Annual Report 2014 – 2015

Scottish Paediatric and Adolescent Rheumatology Network

1.0 Introduction

The Scottish Paediatric and Adolescent Rheumatology Network (SPARN) was designated as a National Managed Clinical Network (NMCN) in April 2009. The Network had been working informally before being officially recognised as an NMCN by National Service Division. The MCN was officially launched on 27th April 2009 at the Crowne Plaza Hotel, Glasgow.

Juvenile Idiopathic Arthritis (JIA) is the most common rheumatological condition affecting children. The known prevalence of this condition in the UK is 1 in 1,000 children. In areas where the network clinics are well established the number of known cases is in line with this. Early recognition and optimal treatment of JIA is known to be associated with improved outcome and the network aims to ensure that all children with JIA in Scotland, including those with JIA associated Uveitis, are diagnosed promptly and managed appropriately.

Complex autoimmune inflammatory conditions such as Juvenile Systemic Lupus Erythematosus, Juvenile Dermatomyositis, Scleroderma and Systemic Vasculitis are individually rare but together represent a significant workload for paediatric rheumatology services. These children have complex diseases often requiring access to multiple specialties for optimal care.

Hypermobility and other non inflammatory musculoskeletal conditions affecting children are also recognised as a part of paediatric rheumatology workload. Initially the network has necessarily focussed on JIA. More consideration is now being to be given to these other patient groups.

2.0 Network Governance The network’s current lead clinician is Dr Cath Lees, Consultant Paediatrician. The Coordinator for the network is Michael Durkan. The Steering Group chair is Dr Paul Galea, retired Consultant Paediatric Rheumatologist. The Steering Group has representation from all professions involved in the network and including AHPs, Pharmacy, Primary Care and the Voluntary Sector. The purpose of the steering group is to direct and support the development of the network and the services it encompasses. It has the remit to establish work streams and support implementation of recommendations/guidelines which will enable delivery on the networks’ designated objectives.

Rather than working with traditional sub-groups the network has previously made the decision to work with various work streams allowing for more fluidity and for much of the work to be done virtually. The work streams are:-

Education and Training Working with families Quality Outcomes and Audit Service Development Guidelines Transition

In addition to these work streams there are now well established professional groups lead by the appropriate Steering Group member (link paediatrician, Occupational Therapist, Physiotherapist and Specialist Nurse). Each group provides support, training and professional development to the relevant staff group. The leads for the Professional groups are: Kirsten Healy Paediatrician (Fife) Alison Elder (Grampian) / Zoe Whyte (Tayside) Occupational Therapists Caroline Grant (Greater Glasgow and Clyde) / Jenny Hagger (Lothian) Physiotherapists Alison Ross (Grampian) Nurse Specialist 3.0 Network Designation Objectives A) Patient Centred

Encourage and facilitate the involvement of families, children and patient support groups in the network and engage them in service improvement.

B) Safe

Identify training needs and facilitate the design, development and delivery of education and training

Promote multi disciplinary meetings with access to teleconferencing to overcome difficulties in attending

Promote opportunities to develop knowledge, skills and competencies both for those directly involved with the client group as well as general practitioners, AHPs and primary care colleagues

Organise and host an annual meeting

C) Effective

Develop standardised care and referral pathways for specific conditions

Develop network protocols enabling more care to take place locally, including network clinics

Facilitate links to other specialties

Facilitate equity of care across Scotland D) Efficient

Agree data collection, audit and research to provide a basis for further service improvement and in monitoring clinical outcomes

Standardise how investigations are performed and interpreted E) Equitable

Establish systems and processes to ensure that stakeholders are identified and are engaged effectively in the establishment and ongoing development of the network

Develop and deliver a communication strategy to support stakeholder engagement, effective internal and external communication including the development and sharing of protocols and information leaflets and the development of a website

4.0 Plans for the year ahead The priorities identified for the network in 2015 / 2016 include:

Patient satisfaction surveys – A patient satisfaction survey created and piloted by the team in Ayrshire and Arran to be adopted and adapted for use across the Network.

Families Information Day – At the request of the families it has been agreed that repeating the families day for patients with more complex rheumatic conditions will be arranged.

Education o Annual Meeting 2016 to be held in Crosshouse. Programme to follow a

similar format to previous years. o Monthly Education sessions to continue. Topics identified from updated

LNA

Transition documentation – Southampton Ready Steady Go documentation to be discussed and possibly adopted by the network.

