Case study: Rapid access clinic, NHS Lothian

Case study: Rapid access clinic, NHS Lothian

As almost 50% of IBD patients experience at least one flare each year, prompt access to advice and support is very important. When specialists assess patients early, they can create a timely and effective treatment plan. This can reduce the risk of complications, including excessive steroid use and unscheduled emergency department attendances.

For patients, a flare can be a very worrying experience. Fast access to healthcare teams who know them can help provide important support and reassurance. All patients should know how to recognise a potential flare and who to contact. IBD service advice lines can be an important route for this, and it is essential that these are staffed appropriately by trained personnel ­– and that patients know about them.

Statement 4.3

Rapid access to specialist advice should be available to patients to guide early flare intervention, including access to a telephone/email advice line with response by the end of the next working day.

Statement 4.4

Patients with IBD should have access to review by the IBD team within a maximum of five working days and be able to escalate/start a treatment plan within 48 hours of review.

Who's doing it well?

From the mid-2000s onwards, Ian Arnott and colleagues have been testing innovative ways of delivering services to help them cope with growing patient volumes and deliver more patient-centred care. This has included establishing nurse-led community IBD clinics in community hospitals across West Lothian and video consultations via the NHS Near Me platform. One of the most pressing challenges, however, was to provide faster access to specialist advice and guidance during flares - to bring the disease under control without the need for a hospital admission.

The idea

A new rapid access clinic was established in Western General Hospital. IBD nurse specialists staffing the advice line and community clinics can refer patients directly into the flare clinic, where staff can see patients on the day to prevent a hospital admission. In the past, a patient experiencing a flare might see their GP or nurse and be given steroids in the short term, while potentially waiting weeks to see a consultant and be put on the right medication. With the new clinic, patients can see an on-call consultant gastroenterologist on the day who can institute the right treatment regime immediately.

The team has been able to move to this more responsive model by reviewing the need for routine follow-ups for patients, based on their individual needs. They now use a system of patient initiated follow-up, where patients contact the service if they need to see a clinician. Patients are given information about how to do this and provided with information about the advice line, community clinics and rapid access clinics. Clinicians identify patients who might struggle to use this system and follow up proactively with them, ensuring a personalised approach.


The IBD team are now monitoring the impact of moving to the new system. But they estimate that they should be able to avoid 2000 to 3000 consultant-led consultations per year, making it easier to provide fast access to review and treatment during flares and cope with increasing volumes of patients with IBD.

IBD services need to change; the traditional model of seeing everyone with IBD in a face to face clinic at fixed intervals is no longer fit for purpose. A follow up model that is more aligned with the needs of the individual is needed now. There are large differences in what people with IBD need and we should, as a service, be able to provide this. We have therefore re-designed our service at the Western General Hospital, to provide a full range of follow-up options; ranging from a patient initiated follow up pathway to those who need regular face to face review. There are a range of clinicians with different skill sets who people will meet and it is also vital that people can move rapidly between follow up modes. Rapid access to specialist advice is a key part of any IBD service. We have a flare clinic for people who need to be seen that day or next, flare slots on regular clinics for those needing to be seen within a week and advice slots for those not needing to be seen. A group of motivated patients, nurses, gastroenterologists, dieticians, surgeons and managers form our QI group and this is the driving force behind a process of continual change and improvement. It is a team effort!

Dr Ian Arnott

Date created: April 2021