Portsmouth Hospitals NHS Trust

Rapid access and treatment service; integrated biologics day case service and patient conferences


  • - 455 calls made to the telephone advice line in a month
  • - Total service costs have been calculated at only 80% of the national average
  • - Almost £250K saved over twelve months

Download a printable pdf of the Portsmouth Hospitals case study

The Portsmouth Hospitals NHS Trust rheumatology service has developed a series of initiatives in the pursuance of continual improvement of services:

- A Rapid Access and Treatment Service (RATS) for acute care in rheumatic diseases

- An integrated biologics and day-case service

- Patient conferences as a model for delivering education, service feedback and patient involvement


The challenge


  • - To avoid unscheduled admissions
  • - To deliver improved support to those patients on biologic therapies
  • - To educate and inform patients about their disease and increase self-care

The solution


  • - Patients have access to immediate day-case treatment, ultrasound, radiology and blood tests, and can have investigations and treatments on the same day
  • - The integrated biologics and day-case service is provided from the day-case unit and nurse-led clinics at two peripheral centres
  • - Patient conferences are held regularly with patient speakers as well as other experts and clinicians
  • - A telephone helpline offers advice and information to patients experiencing a flare

Service performance and outcomes


  • RATS, based in Queen Alexandra Hospital, runs for up to four days each week and patients are “batched” enabling increased efficiency.
  • RATS takes referrals from:
  •       - General practice
  •       - Emergency departments
  •       - Medical assessment units
  •       - Other consultant teams
  • - The integrated biologics and day-case service supports around 600 people by co-ordinating assessments, entry to the biologics register, delivering the biologics (infusion in central or community hospital or injection at home) and providing a rapid review if urgent attention is required
  • The patient conferences attract from around twenty attendees, when covering rarer disorders, to as many as five hundred

Patient focus and satisfaction


  • In a patient survey, carried out between March and June 2013, when asked “Do you think the biologic therapy service is well run?” more than 95% answered yes
  • Patient feedback showed more than 90% satisfaction across a range of measures

Financial performance and outcomes


  • - The integrated biologics and day-case unit has calculated a saving of £200K over a 12 month period
  • - Home delivery savings are calculated at almost £50K per year
  • - In-patient savings arising from RATS now exceed the cost of the day case service
  • - The total Portsmouth Hospitals rheumatology service cost 80% of the national average in 2011-12



Commissioning priorities


The Portsmouth Hospitals rheumatology service is an example of commissioning best practice in rheumatology and meets a number of the priorities for commissioners as outlined by the King’s Fund in 2013:
  • - Active support for self-management – patients are given advice and education as necessary eg patient education and information through the regular patient conferences and workshops
  • - Secondary prevention – telephone helpline and open access clinics help to quickly control disease activity and prevent patients’ disease from worsening
  • - Care co-ordination – the rheumatology nurse specialist role helps patients to access appropriate services quickly and easily
  • - Medicines management – treat to target therapies delivered by nurse-led pathways facilitate escalation to DMARDS, flare management and access to biologic drugs where appropriate