Clinical Audit System – Expand the use of the CAS to ensure data collection becomes standard practice across all centres.

Guidelines – Continue to develop guidelines for use across centres. Priorities include a guideline for the identification and management of Macrophage Activation Syndrome (MAS), Methotrexate Shared Care, Methylprednisolone and Non-steroidal Anti Inflammatory Drugs.

5.0 Network Objectives Progress 5.1 Patient Centred Family Involvement Working with Families work stream continues to be chaired by Imogen Kelly, Paediatric Rheumatology Nurse Specialist. SPARN has continued to strengthen links to existing patient support groups. SPARN continues to work closely with SNAC. Clinicians are regularly involved in SNAC events (this includes the annual JIA families support weekend at Crieff Hydro and the annual patients and families’ information day and a number of local activities). There are SNAC members on the Steering Group. A full list of SNAC sponsored events is available from the SNAC website http://snac.uk.com/fundraising-events/recent-event-gallery/#

Work with the Teapot Trust has continued and Art therapists have been appointed to provide formal art therapy for groups of rheumatology patients at both RHSC Edinburgh and Glasgow. Art Therapy drop-in sessions have continued to increase with sessions now taking place in RHSC Edinburgh, RHSC Glasgow and Ninewells Hospital Dundee with plans to expand services to Aberdeen and Inverness in the coming year www.teapot-trust.org. It is hoped that this very successful and well received support for children and families can be extended to all Network Services in the future. An information day for families affected by complex rheumatological conditions including vasculitis, Juvenile Systemic Lupus Erythematosus, Juvenile Dermatomyositis and Scleroderma was held on Saturday 25th October 2014. The day was supported by Lupus UK. This was very well received and at families request a further event is being planned. SPARN have also developed links to the following charities – Lupus UK, Arthritis UK, Arthritis Care, National Rheumatoid Arthritis Society (NRAS) and Lauren Currie Twilight Foundation. This includes participation in the review of care for children with JIA in the UK commissioned by NRAS - http://www.jia.org.uk/ and Arthritis Research UK’s work on a core data set for Paediatric Rheumatology (CAPTURE).

5.2 Safe Education Programme The education work stream is led by Dr Jo Walsh, Paediatric Rheumatologist.

The 2014 Annual Education meeting was held on Thursday 15th May at Queen Margaret’s hospital, Dunfermline. The programme focused on Uveitis in Juvenile Idiopathic Arthritis with the day consisting of a keynote speaker and case presentations. Feedback from the day was overwhelmingly positive, full feedback and a programme is available from the SPARN website.

The 2015 SPARN Annual meeting will held on Friday 8th May, in the Clinical Skills Centre, Ninewells Hospital, Dundee. The programme focuses on Chronic Pain taking a similar format to previous meetings including case presentations, guest speaker/s, interactive workshops and professional group meetings

Monthly telemedicine multidisciplinary CPD meetings are now in the 5th year. These meetings continue to be well attended with representation from all regions throughout the country. A recent request from the Rheumatology team in Newcastle to dial into the sessions was approved by the network. Sessions are now evaluated to measure the impact they are having on practice and to ensure that they continue to meet the needs of rheumatology staff. Where possible previous sessions will be made available as slides and audio alongside relevant links and literature from the SPARN MKN – it is not currently possible to record the audio of the sessions due to an issue with the bridge facility hosted in Grampian.

The previously completed Learning Needs Analysis (LNA) which was compiled in conjunction with NHS Education for Scotland (NES) was updated to ensure that education continues to be relevant and meets stakeholder needs. The results have been used to create an updated education strategy for the network.

In addition the network’s professional groups continue to meet with further meetings planned for autumn.

