6 Modifications to usual care

6.1 Make policy decisions about modifications to usual care at an organisational level. Refer to:

6.2 Only continue core services, including:

  • rheumatology department advice lines (for general rheumatology, connective tissues disease and metabolic bone)

  • essential parenteral day-case treatment

  • blood tests for drug monitoring

  • on-call services for urgent patient review (both new and follow up)

  • delivery and support for patients on new injectable treatments.

6.3 Maintain a robust on-call service for cross-consultant referrals that is available all the time, teaming up with other NHS trusts if necessary.

6.4 In tertiary centres, maintain specialised rheumatology networks and virtual multidisciplinary team meetings to discuss the management of complex disorders and to ratify high-cost drug use.

Primary care and the community

6.5 Use rheumatology department advice lines, run by staff with appropriate knowledge, to provide professional advice to primary care and community colleagues about all patients. If available, use an electronic advice and guidance service for GPs.

6.6 Prioritise urgent and emergency musculoskeletal referrals to secondary care in line with NHS England's clinical guide on urgent and emergency musculoskeletal conditions requiring onward referral.

6.7 In musculoskeletal services, prioritise rehabilitation for patients who have had recent elective surgery or a fracture, and for those with acute or complex needs (including carers). Focus on enabling self-management in line with NHS England's guide on COVID-19 prioritisation within community health services.

Outpatients

6.8 For urgent new referrals from primary care for suspected inflammatory arthritis, suspected autoimmune connective tissue diseases and vasculitis (including giant cell arteritis), offer a phone or virtual consultation followed by a face-to-face appointment after asking about COVID‑19 symptoms.

6.9 For urgent follow ups (such as for ongoing and new flares, and for treatment adjustment after monitoring), think about using phone or virtual consultations followed by a face-to-face appointment, if needed, after asking about COVID‑19 symptoms.

Day care

6.10 Prioritise day-case attendance based on the urgency of a patient's condition (for example, for new or ongoing flares, relapses, intravenous induction treatment).

Inpatients

6.11 Maintain rheumatology ward cover, and an out-of-hours on-call service if possible, to:

  • provide advice on immunosuppressive drugs

  • carry out assessments of rheumatological and COVID‑19 disease status

  • enable early discharge.