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BSR launched the Best Practice Awards over five years ago to highlight and share innovative solutions to challenges in rheumatology. At NHS Greater Glasgow and Clyde, the first rheumatology nurse specialist training programme in Scotland has been established and is already seeing great progress.


Back in 2012, the Scottish Public Health Network report highlighted that a lack of succession planning for Clinical Nurse Specialists (CNS) posts posed a significant risk to the sustainability of rheumatoid arthritis services.


Dr Anne McEntegart of NHS Greater Glasgow and Clyde (NHSGGC) and President of the Scottish Society for Rheumatology (SSR) and Sister Liz McIvor, CNS at Stobhill Hospital recognised that something needed to be done. “When we looked at our services we found we had 15 nurse specialists across the eight hospital sites. A number of them were senior and we were dependent on them running the services. We realised that if in the next few years some of them wanted to retire, we needed to train people to step into those posts.”


Recruiting nurses into CNS roles within rheumatology, which is largely outpatient based, was identified as a significant issue. Additionally, it takes time to acquire the skills needed to undertake a complex specialty with an ever-changing array of therapies.


In response to this NHSGGC set up the Associate Rheumatology Nurse Specialist Training Programme in 2014 to recruit nurses and train them for future CNS posts. It operates on a secondment basis, allowing nurses to gain experience in the role, but also giving them the flexibility to return to their previous posts should they choose to do so.


During the year-long programme trainees spend four months in each of three rheumatology units in North Glasgow, South Glasgow and Clyde “We describe it as an apprenticeship,” said Dr McEntegart. “It’s hands-on and nurses are trained by experts in their field.”


She highlights that it’s a good way of attracting nurses into the specialty, “It’s a comprehensive training programme that also includes gaining an honours level academic qualification from Glasgow Caledonian University. We end up with nurses who are ready to hit the ground running and they develop a true insight into why rheumatology is an interesting and varied area to work in.”


Nurses get to learn joint aspiration and injection techniques, gain knowledge in biologic prescribing and blood monitoring, as well as shadowing the existing CNS at each unit.


Four nurses have been trained so far, with all of them taking up permanent substantive posts, and the fifth opportunity is about to be advertised. Every year there is a rising number of high-quality applicants from an increasing range of backgrounds. 


Benefits of the new CNS posts include the establishment of biologic screening and tapering clinics, an increase in the number of joint injections that can be performed and the establishment of a patient telephone helpline in one of the hospitals. A key challenge, as Dr McEntegart highlights, has been getting the posts funded. “It costs just over £30,000 to run the programme each year, but there are clear benefits not just to patient care but also finances.”


Analysis shows that there are cost and resource savings to be made by increasing CNS posts.  CNS can review return patients at clinic and also reduce the need for an A&E, GP or rheumatology consultant appointment for patients with a flare of disease by providing quick access through a helpline.  Additionally CNS can by overseeing the switching of patients to biosimilar agents achieve significant drug cost savings.


Last Autumn a joint report by BSR and SSR called Rheumatology in Scotland: The State of Play provided a complete picture of rheumatology services in Scotland including treatments, diagnostics and workforce recruitment. The nurse training programme was one of the case studies in the report highlighted as best practice.


Following the publication of the report, Dr McEntegart, British Society for Rheumatology President Dr Elizabeth Price and our Develoved Nations Officer, Lauren Bennie, met with Joe FitzPatrick MSP, Minister for Public Health, Sport and Wellbeing. One of things on the agenda was the variation of nurse specialists across the country and how the programme is tackling this issue. The Minister has instructed his officials to investigate how the Scottish Government can raise awareness of the Associate Rheumatology Nurse Specialist Training Programme asking what is being done to inform Scottish Health Boards of this programme.


Overall, it’s hoped that the training model will help others facing recruitment and retention challenges. “Services are run differently across the country with different structures,” says Dr McEntegart. “But if the programme fits with the running of services in other areas I’d like to see further health boards take it up. Rolling out the programme elsewhere in Scotland is something that I’d really like to achieve.”


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