5.3 Effective a. Service Mapping The previously completed detailed mapping of services and personnel in Scotland highlighted significant gaps in services. It was agreed that this would be revisited once all National Delivery Plan posted had been filled however as there continue to be gaps in services it was agreed that the network would revisit the exercise to show the changes to date as a result of the work of SPARN and NDP funding. The mapping exercise has now been complete and the visual map is included as an appendix. There is now a recognised network clinic in all regions with plans in place to create some satellite centres in some of the remote and rural regions. This includes plans for a visit for clinic and teaching purposes to Orkney. b. Service Developments and Guidelines The Service Development and Guidelines work stream has been split into two separate work steams. Dr Joyce Davidson continues to lead the Service Development work stream and Dr Neil Martin, Paediatric Rheumatologist taking over the Guidelines work stream. A SPARN standard for a paediatric rheumatology network service which was initially developed as part of the Support of Specialist Services for Children and Young People within a DGH document has been completed and circulated throughout the network. Plans are underway to create an annual review process in the form of self assessment to be undertaken by local centres. These will then be followed up by informal network visits. Various drug guidelines for use within the network are being agreed. Guidelines for the use of Tocilizumab for Rheumatology patients, varicella exposure and influenza have been agreed and are available from the MKN. Guidelines for Infliximab, Pamidronate Infusions and Cyclophosphamide are awaiting sign off and will soon be in use by the network. Future plans include guidelines for Methotrexate shared care, Methylprednisolone and Non-steroidal Anti Inflammatory Drugs. In addition a guideline for investigation of children presenting with Raynauds Syndrome is planned. SPARN now links in with SNAPP (Scottish neonatal and paediatric pharmacy group) for input into all medication guidelines and we now have a Pharmacist on the Steering Group. In addition work is underway on raising awareness among non rheumatology colleagues of Macrophage Activation Syndrome (MAS). This is a rare but well recognised and potentially life threatening complication of rheumatological disease, particularly Systemic Onset JIA (SoJIA). A guideline for recognition and initial management is in draft.

5.4 Efficient Data Collection and Quality Indicators The Data Collection and Quality Indicators work stream is led by Dr Cath Lees, Consultant Paediatrician. The clinical audit system has been rolled out across the network. Although we continue to actively encourage teams to enter data onto the CAS in real time the option of paper forms is still available and preferred option to date used by most teams. The next step is to ensure that those regions collecting data routinely continue to do so and that more regions begin to collect data more frequently/consistently. There are now more than half the children known to Network Teams on the data base. The 2 major centres are beginning to enter data and we anticipate a much higher percentage on the data base for the next annual report Further work is required to adapt the CAS for further data collection. It is envisaged that this will take place as part of an annual review process. Report on agreed Quality Indicators – historical data

Indicator Initial data collection*

1 October 2012 – 31 March 2013

1 April 2013 – 30 September 2013

1 October 2013 – 31 March 2014

Percentage of patients with JIA seen by paediatric rheumatologist within 10 weeks of onset of symptoms

48% 57% 57%

76%

Percentage of patients with JIA who receive an eye screen within 6 weeks of diagnosis of JIA

32% 52% 54%

52%

Percentage of patients who have regular access to an appropriate specialist multidisciplinary team

96% Not yet being collected. To be collected in second stage of data

collection 2014

Percentage of JIA patients who receive joint injection/s within 6 weeks of decision t o treat (ie date patient seen, NOT receipt of referral)

79% Not yet being collected. To be collected in second stage of data

collection 2014

Percentage of newly diagnosed patients who start methotrexate (1)6 (2)6-12 / (3)12 + months after diagnosis

1. 75% 2. 9% 3. 16%

1. 76% 2. 14% 3. 10%

1. 75% 2. 15% 3. 10%

Percentage of young people over 14 years of age who have an individual transition plan

22% To be collected once working group looking into transition

documentation has completed its work

Percentage of newly diagnosed patients who receive the Network standard information pack at diagnosis

0%* 40% 60%

72%

*Initial data was collected in 2010/2011 using 10 patients from each region * There was no SPARN new patient information pack pre 2012

Current Data The following data is that currently available on CAS. It should be recognised that data is not currently being collected by all centres, and not all individual patient data is complete. This is particularly the case for historical patients entered retrospectively. The Network team continue to encourage and support that CAS data entry becomes standard practice for all new patients in all centres and aims to include all historical patients ultimately. In total there are now 471 patients on the SPARN instance. Percentage of patients with JIA seen by a Paediatric Rheumatologist within 10 weeks of onset of symptoms

Total Patients in report = 75 Seen within 10 weeks of onset of symptoms Not seen within 10 weeks Total

Total patients 17 58 75

Percentage of patients 23 77 100

Percentage of patients with JIA who receive an eye screen within 6 weeks of diagnosis

