The ROSMaC model is a one-stop clinic where a patient has access to the right clinicians and diagnostics. This piloted approach sought to improve user experience by making the patient journey more efficient with fewer steps and waits, ultimately providing a more comprehensive and timely experience for rheumatology patients.
The ROSMaC pilot was led by Imperial College Healthcare NHS Trust (ICHT) in collaboration with the Healthshare Group (HG), supported and funded by NWL ICS. Its main objective was to reduce waiting times for MSK Rheumatology outpatients in NWL, specifically at ICHT. Imperial College Health Partners (ICHP) led the evaluation of this pilot, working closely with the ICHT and HG teams to determine the scope. The evaluation involved comparative analysis between the traditional model (Traditional Imperial Rheumatology Outpatient Clinic or TIROC), and the new ROSMaC model, and ultimately aimed to evaluate and evidence the impact of this new model of care.
Success of the ROSMaC pilot could directly contribute to reduced waiting lists, reduced unwarranted variation in care, and prevent harm by ensuring that patients are seen in the right place, at the right time, with the right care.
Rheumatology is a medical specialty that encompasses the diagnosis and treatment of conditions affecting joints, bones, muscles, and connective tissues. Musculoskeletal (MSK) health is at the core of rheumatology, as it involves addressing musculoskeletal disorders and diseases, such as arthritis, lupus, fibromyalgia, and vasculitis.
MSK conditions are the leading cause of disability in the UK and poor MSK health has a significant impact on individuals, families, employers, the NHS, and the wider economy. It is estimated that over 30 million working days are lost due to MSK conditions each year in the UK, and they account for up to 30% of GP consultations in England (NHS England, 2019).
In North West London (NWL), long wait times for rheumatology services are observed across trusts, mainly due to variations in service delivery linked to an imbalance between capacity and demand, as highlighted in the Get It Right First Time (GIRFT) for Rheumatology report (GIRFT, 2021) . Referral-to-treatment (RTT) timeframes for rheumatology outpatients exhibit significant variation, ranging from less than five weeks in the best-performing trusts, to over 30 weeks in others. Waiting times for rheumatology outpatients across NWL integrated care system (ICS) were further impacted by the COVID-19 pandemic.
In the context of rheumatology, long wait times can have a direct impact on outcomes for patients. Early detection and evaluation of diseases such as early inflammatory arthritis, giant cell arteritis (GCA), and vasculitis can reduce the risk of long-term complications.
In response to these challenges, an innovative model of care was developed to reduce the backlog of outpatient rheumatology patients: the Rheumatology One Stop Mass Clinic (ROSMaC).
The evaluation involved comparative analysis between the Traditional Imperial Rheumatology Outpatient Clinic (TIROC) and the ROSMaC, and used a mixed-methods approach of qualitative and quantitative analysis. This allowed for a comprehensive assessment of the ROSMaC service, with quantitative analysis providing objective data on the outputs, outcomes, and incremental costs of the service. Qualitative analysis provided insights on the process, outcomes, and sustainability of the service from the perspectives of key stakeholders. Finally, a cost analysis provided a financial estimate of the incremental costs of the service.
Project leads conducted semi-structured interviews with key stakeholders, including clinicians, commissioners, and administrative staff from ICHT, HG and the ICS.
The interviews focused on five key areas, agreed by the evaluation steering group:
Insights showed that clinicians generally held a positive perception of the ROSMaC initiative, highlighting its effectiveness in reducing waiting times and providing comprehensive and efficient care.
The quantitative analysis involved collecting data from a random sample of 100 patients from each of the ROSMaC and TIROC services, on the outputs, outcomes, and incremental costs.
The evaluation of the ROSMaC service revealed positive outcomes in reducing waiting times and improving patient experience. Evidenced impact includes:
Opportunities identified for enhancing this new model include:
In conclusion, the Rheumatology One Stop Mass Clinic initiative (ROSMaC) has proven to be a successful pilot program in NWL. Some of the key strengths of the initiative included the multidisciplinary approach, the collaboration between healthcare professionals, its one-stop-shop model, and its efficiency in service delivery.
The evaluation of the initiative revealed positive outcomes, including a reduction in waiting times for rheumatology appointments and improved diagnostic efficiency. Furthermore, the ROSMaC model showed improved capability of closing the patient treatment loop when compared to the traditional model, by reducing the number of appointments needed for diagnosis.
The ROSMaC pilot has been recognised at national level, via NHS England GIRFT team as a model to be considered for reducing waiting lists. It is also likely to inform the NWL ICB Strategy moving forward.
Following the success of this pilot, ROSMaC has been positioned as a future model to support outpatient waiting lists across other sites in NWL.
To support further improvements across the ROSMaC service, the evaluation proposed a series of recommendations:
“I feel I was able to discharge a large number of patients in the first visit. With more training I wonder if some consultant be able to discharge a higher number of patients.” Rheumatology Consultant
“The big vision is to come up with a model of care that can become the new model of care which demonstrates improved patient access, improved outcome and cost effective for relatively low risk patients. – hopefully doing this at NWL will lead to reduce wait times for high volume low complexity patients.” Staff interview
“This model also demonstrates that Advanced Physiotherapy Practitioners have a real value add.” Staff interview
“I feel the format of the clinic works well. This model is something that should be considered for the future.” Staff interview
We extend our gratitude to the Imperial College Health Trust Transformation Team, the clinicians and staff of Imperial College Health Trust, and the Healthshare Group, whose invaluable contributions and collaborative efforts were instrumental in making this evaluation possible.
If you’re interested in learning more about this initiative, please contact Larry Koyama, Larry.Koyama@imperialcollegehealthpartners.com.