P032 Allied health professional led triage in rheumatology services at Southend Hospital: service evolution and outcomes

Abstract Background/Aims The Southend Rheumatology service has undergone significant transformation through the development of Allied Health Professional (AHP)-led triage pathways, with a particular emphasis on physiotherapy-led “Grey Clinics.” This model was introduced to streamline patient access, reduce wait times, and ensure appropriate use of specialist resources. The pathway integrates initial AHP-led assessments, the ability to order investigations and blood tests as required, and structured multidisciplinary team (MDT) meetings—including joint rheumatology and radiology discussions—for complex cases. Methods Data from July to December 2023 demonstrated that 13% of referrals were directed to the osteoporosis service, 47% to rheumatology clinics, and 19% to Grey Clinics, while 20% were either rejected, redirected, or required further information. Initial service changes introduced in December 2023 aimed to refine triage accuracy and improve referral clarity. Subsequent data from 2024 reflected evolving trends: 11% of referrals to the osteoporosis service, 48% to rheumatology clinics, 9% to Grey Clinics, and 33% either rejected, redirected, or requiring further clarification. Comparative analysis between December 2023 and December 2024 demonstrated improvement in referral management and reduced wait times. A structured rejection template was introduced in 2025 to standardise communication with referrers, requesting essential clinical details such as evidence of active synovitis, symptom duration, relevant investigations, and the presence of early morning stiffness. This has supported safer triage and encouraged the use of Advice and Guidance (A&G) where diagnostic uncertainty persists. Despite this, challenges remain: general practitioners (GPs) have been omitting key details—particularly regarding fibromyalgia and hypermobility—while the introduction of incentivised A&G requests has further increased service pressures. Referral volume overall has risen from 160 to an average of 200 per month, a trend potentially linked to both reduced wait times and re-referrals following requests for additional information. Results The service has demonstrated measurable benefits in terms of patient flow and wait time reduction. However, ongoing pressures highlight the need for further system evolution. Future priorities include enabling the ordering of investigations prior to face-to-face appointments, allowing clinicians to accept referrals with annotated feedback rather than rejection, and expanding physiotherapy-led and Grey Clinics through workforce upskilling. Conclusion In conclusion, the Southend AHP-led rheumatology triage model has successfully restructured referral pathways, delivering more efficient patient management and improving access to specialist care. Continued refinement, enhanced collaboration with primary care, and investment in AHP-led clinics represent key opportunities to further optimise service delivery and sustainability. Disclosure G. Morriss: None.