Total Patients in report = 73

Seen within 6 weeks of referral Not seen within 6 weeks Totals

Total patients 15 58 73

Percentage of patients 21 79 100

Percentage of newly diagnosed patients who start Methotrexate within 6 / 6 – 12 / 12+ months of diagnosis

Patients Given Methorexate after Diagnosis

Number of Patients Percentage

Within 6 months 96 76%

6-12 Months 13 10%

Over 12 months 18 14%

Total 127 100%

Percentage of newly diagnosed patients who receive the network standard information pack at diagnosis*

* There was no SPARN new patient information pack pre 2012 5.5 Equitable a. Communication SPARN has developed both a website and an MKN. The number of hits to the SPARN website are in the table below.

Month Number of hits

April 47

May 62

June 59

July 53

August 68

September 95

October 69

November 89

December 87

January 66

February 100

March 99

b. Transition The Transition lead for the network is now Dr Elaine Morrison, Consultant Physician and Rheumatologist. It has proved difficult to develop transition work at the desired rate in part due to the lack of recruitment to NDP funded adolescent nursing post in GGC. However Dr Liz Murphy (Adult Rheumatologist) the previous lead for our transition work stream has made significant progress in the last few months engaging with adult colleagues who recognise the need to develop transition services although have major capacity issues limiting their ability to fully engage and develop services. Draft welcome letters from adult teams providing information about their service for both the paediatric rheumatology staff and the young people coming in to the service in order to facilitate transition planning have been created they will be incorporated within transition documentation currently in development. Various transition documents have been piloted in several network centres in. Feedback was mixed and indicated that none was fit for purpose. A small working group was formed to look at transition documentation for use in all network clinics. It has been agreed that the paperwork created by the team in Southampton will be used. The documents are currently with local teams with training in its use planned. Two members of SPARN have been appointed to the Barbara Ansell National Network for Adolescent Rheumatology (BANNAR), a recently set up research network funded from a grant by Arthritis Research UK. The group aims to oversee a national research portfolio covering the spectrum of disease and research methods in adolescent and young adult rheumatology - http://bannar.org.uk/default.htm 6.0 – Finance

Description Amount

Meetings and events including

Annual Education meeting

3 Steering Group meetings

Monthly Education Sessions

Professional Group meetings

Families Education meeting

£2162.73

Printing costs £16.62

Travel £44.30

Total £2223.65

Steering group membership

Name Designation Joyce Davidson Standards Lead

Alan Douglas GP Representative

Julie Duncan DGH Representative

Michael Durkan Network Coordinator

Alison Elder OT Representative

Paul Galea Chair

Caroline Grant Physio Representative

Jenny Hagger Physio Representative

Imogen Kelly Working with Families Lead

Cath Lees Lead Clinician

Neil Martin Guidelines Lead

Lynsay Mcaulay Pharmacy Representative

Jan McClean Regional Healthcare planner SEAT

Elaine Morrison Transition Representative

Tracy Rendall SNAC Representative

Alison Ross Nurse Representative

Jo Walsh Education Lead

Zoe Whyte OT Representative

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

Patient Centred: Providing Care that is responsive to individual preferences, needs and values and assuring that patient values guide all

clinical decisions.

Family Involvement

Encourage and facilitate the

involvement of families,

children and patient support

groups in the network and

engage them in service

improvement

Ongoing Continuing to work with SNAC to ensure accessibility for all families including activities

below

SNAC representative on SPARN

steering group

Tracy Rendall, SNAC Secretary

attending SG’s

Green

Support for 2014/2015 parents day and

various local family support events

http://snac.uk.com/fundraising-

events/recent-event-gallery/#

Green

Planning for 2015/2016 events

Network day planned for non JIA

patients – Vasculitis/Systemic Lupus

Erythematosus and Juvenile

Dermatomyositis/ Scleroderma

Event took place 25/10/14, Dynamic

Earth, Edinburgh. Attended by 14

families.

Green

Patient request for a repeat of Network

day for Complex Rheumatic

Conditions event

Possibility discussed following request

from family and funds raised

Amber

RAG status Description

RED (R) Little/no progress been made to date to achieving network objective/standard

AMBER (A) Significant progress been made to date to achieving network objective/standard, however further work is required to fully

achieve the network objective

GREEN (G) The network has been successful in achieving the network objective/standard

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

Develop links with Arthritis Care

Arthritis Care stands at SPARN Annual

Education meeting. Information and

events circulated to local teams via

network office.

