Case study: Evaluating a new care model to reduce wait times

Partners: Imperial College Healthcare NHS Trust (ICHT), Healthshare Group, NW London ICS

ICHP worked with ICHT in collaboration with the Healthshare Group and NW London ICS to design and deliver an evaluation of its Rheumatology One Stop Mass Clinic (ROSMaC) – a new care model piloted to reduce the backlog of rheumatology outpatients.  

In NW London variations in service delivery (linked to an imbalance between capacity and demand) have led to long wait times for rheumatology services, impacting patient outcomes. Early detection and evaluation of conditions such as early inflammatory arthritis and vasculitis can reduce the risk of long-term complications.  

ROSMaC – a one-stop clinic giving patients access to the right clinicians and diagnostics – was piloted to respond to this challenge, aiming to improve patients’ experience and make their journey more efficient with fewer steps and waits.  

ICHP used a mixed-methods approach of qualitative and quantitative analysis to evaluate ROSMaC alongside the Traditional Imperial Rheumatology Outpatient Clinic (TIROC). The former provided insights on the process, outcomes, and sustainability of the service from the perspective of clinicians and administrative staff. The latter provided objective data on the outputs, outcomes, and incremental costs of the service.  

This approach evidenced ROSMaC’s positive outcomes across reduced waiting times and improved diagnostic efficiency, with impact including:  

  • Average waiting time from referral to appointment decreased by ~2 months 
  • On average, diagnosis was received within the same month from first appointment 
  • Definitive diagnosis for 81% of patients from one appointment (compared to 75% of TIROC patients over an average of three appointments) 
  • No exacerbation of health inequalities in access to services  
  • Suggestive evidence of lower incremental costs for service delivery  
  • Positive impact on staff learning opportunities through multidisciplinary working

Further to the evaluation, the ROSMaC pilot was recognised at a national level via NHS England’s Getting It Right First Time (GIRFT) Team as a model to be considered for reducing waiting lists. ROSMaC has also been positioned as a future model to support outpatient waiting lists across other sites in NW London. 

“This model demonstrates that Advanced Physiotherapy Practitioners have a real value-add.” Staff interview