GP case study: Rheumatology
Dr Emma Rowley-Conwy works at The Exchange Surgery in Lambeth, London, and has been a GP for over 25 years. Dr Rowley-Conwy has access to Phone Advice & Guidance from both Guy’s and St Thomas’ and King’s College Hospital. The service is commissioned by three local clinical commissioning groups (CCGs) – NHS Lambeth CCG, NHS Southwark CCG and NHS Bromley CCG, and delivered by Consultant Connect.
We asked Dr Rowley-Conwy to provide us with an example of when a recent clinical issue prompted her to use the service with a patient.
Elderly patient with swollen lower legs and joint pain
“Our patient was an elderly man in his 80s who presented with swollen lower legs and joint pain. Our registrar had referred to Musculoskeletal (MCATTS) Team and arranged bloods. I saw him with his results which showed a strongly positive rheumatoid factor and raised ESR. I did an early arthritis referral form and started him on anti inflammatories and Furosemide. However, I was a bit concerned as to the diagnosis as he was not a typical presentation for Acute Rheumatoid Arthritis, being male and elderly, and I thought that the positive rheumatoid factor was possibly misleading. At a review 10 days later, he was still very incapacitated and had quite severe swelling in his lower legs, despite the Furosemide. It wasn’t clear from looking at records what appointments he had. I also felt more nervous about whether I was making the right diagnosis.”
How Phone A&G helped:
“I spoke to a Rheumatology Consultant at Guy’s and St Thomas’. He confirmed he was seeing the patient himself the next week. The consultant reviewed the blood results and confirmed a likely diagnosis of Rheumatoid Arthritis and advised they would most likely give Depomedrone injection and then consider DMARD. I was able to relay this information to the patient and his wife, which I believe made them feel less anxious. I saw the patient after he had seen Rheumatology, and this was the care he had received. He was much, much better – a really dramatic improvement. Speaking to the consultant made me feel confident to continue to support the patient and his wife, and meant they knew what was likely to happen. They had a chance to read preparatory patient information so could make an informed decision regarding starting a DMARD in that first outpatient appointment.“
Dr Rowley-Conwy also commented that:
“It was easy to get through, and a few minutes on the phone meant that we could work in an integrated way across primary and secondary care. Together we were able to deliver good quality care to this vulnerable patient.”
Related case studies
Dr Davey, a consultant on the National Consultant Network, answers a GP's Phone Advice & Guidance call - preventing a possible stroke for a patient.
A GP in North East Essex uses Phone Advice & Guidance and speaks to a consultant on the National Consultant Network to help an elderly patient.
A GP in Wiltshire CCG explains how she used Phone Advice & Guidance to get immediate A&G from Royal United Hospitals Bath NHS Foundation Trust for a complex gastro case.
A GP in South Warwickshire CCG used Phone Advice & Guidance to get A&G from South Warwickshire NHS Foundation Trust, and gets great results for a diabetes patient.
For more information about how we work with commissioners, hospitals & mental health trusts to improve patient care, please get in touch.
Join a webinar
Listen to health experts from the comfort of your desk as we bring the experts to you in our series of online webinars.
Join our mailing list
Join our mailing list and we'll keep you informed of our latest blogs, project news, and upcoming webinar dates and topics.
Most Read Articles
One of the biggest challenges for hospitals delivering an Advice & Guidance service is staffing it. Whether the requests come in from GPs by phone or in writing, most clinicians are expected to respond whilst also doing their day job. This can mean using consultant admin time, for example, to squeeze in advice & guidance […]read more
Writing a strong NHS business case for Advice & Guidance can make all the difference. That’s why we are sharing this real-life example.read more
We have recently been working with NHS Dorset CCG to create a free guide for taking the best photos for Teledermatology. Read on to find out more.read more
When the NHS LTP was published we recommended that local commissioners and Trusts could approach the challenge by looking for the easiest bits of the plan to gain quick, high-impact wins. Nine months on, we reflect on these recommendations.read more
One of the biggest challenges for hospitals delivering an Advice & Guidance service is staffing it – particularly during winter. The good news is that there’s now a way you can “switch on / switch off” additional consultant resource this winter.read more
Just a few weeks ago, we were included in the “rethinking referrals” part of the Neurology handbook. You can access the full handbook here.read more
Consultant Connect Ltd
One St Aldates, Oxford, OX1 1DE
Company registered in England & Wales.
Company number 09488206
01865 261 467