Rheumatology Department

Welcome

Welcome to our rheumatology team, we are pleased to have you join us for your next attachment. We hope this booklet will be of use to you but please feel free to discuss any queries with any member of the team.

 

Handbook including local guidelines download here 

 

The Team

Rheumatology Consultants

 

Dr Hoda Temple

Dr Deepti Kapur

Dr Jenny Nixon

Dr Theresa Barnes

Consultants can be contacted by email or on their mobiles via switchboard.

 

Secretaries

Our secretaries are based over at Ellesmere Port hospital; however you can reach them on the details provided below:

Name	Consultant	Contact - extension
Alison Stevens. Team Leader.	Theresa Barnes / Hoda Temple	5852
Marion Hinde	Jenny Nixon / Deepti Kapur	6426
Penny Jones	Biologics secretary	2156
Michelle Perks	Support secretary	6900
Valerie Parkinson Natasha Lally	Support secretary Support secretary	6917 6917

 

Rheumatology registrar (dual trainee)

Rheumatology Specialist nurses.

        Cath Brownsell, Emma Mulvey, Emma Gilgeours, Claire Hiles                     

Rheumatology Pharmacists

        Rebecca Houston and Sasha Dunt

 Rheumatology physio.

        Sally Beadle                                                                                                                          

 Rheumatology OT.

        Trena Salmon, Kate Dulson, Victoria Adams

 Rheumatology Podiatrist

        Emma Gallagher

 Rheumatology CBT practitioner

        Claire Dutton

 Rheumatology Business Performance managers

        Sophie barker and Wendy Davies

 

Introduction to the department

Rheumatology outpatients clinics

Outpatient clinics are held predominantly at the Countess of Chester Hospital and Ellesmere Port (the Cottage) Hospital.

At the Countess clinics are held in Outpatients 1, 3, 4 and the Urgent Care Treatment Centre

Most clinics are general rheumatology clinics. The rheumatology nurses have separate lists of their own patients. They also conduct telephone clinics for appropriate patients. The rheumatology pharmacists see patients in biologics clinics and for education.

 

There are also a number of speciality clinics:

• Ankylosing Spondylitis (Dr Nixon)
• Early arthritis clinics (led by Dr Temple who also has an interest in psoriatic arthritis)
• Systemic sclerosis clinic (Dr Barnes)
• Refractory arthritis clinic (Dr Barnes)
• Biologics clinics (Rheumatology specialist nurses/Dr Barnes and Dr Temple)
• Connective tissue disease clinic (Dr Kapur)

 Please see the downloadable handbook for details of the clinic timetable.

 

Rheumatology Day Case Unit

The following medications are administered on the medical day case unit (Ward 60):

Methylprednisolone

Cyclophosphamide

Infliximab

Rituximab

Tocilizumab

Abatacept

Iloprost

Zolendronic acid (refer patients to Karen Perkins for this)

 

Prior to booking patients on the day case unit the patient should have an MRSA screen (less than one month old). Patient education packs are available from Rheumatology nurses.

The day case unit is covered by the medical staff. The registrar will be the first port of call when available. When the registrar is not available the consultants will cover the day case unit and will be available to give advice to the registrar at all times. There is a speadsheet on the S drive to add patients to for rituximab when they are ready for the next infusion. All other drugs to discuss with consultant / rheumatology pharmacist.

 

Ward referrals

Ward referrals are seen by the Registrar when available.

The consultants will cover ward referrals (timetable on s drive), seeing patients when the Registrar is not available or to give advice to the Registrar as required. Urgent referrals need to be seen within 24hrs, routine referrals need to be seen within 48hrs.

 

All referrals seen by the registrar should be discussed with the consultant on call that day. The rheumatology secretaries will email the registrar and the consultant on call with routine referrals or bleep / phone with urgent referrals.

 

DMARD protocols

We have shared care agreements with the majority of our local GP’s in western Cheshire to initiate and prescribe DMARD’s. Patients are educated in clinic (Early arthritis patients may attend the group education session for MTX) and given a pink form to take to their GP to get the DMARD initiated and for monitoring. The shared care agreements are available on the intranet. Hope Farm Medical centre in Ellesmere Port is the exception to this and we need to initiate and monitor the DMARD in the first instance. They are happy to take over once the patient is stable. A few out of area GP’s occasional ask us to prescribe as well initially. In these cases, issue a prescription on FP10 and give the patients sufficient blood forms for monitoring until their next visit. Please also email the rheumatology nurses (rheumatology.specialistnurse@nhs.net) so they can add the patient to their monitoring file. Give the patient the nurse specialist advice line card (available in clinic) so they can get in touch is any problems.