Green

Continue to strengthen links with new

charity Teapot Trust, formed to

support children in hospital with

Rheumatic conditions by providing art

based therapies.

Art Therapy sessions have expanded

across Scotland including sessions at

SPARN family education day 25/10/14

at Dynamic Earth

Green

Continue to develop links to Lauren

Currie Twilight Foundation, a new

vasculitis charity. See website

Support for 25/10/14 meeting Green

Patient and Families input into

development of guidelines

Circulated for comment, SNAC rep on

SG

Green

Patient Satisfaction survey

Patient satisfaction survey created and

piloted by the A&A team to be adopted

and adapted for use throughout the

country.

Amber

SAFE: Avoiding injuries to patients from care that is intended to help them

Education

Identify training needs and

facilitate the design,

development and delivery of

education and training

SPARN website and MKN integrated Live, content updated. Further

developments on hold pending PCF

website review

Amber

Ongoing Hands on training through the delivery

of network clinics attended by

Following feedback from local

clinicians plans underway to look into

Amber

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

Provide opportunities to develop

knowledge, skills and

competencies both for those

directly involved with the

patient group

Organise and host an annual

meeting

Paediatric Rheumatologist. the possibility of documenting learning

from Network Clinics.

2014 Review Learning Needs Analysis Updated LNA completed, results used

to update SPARN education strategy

and select topics for education sessions.

Green

Individual Professional Groups

Nurses 30th

September 2015 Green

Occupational Therapist TBC Amber

Physiotherapists TBC Amber

Paediatricians with an interest Due to the time constraints and varying

education needs of what is a small

group a meeting has not been possible.

Following discussion the possibility of

documenting education taking place

during network clinics to be

investigated

Amber

Education / Awareness of MAS Information being collated to ensure

increased awareness of MAS –

information to be included in induction

packs. Pathway also in discussion.

Amber

2014 2014 Annual Meeting held in Fife,

Evaluation available from MCN office

15/05/14

Green

2014

2015 Annual Education meeting to be

held in Dundee

08/05/15 Amber

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

Promote local multidisciplinary

meetings with access to

teleconferencing to overcome

difficulties in attending

Ongoing Programme arranged for monthly CPD

afternoon offering high quality

multidisciplinary education via

telemed

http://www.knowledge.scot.nhs.uk/chi

ld-services/communities-of-

practice/scottish-paediatric-and-

adolescent-rheumatology-

network/education-resources.aspx

Established VC education sessions now

into 4th

year, now being evaluated to

measure impact on practice. Previous

sessions now being uploaded to MKN

once approved by speakers. Links to

relevant literature to be added.

Green

EFFECTIVE: Providing services based on scientific knowledge

2014 Work with academic department to

develop a research programme for

SPARN

Workshop held at SPARN annual

meeting supported by ScotCRN to

investigate the barriers to research

within SPARN. Initial plan are to

ensure that all patients are entered onto

the biologics register and continued

input into BANNAR project

Amber

Quality indicators

SPARN agreed quality indicators are

being incorporated into the Clinical

Audit system. More information on

CAS is under data collection.

Clinical Audit System Green

Standards Guidelines and Protocols

Develop standardised care and

referral pathways for specific

Joint Uveitis guideline to be carried

forward and reviewed bi-annually by

SPARN

2016

Green

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

conditions

Develop network protocols

enabling more care to take place

locally, including network

clinics

Developing standards for a network

clinic – formerly part of Support of

Specialist Services for Children and

Young People within a District

General Hospital document

Complete and added to SPARN

website

Green

All SPARN produced guidelines and

protocols to be reviewed to measure

impact including medication booklet,

MDT Annual Review for JIA, Joint

injection proforma and new JIA

information pack

Following the pilot of a patient

satisfaction survey to be used across

clinic focus will move to measuring the

impact of specific pieces of work.

Amber

Physio guideline on assessment and

management of children with JIA

Signed off and added to SPARN

website

Green

AHP led protocol for Hyper mobility

clinic

Signed off and added to SPARN

website

Green

Guideline for management of MAS

and alert card for hand held booklets

of at risk patients

Information being gathered and draft

discussed. Awaiting results of case

review.

