I10. Doing Things Differently: Managing RA in Primary Care

Abstract

Pilot community rheumatology service objectives: to (i) develop an integrated community rheumatology service hosted in primary care which includes a dedicated early inflammatory arthritis pathway and the ability to rapidly access secondary care based services where necessary; (ii) develop a patient centred service delivered by specialist rheumatology nurses, general practitioners (GPs) with a specialist interests, extended role physiotherapists and consultant rheumatologists through use of existing local primary care estates and IT systems; (iii) improve patient engagement, retention and management of their long-term chronic disease flexed in the community; and (iv) facilitate patient recruitment for research directly from primary care and encourage education and training for relevant healthcare professionals. It has been said that the most difficult part of building anything new, is not the engineering, but changing attitudes. In 2008 a small practice in inner city Birmingham developed a long-term strategy to redefine primary care from the small partnership model into a large integrated care organization with multiple outlets. This required the merger of small practices to develop a single super-partnership. This in itself required enormous effort as each partnership is regarded as an individual business, requiring financial, legal and clinical due diligence. Each merger required harmonization of clinical best practice, IT systems and operational policies, overseen by a single clinical, managerial and financial team. The vision was to reduce inequalities in clinical provision, develop back office economies of scale, a mobile GP and nursing workforce, to develop specialist nurses and GPs that could be accessed by patients across the organization. In parallel with the creation of a super-partnership, in 2009 a community rheumatology pilot service was commissioned. This was focused around the objectives detailed above. This model has facilitated (i) a patient focused agenda; (ii) the ability to deliver treat to target care in the community using primary care IT to capture outcomes in a robust manner; (iii) education: mentorship and training of GP specialists and junior trainees to help early identification of inflammatory arthritis; (iv) research: direct enrolment of patients from primary care into rheumatology research studies; and (v) financial benefit: use of GP estates and IT allow a 20-30{%} reduction in tariff.