18 May 2023
Initial feedback from an external review of the Jersey rheumatology service suggests
the need for a more integrated relationship between primary and secondary care,
closer links with other rheumatology services and a reduced reliance on
pharmaceutical companies for drug information and training.
The Royal College of Physicians review was commissioned by Health and Community
Services (HCS) when questions were raised about clinical record keeping and case
management within the rheumatology service in the period before January 2022.
The feedback notes a number of service weaknesses at that time including poor
written patient notes, some inappropriate prescribing of biologic agents, and
prescriptions that did not include the clinical condition being treated.
Recommendations from the Royal College of Physicians include:
- Greater access to physiotherapy and pain services for rheumatology patients
- Education sessions for patients newly diagnosed with rheumatoid arthritis
- A standardised written correspondence template to reduce the risk of missing key
information within communications
- More regular updates from the HCS pharmacy on the prescribing of biologicals
The relevant regulators – including the General Medical Council, the Nursing and
Midwifery Council, the Health and the Jersey Care Commission – are being made aware
of the Royal College preliminary findings and in due course they will deal with any
regulatory matters that may need to be addressed.
The Minister for Health and Social Services, Deputy Karen Wilson, said: “This initial
feedback from the Royal College of Physicians highlights some systemic governance
problems in the rheumatology service that are likely to be present in other parts of
HCS.
“The Royal College has said it was reassured to hear that steps were being taken to
develop an open and transparent culture within HCS and to implement a governance
framework that allows scrutiny of all aspects of healthcare. But nobody should be in
any doubt about the seriousness of this review and these initial findings.
“It is clear that over a period of time HCS had fallen behind “best practice” in a number
of areas and now needs to catch up. Work is proceeding on improvements
recommended last year in the external review of governance and quality of care and
this initial Royal College feedback underlines the need for a relentless focus on the
strengthening of governance within HCS though the establishment of the proposed
HCS Board.”
The Chair of Jersey Arthritis Society, Maureen Parris, said: “This feedback from the
Royal College of Physicians indicates how important it was to commission this review.
It is now imperative that HCS acts on these findings and establishes stronger
governance across our health service.”
In March of this year the reviewers from the Royal College of Physicians also
recommended that HCS should audit the records of approximately 340 patients on
biological drugs to check and confirm their treatment and care. This audit is on track
to be completed by the end of June.
All 340 of these patients have now been seen and reviewed by professionally trained,
specialist rheumatologists to ensure their present care and treatment is appropriate.
The patient note audit is intended to check that in the period before January 2022
these patients were accurately diagnosed and properly treated.
The Royal College of Physicians has not recommended the audit of any further patient
notes but out of an abundance of caution HCS will be checking more patient notes, as
necessary, in the coming months. If there is a need to see any further patients, they will
be contacted directly.
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