Nurse-led approach to rheumatology is a hit with patients
A team from Pennine MSK Partnership is a finalist in the Community Nursing Award category of the Nursing Standard Nurse Awards. It will find out if it has won at a ceremony in the Savoy Hotel, London, on May 1.
Sarah Crtichley and her team from Pennine MSK Partnership, finalists in the Nursing Standard Nurse Awards. Picture credit: John Houlihan
The nurse-led service was set up in response to increasing waiting times for rheumatology patients at The Royal Oldham Hospital.
‘The care of patients with chronic diseases was reactive, unplanned and episodic, resulting in the inappropriate use of secondary care services,’ says Sarah Critchley, who leads the team of rheumatology specialist nurses, infusion nurses, an outpatient nurse and healthcare assistants. ‘I worked at the acute trust as a rheumatology nurse and saw waiting times of six to nine months and the lack of patient pathways, and how this affected patient care. We wanted to move from this reactive care to a systematic patient-centred approach.’
Sarah reviewed the community-based service as part of her master’s dissertation, before leaving the trust to set up the nurse-led service that could meet patients’ physical and psychosocial needs. New pathways, policies and patient group directions were developed. Sarah also developed a community-based infusion service. ‘We devised a more holistic approach to health in partnership with other NHS services and voluntary organisations,’ she explains.
The transfer of 1,686 patients into the primary care service was completed in September 2011 and the secondary care service was decommissioned.
Under the new nurse-led pathway, the team aims to give patients an appointment within one week of referral. Referrals are triaged by nurses and physiotherapists to ensure patients with inflammatory arthritis have rapid access to care.
Patients are reviewed every four to six weeks until the disease is well controlled. If the patient is stable for 12 months, they are placed on an annual review with access to the team via the advice line if needed. If the patient’s disease remains active despite optimal treatment, or if co-morbidities have been detected, the patient is reviewed by a consultant.
Close collaboration with other organisations has proved key to promoting self-management, says Sarah.
‘Our patients can access support for self-care and psychological needs through new partnerships with voluntary agencies,’ she adds. ‘They have the opportunity to see many different professionals, such as occupational therapists, podiatrists and physiotherapists, and they have longer appointment times.’
The team’s extensive network of links includes employment advisers, social services, benefits agencies, community health professionals, a falls team, smoking cessation services and Oldham Community Leisure. It has also commissioned psychological support.
As well working with district and practice nurses, the service has developed a strong link with the acute trust, enabling rapid access to inpatient treatment when required.
Pennine MSK Partnership executive director Anne Browne says the ‘highly skilled, knowledgeable and, most importantly, compassionate’ team provides ‘a truly holistic approach’ to patient care. The consultant nurse adds: ‘The team endeavours to be responsive to need, whatever that may be, while empowering the patient to self-manage whenever appropriate.
‘Motivational interviewing and shared decision making are embedded in consultations, so the patient is a true partner in their care and treatment planning.’
And patients like the service – 95% are extremely likely or likely to recommend it to friends and family. Furthermore, in 2014, 95% of respondents were completely satisfied or satisfied with their care. In relation to shared decision making, 83% felt that their care was collaborative.
Sarah adds that feedback is collected regularly and acted on. ‘For example, we recently appointed two female podiatrists in response to a patient comment that all our podiatrists were men, which made things difficult for some BME patients.’
In 2014, the British Society of Rheumatology awarded the team best practice model for an outstanding community service, stating: ‘We were very impressed with the structured pathways established by the specialist nurses and the focus on a nurse-led model of care. [Patients said] this was an area they were most pleased with – the confidence they had in their care was clear.’
The team is also highly regarded by consultant colleagues. Rheumatology consultant Neil Snowden says there have been ‘obvious improvements in patient care’ under the nurse-led model. He says: ‘Nurses have a very strong focus on patients and their needs, giving them a particular strength in chronic disease management. They help people to make the most of their episodes of care within the service. It allows the medical team to troubleshoot and problem solve, intervening at decision points and with complex cases.’
The Nursing Standard Nurse Awards judges are also impressed, especially by the integrated holistic approach offered to patients. Chief nursing officer for Wales Jean White adds: ‘This is an innovative, bespoke nurse-led service. I was impressed by its community links and its links with other nurses for co-morbidities. The way the team has thought about lifestyle and how that affects a patient’s lived experience long term was also impressive. Their passion for their patients shines through.’
The team has offered its help to other areas that want to set up a similar service, but also has its sights set on developing its own.
Despite its impressive array of partnerships, it is working to make care even more holistic by developing new ones. ‘We are working with Oldham’s Health and Wellbeing Service to promote healthy lifestyles and increase levels of physical activity,' Sarah adds. 'We are also working with employment advisers to help our patients remain in work and those wanting to return to work, as one in seven give up work within a year of diagnosis. We hope our approach will reach a wider audience with our shortlisting for this award.’