The National Rheumatoid Arthritis Society backs Frontline First

The RCN Campaign ‘Frontline First’ is hugely important and National Rheumatoid Arthritis Society welcomes the opportunity to add its voice and support the call for protection of our Specialist Rheumatology Nurses.

Rheumatology has historically been an under resourced speciality in many units and the role of the Specialist Rheumatology Nurse has been crucial in maintaining continuity of care and support.

In difficult economic times it is all too easy to look at staff reductions as a quick way to save money.  However, our Rheumatology Nurses can actually save time, money, and other resources. Different models of care can find them working across secondary and primary care, supporting both patients and GP’s, and preventing referral back into the specialist, or unnecessary stress and trauma for patients and their carers.

‘Pandora’ is an innovative software programme used by specialist rheumatology nurses and was designed to capture exactly what the nurse does, rather than collecting activity based on pure numbers.  For example, a nurse may see one patient and undertake a wide range of skills and competencies which might include: assessing the disease activity using physical examination; consultation and history taking skills; supporting the patient in managing their lives in the context of their disease. An example of this might be the patient having lost their job because of poor health, or could be the nurse helping to discuss their patient’s psychological problems in coming to terms with the disease.  The nurse may also check their patient’s blood results, administer an injection, or provide information on drugs and side effects. 

'Pandora’ collects the complexities of these activities, as well as recording the emotional labour used in real time by the nurse, to show what specialist nurses do.  The ‘Pandora’ programme then uses this information to report on developments in nursing and monitors the delivery of high-quality, effective, and person-centric care.  Pandora also undertakes economic evaluations of how nurses contribute to costs savings within their organisation. 

A recent study published by the Royal College of Nursing in April 2010 ’Clinical Nurse Specialists: adding value to care’, which used evidence from the ‘Pandora Programme’, showed very clearly the cost-effectiveness of the Rheumatology Nurse Specialist (RNS). 

The average outpatient workload of the RNS is a mean of 16 patients per week.  The vast majority of this is outpatient follow up which, in turn, allows consultants to be released to undertake new patient appointments. The study argues that, by using Healthcare Resource Group (HRG) 4 (DH, 2009), this represents a saving of £175,169 per nurse, per annum.

We conclude from this study that it does not make economic sense to dispense of our Specialist Rheumatology Nurses to save money.  In fact, we should be doing the exact opposite. A recently published report by the National Audit Office shows us that by employing more specialist nurses we could help end the current post-code lottery of care that exists for people with Rheumatoid Arthritis.