In we set up an Early Arthritis Clinic EAC to minimise delay from onset to treatment and to get the best response as soon as possible. Over time we changed our way of working and put together a service very like the NICE clinical guidance on RA with frequent patient contact for early arthritis patients.
Our experience shows that rheumatology units can implement the NICE model of RA care with little extra investment and without being swamped under the extra workload. Patients with other conditions have not been displaced and follow-up patients still have good access. The team has four nurses, three consultants, a registrar, five secretaries and a nurse admin support worker; only four of us work full time. Recently we increased the number of clinics held in the main hospital and started new clinics in three community hospitals and a GP surgery.
We have bought an ultrasound scanner and are training staff to use it in clinic. Other services such as occupational therapy and physiotherapy are available. To get best results we want to see people and start effective treatment as soon as possible after the start of symptoms. To make this happen the whole team regularly reviews practical aspects of care including new ways of working, best treatments, how to assess response and when to change treatment. Doctors and nurses can share the care of RA patients in the clinic, seeing patients and adjusting treatment according to the same plan.
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