P84 Implementation of advanced practice rheumatology clinics

Background Ashford and St Peters NHS Trust implement an iMSK Service with an aim to deliver biopsychosocial assessment and care across Orthopaedics, Pain and Rheumatology settings. Our impression was the Rheumatology Service could be assisted by the implementation of Advanced Clinical Practitioners Clinics considering the benefits that had been offered to Orthopaedic and Pain Services. The Rheumatology Service had high waiting times to see a Consultant, were understaffed in relation to national recommended ratio of Consultant to catchment population and were motivated to promote a biopsychosocial approach to patient care. There were poor links between Rheumatology and the MSK Triage Service as well as the Physiotherapy Service which were recognised as areas for improvement and integration for both patient and staff. The plan was to improve the efficiency of pathway into Rheumatology, reduce unnecessary contacts for the patient and offer best practice advice at first contact. An aim to reduce non-inflammatory referrals to consultants, in turn reducing overall waiting times for inflammatory presentations. Methods We researched and benchmarked against existing services, learning from experiences and various models of implementation. We audited our MSK triage process, to include numbers of referrals into the Rheumatology Service. We developed an ACP Triage Criteria as a multi-disciplinary team to highlight our skillset and best fit to the service needs. We observed the existing MDT in clinic to include consultant and nurse specialists as well as undertaking injection, bloods and radiology training. We collaborated with the service managers to implement ACP clinics for the assessment of non-inflammatory presentations and widespread pain. We are collecting PREM data with the 'CARE' patient satisfaction questionnaire, as well as clinical outcome data collection to include the Widespread Pain Index, Symptom Severity Score and evaluation of patient onward referral destination and management plan. Results We have seen over 60 patients and continue to collate our data. Over 50% of patients have been discharged at first appointment to confidently begin a self-management approach to their care. We have referred only 2 patients onto rheumatology consultant appointments - therefore saving a minimum of 35 Consultant Hours within our service in a 3-month period. We have had 100% positive feedback for patient's who have completed satisfaction questionnaires PREM data after appointment. Conclusion We continue to collect and analyse our data but can already highlight a positive trend for successful implementation of ACP's into the Rheumatology Service within only a 3 month period. We feel this is a starting point for the further development of a Widespread Pain Pathway across the MSK Service to further incorporate integration of Rheumatology, Pain and Physiotherapy Services in the prevention of duplicate or unnecessary appointments and reduction in the ‘revolving door patients’ across all 3 services. Disclosures L.M. Gotting None.