include non-medical prescribing and joint injections

We feel access to research is vital for our current and future patients. The Comprehensive Local Research Network supports recruitment to the ten studies currently in progress within the department, all of which are recruited to from our clinics. We are also recruiting to the Biologics Register for patients having Rituximab and Cimzia.

Each consultant is the responsible investigator for 2 or 3 studies each, supported by the research nurse and clinical trials assistant. The physiotherapists and occupational therapists take referrals from the outpatient clinics and are occasionally involved in the care of patients admitted to the wards. All new patients with RA are referred for education, flare and joint protection advice and treatment. The occupational therapists are also available for help in seeking support in our patients’ personal relationships.

The department is committed to the education of future health professionals. Medical, nursing, physiotherapy, occupational therapy and pharmacy students rotate through the department to gain experience in the area of rheumatology with specific education for medical students provided via alliance with the Hull and York Medical School.

YORKRA support group was established in 2007 by patients who initially met when attending the hospital patient education group and has grown in numbers over the years to boast over 90 members. All members of the MDT regularly attend to discuss the latest information. The Rheumatology Department was nominated by YORKRA for an NRAS team award in 2008.

In the future we aim to have our own dedicated department and we are working toward an annual review clinic and dedicated website. The department endeavours to continue with improvements in rapid diagnosis and treatments to the patients York and its surrounding areas.