OA19 A national survey on clinic templates from the further faster rheumatology programme clinic template working group of GIRFT

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Abstract Background/Aims Variation in outpatient clinic templates has been identified by the Getting It Right First Time (GIRFT) NHS England programme, highlighting inconsistencies across rheumatology services. This affects clinic efficiency, patient flow, and overall quality of care. The GIRFT rheumatology workstream established a Clinic Template Working Group to understand and reduce unwarranted variation nationally by developing best practice guidance for outpatient clinic templates, in collaboration with the British Society for Rheumatology. A national survey was launched to gather qualitative data and clinician perceptions regarding factors influencing clinic templates and patient flow, including reasons for variability and to derive consensus definitions of “clinical complexity”, where more consultation time would be needed. Methods A working group comprising clinical and operational leads from all NHS England regions, alongside BSR, conducted an online mixed-methods survey. Rheumatology specialists across all seven NHS England regions were invited to share views on factors including adequate consultation time, administrative burden, other influences on clinic structure and delivery, and definitions of clinical complexity. Thematic analysis identified common patterns and challenges, grouped under seven themes: timings, complexity, PIFU/overbooking/late running, support, supervision, administrative time and other operational factors. Results A total of 145 responses were received with 89% of respondents being consultants or SAS doctors. District general and teaching hospitals were equally represented (49% vs 51%) from all 7 NHS regions of England. Clinicians were invited to suggest an appropriate length of time for a standard clinic slot. The average preferred time for a standard “Follow-up” slot was 20mins (range 15-30mins) and for “New” 40mins (25-60mins), with time for complex cases increasing by 50-100%. Analysis of common clinical scenarios indicated broad consensus that not all rheumatology conditions are “complex”. The patient groups identified with higher levels of clinical complexity included those with multimorbidity, complex inflammatory conditions, needing treatment escalation, transitional or multidisciplinary input. The main causes of clinic delay included complex multi-morbid patients, overbooked clinics, insufficient slot length and administrative workload. Additional contributors were unplanned PIFU returns, overbooking, inadequate support staffing, supervising trainees/AHP and unreliable IT systems. Some 76% responders rated the amount of admin time allowed for the clinics as “inadequate”. Qualitative feedback highlighted an increasing amount of cumulative administrative burden due to the complexity of patients, influencing the well-being of staff and highlighting opportunities to review current delivery models. Conclusion Clinic efficiency is influenced by the interplay of clinical complexity, scheduling design and support infrastructure. Optimising these factors through maximising existing supporting resources and standardising scheduling taking into account patient complexity can improve patient experience, clinician wellbeing and service sustainability. These findings will underpin the development of a national Rheumatology Clinic Planning Tool within the GIRFT Further Faster handbook to promote consistent, data-driven service improvement across rheumatology clinics in England. Disclosure E. Ntatsaki: None. L. Martin: None. L. Kay: None. P.C. Lanyon: Honoraria; Vifor, AstraZeneca. Grants/research support; CSL Vifor.

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