Improvers of the month!


To mark the New Year, why not make a resolution to improve?

To celebrate the fantastic work of IS4 teams who went above and beyond in their improvement journey, we caught up with the CMFT Rheumatology team following their improvement project. The CMFT Rheumatology team were members of Improvement Science for Academics (IS4Ac) cohort, led in partnership with MAHSC. Here’s their story…

Organisation | Central Manchester Foundation Trust
Domain | Inflammation & Repair
Team members | Dr. Ben Parker, Consultant Rheumatologist, Karen Kemp, Lead Nurse and Vanessa Reid, Rheumatology Pharmacist.

What was your project aim?

Improving a rheumatology biologics service through introduction of a Virtual Biologics Clinic: a mixed methods quality improvement project.

In a nutshell…

The management of chronic inflammatory musculoskeletal diseases has been revolutionised by biologic drugs; they are designed to inhibit specific components of the immune system that play pivotal roles in fuelling inflammation. They have a high cost (£9000) per patient per annum and there is variation in their provision. The team, based at the Kellgren Centre at Central Manchester Foundation Trust (CMFT) had the ambition of implementing a multifaceted quality improvement project which would: improve patient experience (by reducing treatment delay, standardising the service offered, safer prescribing and increasing the opportunities to participate in research); prove beneficial for The Kellgren Centre (through initiating a ‘biologics database’, increasing efficiencies in the service and increasing support to nurses); the wider healthcare economy (through cost savings to the CCG and generating a growth in research income to CMFT); and positively impacting on the translational research agenda (through increased recruitment to translational studies and integrating research into clinical service). Following the implementation of their Virtual Biologics Clinic (VBC) through weekly MDT meeting, designed for the initiation of biologics therapy across all diagnosis and supported by new systems to facilitate reliable, rapid ‘virtual’ decision making the benefits have been reaped across the trust and MAHSC as a whole.

Following its success there has been a similar service introduced in the gastroenterology service, cost savings to the CCG, and an increase in both research participants and research funding for The Kellgren Centre. The team has presented their work at conferences, scientific meetings and have published their work in ‘Rheumatology’.

What changes were implemented?

New systems were established to facilitate virtual MDT review of all new biologic prescriptions. Changes implemented included the development and use of a safety checklist, alterations in lab ordering screens, and the development of individual team roles. A biologics database was also developed and funding for a biologics administrator was secured.

What were the outcomes of your IS4 project?

  • GMMMG biologics pathway was implemented at CMFT.
  • Significant reduction in delays to treatment.
  • Annual cost savings of £113,000.
  • Patients recruited into research increased from 51 in 2012-13 to 96 in 2013-14

Since completion of IS4, have their been any updates to your improvement project?

The VBC and all the necessary systems to support it were successfully implemented within six months, and it has been sustained since. As a result, waiting times for therapy were reduced, research recruitment was doubled, and money was saved for the healthcare economy through increased clinical trial recruitment and more effective use of cheaper therapy options.

How was your project had an impact across the NHS?

The VBC is embedded within rheumatology and has extended into a ‘virtual DMARD clinic’ with similar systems and outcomes. The VBC concept has also been taken up colleagues in gastroenterology, and is a priority for implementation during the singe service development in Manchester. The team was awarded a British Society for Rheumatology Outstanding Best Practice Award in 2016.

What advice would you give to future IS4 teams?

Spend as much time as possible understanding the system you operate in as fully as possible, and don’t just map what you think happens. Think hard about who is going to the bulk of the work – data collection, baseline audits, measurement, databases and qualitative interviews all take time and resources.


Find out how you and four colleagues could be joining the next IS4 cohort with your improvement project. Applications now open for cohort three, Improvement Science for Leaders (IS4L).

What do you think?

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