Research is transforming treatment of long-term conditions

Under the existing model of care, patients with conditions such as arthritis are given routine appointments that often take place when their symptoms are mild. Yet when their condition deteriorates it can be difficult to secure an urgent appointment.

Now, a new approach known as Patient Initiated Clinics is hoping to transform the delivery of care across the South West by putting patients in control. Instead of appointments booked months in advance, the scheme allows people to contact their specialist department whenever their condition deteriorates. They can call a specialist nurse and, if needed, are offered a face-to-face appointment within two weeks.

Research and evaluation of the programme has been led by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR PenCLAHRC) in association with the South West Academic Health Science Network (SW AHSN).

Teaming up with clinical experts at Plymouth Hospitals NHS Trust, the new system has been rolled out to patients with rheumatoid arthritis and is already helping to provide an improved service. More than 450 people have signed up to the scheme called ‘Direct Access’ which enables them to call a nurse-managed advice line whenever their symptoms worsen.

Philip Hawkins suffers from rheumatoid arthritis and has been on the new system for a year. He believes it has transformed the way he manages his condition, “The conventional approach to outpatient care used to provide me with an appointment every six months, often when I was perfectly well. Direct Access allows me to see a specialist when my symptoms are bad, providing quick and effective treatment to help me get on with my life.”

This sentiment is echoed by NIHR PenCLAHRC’s evaluation of the scheme, which has shown it can have a significant impact on patient satisfaction. Participants using Direct Access said they were happier with their care – finding the scheme accessible, convenient and resulting in fewer GP visits than the traditional approach.

Senior Nurse Specialist Nikki Day has helped to lead the new system at Plymouth and hopes this is just the start, “We've had such a positive response to Direct Access that we’re hoping to continue our work with NIHR PenCLAHRC and expand it out to patients with other chronic conditions. Collaborating with the research team has been an essential part of the project’s success, providing the evidence we need to ensure it’s efficient and effective.”

Dr Vicki Goodwin, Lead Researcher with PenCLAHRC at the University of Exeter Medical School, wants to make sure their success is available to NHS Trusts across the country. She said “Patient-initiated clinics are perfect for managing long-term conditions, especially those with symptoms that tend to flare up. Based on the success we’ve had in Plymouth we’d like to see this approach adopted by other departments, so we’re looking at ways to help implement the system for patients with other conditions and in other hospitals.”

Mr. Paul McArdle, Consultant Surgeon and Director of Quality at Plymouth Hospitals NHS Trust said: "We want to make sure patients get the right treatment at the right time in the place that suits them best. Avoiding unnecessary appointments helps us provide care for other patients who require our services and it gives patients the choice to come when they most need to. This collaboration will help us to carefully measure the effect this project has on the care our patients receive making sure they are truly gaining from such an approach, so that as a health service we can provide better care for our patients."