Background All intra-articular and soft tissue injections were previously carried out at the general rheumatology clinic however due to the increasing patient referrals we developed a direct access, one-stop intra-articular and soft tissue injection clinic.

Plan Training of the rheumatology nurse specialist (RNS) in intra-articular and soft tissue injection using corticosteroids took place prior to notifying general practitioners of the rapid access clinic. Local general practices were informed of the service and guidelines for referral were developed outlining the appropriate patients to refer.

Action Twelve months consecutive referrals were seen at a specialist joint injection clinic. 8 patients were appointed for each clinic, allowing adequate time for assessment, education and, if required, injection. Patients were sent the Arthritis and Rheumatism Council information leaflet on intra-articular injection with their appointment and are encouraged to ask questions regarding their treatment.

269 consecutive patients were seen, assessed and treated. All were sent a questionnaire 3 months after their appointment.

Referring general practitioners were also questioned to assess their impressions of the service.

Results Of the 269 questionnaires sent to patients, 189 (71%) were returned. 253 (94%) patients felt that they received sufficient information prior to their appointment. Response duration (as determined by patient) was as follows;

• three months: 61 patients (32.2%)

• 172 (91%) patients stated that they would be willing to receive a further injection if required and 185 (98%) patients rated the service overall as good or very good.

The survey of general practitioners, carried out six months after the clinic had commenced, returned 65 of 80 questionnaires (81%). 59 (90.8%) stated that they were aware of the clinic, 35 (53.8%) stated that they referred patients directly to the joint injection clinic, 21 (32.3%) had not required to refer patients and 9 (13.8%) continued to refer to the General Rheumatology clinic. 62 (95.4%) thought it was a valuable resource and were satisfied with the service provided.

Conclusions It can be concluded from the results of the patient questionnaire that overall the joint injection clinic is a well-accepted effective method of organising joint injections, both for patients and referring doctors. This has been achieved through no need for additional funds. Importantly, it reduces pressures on the standard rheumatology clinic and provides an additional educational role, which has proved a valuable resource to health care professionals. Maximum waiting time is two weeks from referral.

We are planning to introduce an electronic appointment system, whereby general practitioners can book patients appointments directly via the GPASS desktop system, with emailing of the referral letter to the clinic.