OA20 Implementing a rheumatology advice and guidance pathway: improving patient access, supporting PIFU and optimising MDT workload

Abstract Background/Aims Growing demand for rheumatology services places pressure on outpatient capacity and general practice workload. Many patient queries can be resolved without a face-to-face appointment if directed appropriately. Previously, patient-initiated queries were directed to a nurse-led helpline, which very quickly became overwhelmed, leading to delays and suboptimal patient satisfaction. To address this, we developed and implemented a rheumatology advice and guidance pathway to improve timely access to the MDT, reduce unnecessary appointments, redistribute workload, and ultimately support national priorities such as patient initiated follow-up (PIFU). Methods Patients contacted the department via phone or email. Queries were received by secretaries, triaged using a structured ‘triage map’ and directed to the most appropriate professional: doctors: (diagnostic queries), clinical nurse specialists (flares of inflammatory arthritis, rheumatoid arthritis, psoriatic arthritis, travel advice, planned surgery, infection queries, blood results), pharmacists/pharmacy technicians (drug reactions/side effects, vaccinations, travel advice), physiotherapists (ankylosing spondylitis, fibromyalgia) or the osteoporosis team. We retrospectively analysed advice and guidance requests in December 2024. Data collected included: mode of patient contact; type of query; response method either via email or help line; response time; need for urgent appointments; distribution of requests amongst MDT. Results A total of 444 patient queries were reviewed. Of these, 76.4% were received via phone and 23.6% via email. The majority, 78.6%, related to medical issues, with 15.1% concerning appointments and 6.3% test results. Responses were mainly provided via email (82%). Most queries, 70.8%, were resolved within one working day. Only 12.4% required an urgent appointment, demonstrating effective triage. Workload distribution showed 41.7% of queries were managed by doctors and 58.3% by CNS, pharmacists, or secretaries. Conclusion The rheumatology advice and guidance pathway has successfully addressed the challenges faced with the previous nurse-led helpline. It reduced administrative burden, redistributed workload across the MDT and enabled the secretarial staff to play a more active role in patient triage. The pathway supports PIFU by creating a responsive system to safely manage queries outside of scheduled clinic appointments.This pathway promotes MDT working, reduces unnecessary clinic appointments and ensures timely patient support by enhancing access to the rheumatology team. It aligns with the NHS long-term plan by promoting digital-first access, reducing GP workload, and enhancing MDT-based care. It adheres to NICE guidelines for rheumatoid arthritis by providing patients with ongoing access to the MDT outside of scheduled clinics and supports BSR guidelines for ANCA-associated vasculitis and GCA by ensuring patients have timely access to nurse advice and urgent consultant review when required. Future steps: we are now building towards an automated process, with potential integration of an AI-driven chatbot support using regulated data. This would further enhance efficiency, improve the safety of PIFU, and future-proof the service. Disclosure M. Gabriel: None. M. Sharif: None. H. Kamran: None. B. Benfitor: None. S. Plumb: None. M. Mustafa: None. A. Peall: None.