A Bristol service for people with rheumatoid arthritis has been held up as a national example of one of the best ways to support people with long-term health problems.

The 'Direct Access' system at United Bristol Healthcare Trust's Rheumatology Unit has been cited in a Department of Health guide produced to support NHS and social care staff in promoting self-care among their patients.  Self-care aims to help people with long term conditions manage their health better and stay out of hospital.

John Kirwan, Professor of Rheumatic Diseases at Bristol University and consultant nurse Dr Sarah Hewlett were the inspiration behind the Direct Access system which allows people with rheumatoid arthritis to get advice and arrange hospital outpatient appointments at their choosing through a dedicated helpline.

If a patient is in pain from their condition, they can call the helpline which is staffed by a team of specialist nurses who can advise and book them in to see a doctor if they need treatment or medication within days. They can also book them in to nurse appointments or refer them to other team members such as physiotherapists or occupational therapists.

This replaced the old outpatient appointment system for rheumatoid arthritis.

Professor Kirwan said, "Two concerns were that patients would either overwhelm the system with frequent requests for review, or that they would be reluctant to access the service, not come for review, and suffer avoidable declines in their health.  However, neither problem occurred.

"After six years, patients who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews. They requested fewer appointments, found direct access more acceptable, and had more than a third fewer medical appointments."

The Direct Access study took six years to complete and was funded by the Department of Health. The results were published in the British Medical Journal.

It found that patients needed 38 per cent fewer hospital appointments and that GPs and patients preferred the new system.

Nurses have played a key role in the study.  They meet with patients to explain how the new system works, they staff the helpline which patients ring and if a patient hasn't had an appointment for a certain length of time, the nurses will contact them to see how their condition is.

Tested initially with about 100 patients, more than 600 out of the 800 rheumatoid arthritis patients that UBHT treats are now seen under the new Direct Access system.

A committee including several patients from the original study managed the roll-out.  On their advice, a short education session and information leaflets have been introduced for patients entering the scheme.

The project has been a big success and has sparked international interest.  The team have visited Canada, the USA and Sweden to talk about Direct Access and have been visited by doctors from Denmark.

The document 'Supporting people with long term conditions to self-care' has been produced by the Department of Health to support NHS and social care staff in promoting self-care among their patients.