P006 Embedding musculoskeletal expertise in secondary care rheumatology: a musculoskeletal advanced practice physiotherapist can effectively assess and manage patients referred to rheumatology with a low suspicion of inflammatory disease

It is estimated that one third of patients referred to secondary care rheumatology have non-inflammatory musculoskeletal conditions. Effective triage and appropriate use of primary care and community musculoskeletal services can reduce the burden of non-inflammatory conditions on rheumatology services. However, some patients require specialist clinical assessment to exclude inflammatory diagnoses, even when the suspicion of inflammatory pathology is relatively low. This has traditionally been the role of rheumatologists, despite most of these patients being diagnosed with non-inflammatory conditions after clinical assessment. Musculoskeletal advanced practice physiotherapists (APPs) have an established role in orthopaedic services diagnosing and managing patients with non-inflammatory musculoskeletal conditions. We therefore hypothesised that an experienced musculoskeletal APP could effectively assess and manage this cohort of patients that would have previously been assessed by a rheumatologist.

As part of a quality improvement project, an experienced musculoskeletal APP from a community musculoskeletal assessment and treatment service was seconded to secondary care rheumatology for one clinic a week to assess and manage a subset of patients from the routine general rheumatology waiting list (those with the lowest suspicion of inflammatory pathology at triage and the longest waiting times). The clinic was supported by consultant rheumatologists. Approximately 60% of patients were considered appropriate for the clinic.

In the first 12 months (April 2023 to April 2024), 225 patients were assessed, of which 14 (6%) were subsequently referred to a rheumatologist. Four patients (2%) had suspected inflammatory arthritis, of which three (75%) had the diagnosis confirmed by a rheumatologist. Ten patients (4%) had a suspicion of connective tissue disease (CTD) and/or positive serology. Four (40%) of these were identified as potentially having CTD by a rheumatologist. When the clinic was established in April 2023, rheumatology waiting times were increasing and 1026 patients were waiting over 52 weeks to be seen. By June 2024 waiting times were decreasing and only 4 patients were waiting over 52 weeks. Numerous factors impacted waiting times, but this clinic independently managed 211 patients that would previously have seen a rheumatologist saving over 140 hours of clinical activity and associated costs. Upskilling an APP to support colleagues and improve links between services also contributed to reducing referrals from musculoskeletal services to rheumatology from 172 in the 12 months before the clinic was established to 92 in the 12 months following implementation.

This demonstrates that a musculoskeletal APP can successfully work in secondary care rheumatology assessing, investigating, and managing a subset of patients that would previously have been seen by a rheumatologist. This liberated rheumatologists to concentrate on patients with a higher suspicion of inflammatory pathology, embedded expert management of musculoskeletal conditions in secondary care rheumatology, and contributed to a significant reduction in rheumatology waiting times.

P. Regan: None. W.J. Gregory: Honoraria; W.G. has received honorarium for speaking and advisory board roles from Abbvie, Jannsen, Novartis, Sofi and UCB. P. Barratt: None.