P024 Specialist nurse-led new patient clinic for non-inflammatory rheumatological conditions: results of a pilot study of the Getting It Right First Time directive from a district general hospital

Waiting times consistently rank as one of the main concerns within the NHS, including in rheumatology departments. The British Society for Rheumatology (BSR) highlights long average waiting times for new patient reviews. In February 2024, the Bolton rheumatology department had over 900 patients awaiting first review (822 routine and 168 early inflammatory arthritis).We decided to pilot the Getting It Right First Time (GIRFT) directive of specialist nurse (SN)-led new patient clinics set up to tackle the long waiting lists and encourage development of enhanced roles within the multidisciplinary team.

SN clinics were commenced weekly with effect from 13/5/2024 with three new patients seen per clinic for a period of eight weeks by the same SN. Patients were triaged from the routine long waiters’ list by the lead consultant. For the purpose of this pilot, the referrals suggesting a non- inflammatory problem were triaged to the SN clinic. Each patient was given a 45 minutes slot to be reviewed, and consultant supervision was available contemporaneously if needed. Data were collected on patient diagnosis, follow up plans, supervision needed and change to treatment plan (if any). We also looked at impact on the routine new patient waiting list following this pilot study.

24 new patients were booked to the SN clinic over the eight week time frame with 2 cancellations and no did not attends. 10/22 patients (45.5%) were diagnosed with fibromyalgia. 6/22 (27.3%) had musculoskeletal related non-inflammatory issues, 2/22 patients (9%) had osteoarthritis, and 1 patient (4.5%) had gout. 3 patients (13.6%) had a positive immunology that needed further medical input. After review, 17/22(77.2%) patients were discharged. Follow up was needed for 5/22 patients (22.7%), with 2 patients needing a subsequent SN clinic follow up and 3 patients requiring follow up in a consultant-led clinic. Consultant supervision was needed for 10 patients (remote only). One patient needed a change to treatment plan after discussion. We have 650 patients on the routine new waiting list in August 2024.

Our observations indicate that SN-led new patient clinics have the potential to work well for patients with non-inflammatory rheumatological conditions. This will free up slots in consultant clinics to see patients with the greatest needs (e.g., early inflammatory arthritis patients) and will also help SNs widen their scope of practice. Presence of effective and appropriate triaging, contemporaneous consultant supervision availability and a robust organisational framework will help implement these clinics widely and successfully.

S. Wig: None. R. Wray: None.