Arthritis Research UK. State of musculoskeletal health 2017 report. 2017. (accessed 8 May 2019)

Been-Dahmen JMJ, Walter MJ, Dwarswaard J, Hazes JMW, van Staa A, Ista E. What support is needed to self-manage a rheumatic disorder: a qualitative study. BMC Musculoskelet Disord. 2017; 18:(1)

Self-management for long-term conditions: patients' perspectives on the way ahead. 2005. (accessed 8 May 2019)

Dau JD, Lee M, Ward MM Opioid analgesic use in patients with ankylosing spondylitis: an analysis of the prospective study of outcomes in an ankylosing spondylitis cohort. J Rheumatol. 2018; 45:(2)188-194

Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013; 3:(1)

Continuity of care and the patient experience. 2010. (accessed 8 May 2019)

Hughes RA, Carr ME, Huggett A, Thwaites CEA. Review of the function of a telephone helpline in the treatment of outpatients with rheumatoid arthritis. Ann Rheum Dis.. 2002; 61:(4)341-345

Khambh J, Barnick C. Shared-care arrangements and the primary/secondary-care interface. Prescriber. 2007; 18:(7)23-29

Manchikanti L, Kaye AM, Knezevic NN Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2017; 20:(2S)S3-S92

Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology. 2013; 52:(12)2136-2148

McCorkle R, Ercolano E, Lazenby M Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin. 2011; 61:(1)50-62

Patients in control: why people with long-term conditions must be empowered. 2014. (accessed 8 May 2019)

NHS Digital. What is advice and guidance and when might it be used?. 2017. (accessed 14 May 2019)

NHS England. Musculoskeletal conditions. Why is it important?. 2016. (accessed 8 May 2019)

NHS England. Next steps on the NHS five year forward view. 2017. (accessed 8 May 2019)

NHS England. Musculoskeletal: Helping people with painful bone and joint conditions see the right person. 2019. (accessed 8 May 2019)

Royal College of Nursing Rheumatology Forum. Telephone advice lines for people with long term conditions: guidance for nursing practitioners. 2006. (accessed 8 May 2019)

Using telephone advice for patients with long-term conditions: an RCN guide to using technology to complement nursing practice.London: RCN; 2012

Royal Liverpool and Broadgreen University Hospitals NHS Trust. Make a Difference Awards. Quality improvement and transformation award. 2016. (accessed 8 May 2019)

Shah R, Tan LT, Lim G. PTH-163 Nurse led telephone clinics-the NHS revolution in making. Gut. 2013; 62:A277-A278

Shaw J, Young J, Butow P, Chambers S, O'Brien L, Solomon M. Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication. Patient Educ Couns. 2013; 93:(3)444-450

Sokka T, Puolakka K, Turesson C. Comorbidities of rheumatic disease. In: Watts RA, Conaghan PG, Denton C, Foster H, Isaacs J, Müller-Ladner U (eds). Oxford: Oxford University Press; 2018

Thwaites C, Ryan S, Hassell A. A survey of rheumatology nurse specialists providing telephone helpline advice within England and Wales. Rheumatology (Oxford). 2008; 47:(4)522-525

Twomey C. Telephone contacts with a cancer nurse specialist. Nurs Stand. 2000; 15:(3)35-38

A nurse-led rheumatology telephone advice line: service redesign to improve efficiency and patient experience

23 May 2019
Volume 28 · Issue 10



nurse-led telephone advice line (TAL) services have been endorsed by the Royal College of Nursing (RCN) and provide patients and their carers with expert advice and self-management strategies. Identified helpline shortfalls in one rheumatology TAL included a high number of inappropriate calls, calls not recorded in patients' records, and no formal process for assigning calls to nurses. Using RCN guidelines, the service was redesigned by specialist rheumatology nurses to address these issues.


troubleshooting sessions were used to identify solutions to shortcomings in the helpline processes. Following service redesign, nurse/user feedback was collated, and efficiency savings achieved from reducing face-to-face appointments were calculated.


the new TAL received fewer inappropriate calls, was received positively by staff and patients, and saved approximately £354 890 a year for the local clinical commissioning group.


rheumatology nurses successfully improved a TAL using RCN guidance. The approach could be used by other trusts to improve patient helplines and contribute to the NHS drive for efficiency.

Musculoskeletal conditions affect around a quarter of the adult population and account for approximately 30% of GP consultations in England (NHS England, 2016). In 2011, musculoskeletal conditions were estimated to account for nearly £4.8 billion of NHS spending (NHS England, 2016). The prevalence of musculoskeletal disorders correlates with population age; consequently, the burden on primary and secondary care resources is predicted to increase as the UK population ages (Arthritis Research UK, 2017).

Nurse-led telephone helplines are increasingly being used to address demands on NHS services, and help fulfil patients' need to access relevant information and advice from health professionals (Twomey, 2000; Hughes et al, 2002; Shah et al, 2013; Shaw et al, 2013). Telephone helpline services may promote patient and caregiver empowerment and disease self-management, and, if used effectively, could help reduce the burden faced by NHS services (McDonald, 2014; Arthritis Research UK, 2017). For example, patients with long-term conditions reported that they would like a named contact for day-to-day queries, and that they thought this would reduce GP visits and hospital admissions (McDonald, 2014).

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