13 February 2019
We launched our first Best Practice Awards some five years ago now, with the aim of recognising the outstanding innovative projects that our members work on in the name of improving the delivery of rheumatology services. As the awards develop, we also want to share the successes of our award winners with our wider membership, and explore how we can help spread the word of those projects and help implement successful programmes in other areas.
The Eastern Network for Rare Autoimmune Disease (ENRAD), based out of Addenbrooke’s in Cambridge, were one of our winners in 2018 with their videoconferencing MDT project. The first project of its type within rheumatology, ENRAD brings together the rheumatology leads from 14 trusts across the east of England to provide a forum for discussion and advice regarding the diagnosis and management of complex connective tissue disease and vasculitis. Perhaps most importantly, it means access to specialist knowledge on a wider range of rare conditions that might be expected to be available in any given rheumatology department – hopefully allowing for better outcomes for patients (as well as financial savings).
One of the prompts for the development of the ENRAD videoconferencing project was the challenges posed by prescribing high-tariff drugs for rare autoimmune diseases. Previously, access to high-tariff drugs required either a specific arrangement between an individual Trust and commissioners, or left clinicians needing to submit an individual funding request. Inevitably, this led to uneven access for patients across the east of England region. One of the key successes of the ENRAD project has been NHS England sanctioning the use of rituximab for Lupus and for ANCA-associated vasculitis as long as the decision has been made via the ENRAD videoconferencing and ENRAD can demonstrate expertise of at least one local clinician.
The judging panel for the awards were particularly impressed at the simplicity and efficiency of the project once it’s up and running. Twice monthly meetings to discuss complex cases, a series of standardised proformas to ensure consistency of approach across the region, and a unified data analysis tool mean that incorporating the videoconference approach into routine work has been as easy as possible, while still achieving great results. As well as better clinical outcomes (some of which are detailed in the award case study, available here), the approach has also led to financial savings for the trusts involved, through successes such as reducing referrals to specialised rheumatology centres, reducing the number of follow-up appointments and reducing co-morbidities for patients.
As well as being an innovative approach to an old problem, one of the big up-sides of the ENRAD project is its scalability. Not only could it be replicated in other regions following the exact model presented by ENRAD – using standard forms and readily available software – our judging panel also recognised its potential to help other areas of practice, such as within paediatric rheumatology, or even connecting individual clinicians across more remote regions of the UK.
To that end, we’ve been looking at how best to help you if you’re looking to develop a regional networks and adopt the ENRAD approach to consulting. Soon, we’ll be adding a dedicated Best Practice resource page to our website where you’ll be able to download guides and standard forms used by ENRAD in their work, allowing you to replicate it in your region. We’re also looking at other ways of connecting members locally. If you’ve got any thoughts on how we might do this best, then please let us know – and otherwise keep an eye on the website for future updates.
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