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Peer review in rheumatology is a locally-run process where a multi-disciplinary team of appointed reviewers assess a rheumatology unit within their region.

Peer review has many benefits, both at an organisational level (e.g. in line with CQC, supporting specialist commissioning etc.) and at an individual level, providing evidence for CPD and revalidation purposes.

In regions where peer review is active it is seen as mutually beneficial and an educational experience for both reviewers and those reviewed. The outcome of visits commonly addresses staffing needs and results in expansion of nursing, medical, secretarial or health professional jobs.

Why get involved?

Shabina Sultan, Consultant Rheumatologist, Airedale NHS Foundation Trust

In 2012 we underwent our first Peer Review. The visiting team consisted of three consultants, a specialist trainee, a therapist and a manager. The report said: "Whilst a lot has been achieved in a relatively short period of time, there are clearly some areas that need improving".

Over the next two years I used the peer review recommendations at business meetings as support for developing the service. They identified what the nurse specialists were doing and time taken and if support was given for admin what the service could get in return.

Overall the review gained the engagement of management, raised the profile of rheumatology in the hospital and proved a positive experience; pivotal in improving quality of service, increasing capacity, MDT appointment and driving change.

Case study report recommendations

1. Issue raised: the lack of specialist therapy services available to patients, in particular occupational therapy

Change achieved: 0.5WTE OT appointed

2. Issue raised: capacity remains an issue – access for urgent NP and FU is needed. Urgent CNS access should be available, giving patients the confidence that they can be seen at short notice for urgent problems

Change achieved: template changed – urgent slots created for both NP and FU; two urgent slots a week for CNS access

3. Issue raised: while the telephone helpline seems to be very good, it takes a lot of nursing time which could be better used increasing FU capacity

Change achieved: 10hrs band 2 admin time to support CNS to take off advice line calls and prepare clinics, allowing for additional weekly CNS clinic

4. Issue raised: the day unit is mainly run by surgical day unit staff with support from one of the Nurse Specialists

Change achieved: additional band 5 CNS to support day unit, allowing additional band 7 clinic alternative weeks in satellite unit

5. Issue raised: consultants see day case patients; could be seen by CNS

Change achieved: assessment proforma developed for CNS, freeing consultants for more appropriate care