 

For patients with a newly diagnosed inflammatory arthritis please provide them with a handheld record folder.

 

For early arthritis patients, there is online education available for those starting methotrexate, sulfasalazine or leflunomide. This is available on the Countess rheumatology page, Consent forms need to be completed for online education patients. There is the option to refer for one to one education for those patients not suitable for online education. See pathway here

 

For methotrexate patients, the rheumatology pharmacist will send the initial FP10 prescription and blood forms for monitoring.

For sulfasalazine and leflunomide patients, the GP’s should be asked to prescribe and monitor bloods as per the shared cared protocol.

Referrals to other members of the team

Referrals to OT and physio are done via Meditech. Referrals for rheumatology CBT are made on the form attached to this booklet and patients sent an activation leaflet with a number they need to phone to activate the referral. Orthotics and NCS/EMG are referred to using the paper referral forms. Referrals to joint injection clinic are also made on paper. All these forms are given to the secretaries to be sent on to the appropriate place.

                                                                     

Registrar responsibilities in rheumatology

If the registrar is unable to fulfil any of the commitments outlined below due to annual leave or on call commitments the secretaries should be informed as soon as possible in order to ensure that cover is provided by the rest of the team. Clinic commitments must be cancelled with at least 6weeks notice and if possible upload any leave onto the shared calendar. Please use “the out of office” on email when on leave or on call so its clear to the team you are not available.

Timetable

                             AM                                                         PM

Monday               AMU ward round                          CTD clinic monthly EPH first Monday ( if          room  available at EPH)

Tuesday               ACU clinic, Medical meeting lunchtime      Ward referrals /admin

Wednesday        NIXJRSPR clinic  (OPD4)                    Admin / ward work / daycase unit

Thursday             RHEUMEAN  (OPD4)                           MDT / XR meeting  /ward work

Friday                  SOS / joint injection clinic (EPH)        Grandround lunchtime,  Regional meeting monthly(Aintree) / ward work

 

Rheumatology Shared Drive (S Drive)

We have a specific Shared drive on the computer for Rheumatology which contains a lot of useful information for trainees, to gain access to the S drive contact IM&T.

 

Education

Tues	Medical grand round	Medical presentation and lunch	All medical staff	Postgraduate centre 1-2pm
Thursday	Radiology meeting	Meet with Dr Arora radiologist with an interest in musculoskeltal imaging to discuss any imaging queries.	Consultants and trainees	Radiology 2pm
Thurs	MDT / CME	Education / MDT discussions / morbidity and mortality meetings. Usually drug sponsored lunch.	Consultants, Registrar, Rheumatology specialist nurses, OT, Physio, pharmacists	Currently on line 1-2pm except 3rd Thursday of month – cancelled due to Rheumatology business meeting.
Fri	Whole hospital grand round	Education and lunch	All specialities and GP’s	Via Zoom

 

Research Opportunities

If you would like to get involved with research please contact our research nurse Helen Jeffrey on extension 3337.

 

Annual Leave and Study Leave

Annual leave should be applied for using the pink forms which can be obtained from medical staffing in T block. Dr Nixon must sign the form prior to you sending it medical staffing. Please also add your on calls and any leave to our shared calendar.

Study leave is applied for using the Tracker2 system, a log in and password can be provided by the medical education team if you contact them via: Ext 3635 or email postgraduate.education@nhs.net.

 

   6 weeks notice is required for either annual or study leave requests

 

   Please inform Alison Stevens, team leader and Dr Nixon of any planned leave

 

Sick Leave

• In the case of sickness, in the first instance juniors should inform the Rheumatology secretaries as soon as possible to allow them to cancel clinics

• Secondly, medical staffing to advise them of your absence

Medical Students

Medical students are encouraged to gain experience in our Rheumatology department. We like to have 1 student attend clinic at a time and they can arrange this by contacting the Rheumatology secretaries. The Thursday morning early arthritis clinic is recommended for students as it is a good opportunity to see inflammatory signs, however there are a number of different clinics available for learning opportunities.

 

Guidelines

 

An up to date list of guidelines and pathways for the Countess of Chester can be found via the homepage of the hospital intranet. Click on the ‘Document Library’ link. You can either then search for specific words or click ‘clinical specialities’ to see a list of guidelines divided by speciality.

Useful Numbers

 

Switch	0
Bleep	‘82’
Rheumatology nurses	4587
Rheumatology Pharmacist	Bleep: 2447
Biochemistry	5651
Microbiology - results	6770
Medical Microbiology - advice	6773
Main radiology reception	5270
Inpatient X-ray enquiries	5278
CT control room	5756
Ultrasound	5274
Interventional radiology	6722