Advice & Guidance Service

Service Overview

Rheumatology advice and guidance services are for all queries regarding adult rheumatology, including patients with inflammatory arthritis (other than suspected early inflammatory arthritis where criteria are met, in which case an urgent referral to EIA clinic should be made - see EIA page for details) , metabolic bone disease including osteoporosis and connective tissue disease.

Please consider existing Rheumatology guidelines on Remedy (including Fibromyalgia in the Pain section) before requesting Advice & Guidance.

This service should be utilised where advice is required on the management of a patient that may avoid the need for referral. It should not be used where immediate advice is required, in which case the on call teams should be contacted in the usual way.

Requests for advice and guidance should be submitted vie e-RS and meet the following criteria:

• Ongoing management of a patient (patients not currently under review or referred to either UHBristol, WGH or NBT Rheumatology team). Requests for advice for patients currently under review, please see the information in the sections below for advice on contacting the relevant rheumatology department.
• For queries in frail patients already under the care of a Geriatrician / Orthogeriatrician at NBT please use  at NBT 

• Advice on a treatment plan.

• Advice on the appropriateness of a referral for their patient (e.g. whether to refer, or what the most appropriate alternative care pathway might be).

• The most clinically appropriate service to refer a patient into.

To enable the consultants to give the best advice possible please consider the following points:

• Give a clear concise history and examination findings- avoid cutting and pasting long lists of consultation notes that are not relevant to the problem in hand.
• Include relevant results, investigations and recent correspondence if appropriate but avoid multiple attachments that can take time to download and make the triage process more cumbersome.
• Ask a clear clinical question and avoid ambiguity.
• Avoid requests for complex patients known to an individual consultant as they are unlikely to be the consultant giving the advice and may not have easy access to details of previous contacts with the patient. In these cases consider writing or emailing the relevant secretary directly.

The Weston Rheumatology team will answer questions and queries relating to fragility fracture risk:

• In which patients DXA (Dual-energy X-ray Absorptiometry) would be indicated and when to request a follow up scan.

• How to assess future fracture risk, treatment thresholds and arrangements for switching treatment.

• The absolute risk of adverse events linked to treatment (eg atypical hip fracture, osteonecrosis of the jaw) and advice around breaks from treatment (so-called drug holidays).

• NICE guidance translated.

• Special groups (e.g. patients on treatment for breast or prostate cancer, osteogenesis etc.)

The Referral Service may also advise referring GPs to use this service, when appropriate, during the triage of osteoporosis referrals to outpatient clinics.

UHBW (Bristol) Advice & Guidance

Advice and Guidance for new and existing rheumatology patients

Please see the Rheumatology A&G Steps (BRI) for further guidance on how to submit a request through e-Referral.

Please process through e-Referral bypassing the Referral Service. Advice requests should ideally be typed into the free text window of the advice request body on e-RS rather than attaching a separate letter or Word document.  If you attach a Clinical Information Summary, please ensure it is named this, so that clinicians at secondary care can opt to look at it if they wish to turn the request into a referral.

• Rheumatology Advice - University Hospitals Bristol - RA7
• Advice & Guidance - Rheumatology - General - Weston Area Health Trust - RA3

UHBW (Weston) advice and guidance

Advice and Guidance for new patients

Please see the Rheumatology A&G Steps  (WGH) for further guidance on how to submit a request through e-RS.

Please process directly through e-RS, bypassing the Referral Service. Advice requests should ideally be typed into the free text window of the advice request body on e-RS rather than attaching a separate letter or Word document.  If you attach a Clinical Information Summary, please ensure it is named this, so that clinicians at secondary care can opt to look at it if they wish to turn the request into a referral.

• Rheumatology Advice - University Hospitals Bristol - RA7
• Advice & Guidance - Rheumatology - General - Weston Area Health Trust - RA3

Advice and Guidance for existing rheumatology patients

For patients known  to the Weston rheumatology team, please email: RheumatologySecretariesWGH@uhbw.nhs.uk

NBT Advice & Guidance

Advice and Guidance for new patients

If primary care would like advice from the specialist team to enable them to manage a patient in the community who is not known to the NBT rheumatology team, please use the Rheumatology Advice and Guidance on e-RS. A reply should be received within 1 week. Please see service overview above for details required when making a request.

If a response has not been received within 7 calendar days please escalate this via Outpatients.Appointments@nbt.nhs.uk

Advice and Guidance for existing rheumatology patients

For existing rheumatology patients, please email Rheumatology (secretaries):

RheumatologySecretaries@nbt.nhs.uk

For advice and guidance requests for elderly / frail patients following a hip fracture, or in patients already known to the BHOOP clinic at Southmead or Cossham please use the A&G service on eRS under Medicine for Older People A and G - Southmead

For immediate advice and guidance

For clinicians who require more urgent advice and guidance please call Rheumatology consultant mobile - 07894 800 989 (M-F 8-4pm)

Response times

The waiting time tool for BNSSG GP practices includes a section on A and G waiting times. You will need to download the document and follow the instructions to access the latest information (updated monthly). Please see the Hospital waiting times page.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.