Amber

Medication guidelines

Tocilizumab

Varicella

Flu guideline

Infliximab

Pamidronate Infusions

Signed off and added to website

To be updated and finalised

To follow

To follow

Green

Amber

Future guidelines to be reviewed by

group

Initial plans include Methotrexate

shared care, above Infliximab and

chicken pox exposure

Amber

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

Facilitate links to other

specialities

Pathway for Behcets SPARN contribution to RDIG request

for a patient pathway. Awaiting SSR

response

Amber

See above re Uveitis network

Green

Joint SPARN/SPRUN education

session repeated – see MKN

11/11/2014 – Complement in Renal

and Rheumatic disease session held

Green

Developing links with pharmacy Pharmacy rep added to steering group,

all future medication guidelines to be

circulated via Lynsay to SNAPP

Green

Developing links with radiology Planned for 2015

Amber

Benchmarking

Facilitate equity of care across

Scotland

Spring 2014 Mapping to initially be revisited once

NDP funded posts were filled. A

further mapping of services has took

place following delays in

implementing NDP posts

A visual map of services is being

compiled. Document complete,

awaiting final draft to be signed off.

Green

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

EFFICIENT: Avoiding waste, including waste of equipment, supplies, ideas, and energy

Data Collection

Agree data collection, audit and

research to provide a basis for

further service improvement and

in monitoring clinical outcomes

CAS partially adapted to SPARN

needs. Users offered refresher training

Real time data now collected in most

regions. Paper forms completed in

others with data input to CAS at MCN

office

Green

Standardise how investigations

are performed and interpreted

Preliminary discussions and agreed

need for standardising MR protocol

for imaging in JIA

Working group including radiologists

to be established

Amber

EQUITABLE: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or

socio-economic status

Communication

Establish systems and processes

to ensure that stakeholders are

identified and are engaged

effectively in the establishment

and ongoing development of the

network

Spring 2014 Stakeholder analysis to be completed

to ensure that al stakeholders have

been identified and that current

communication is effective

Completed stakeholder analysis Amber

Network has a live website

www.sparn.scot.nhs.uk

Green

Develop and deliver a

communication strategy to

support stakeholder

engagement, effective internal

and external communication

communication strategy developed

Survey to be developed to review

communication after stakeholder

analysis

Amber

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

including the development and

sharing of protocols and

information leaflets and the

development of a website

Transition

Meeting of interested clinicians took

place to discuss a way forward for

Transition.

Initial plan discussed adoption of

Southampton Ready Steady Go

Transition documentation.

Following a workshop at SPARN

Annual Education meeting

documentation to be circulated to

network members for comment.

Amber

TIMELY: Reducing waits and sometimes harmful delays for both those who receive care and those who give care Network Clinics

Ongoing Network clinics now in place resulting

in more patient care taking place

locally.

Local education sessions now held

alongside clinics

Network clinics now in place in ALL

regions resulting in more complex

patients being managed locally

Green

Ongoing Satellite clinics in remote and rural

regions

Further development of network clinics

in remote and rural areas particularly in

the Highlands and Islands. Initial clinic

incorporating an education day in

Orkney. Service in Elgin and Western

Amber

Objective Planned

start/ end

dates

Description of progress towards

meeting objective

Outcome / evidence RAG status

Isles in development.

Map of Services – February 2015

Denotes an established SPARN network centre

Denotes a new SPARN network centre

Denotes a future SPARN network centre

*as per SPARN Guideline for a Rheumatology network service

Legend

Denotes number of network clinic sessions per annum

Denotes number of dedicated paediatric rheumatology clinics per month

Recognised as a “network clinic” service provided by recommended minimum core team*

Borders Lanarkshire Dumfries and Galloway

Clyde

Ayrshire and Arran

Forth Valley

West Lothian

Fife

Tayside

Grampian Highland

Orkney/ Shetland Moray

4

7

7

6

*

*

36

*

*

8

*

*

4

*

*

8

*

*

Western Isles

1 8 4

*

*

4 2

1 12

Glasgow Edinburgh

0 0

4

4

Paediatric Rheumatologist

Paediatrician with an interest

Link Paediatrician

Adult Rheumatologist with an interest

Dedicated CNS

Other nursing

Named Physiotherapist

Other Physiotherapist

Named Occupational Therapist

* There is currently no rheumatology service or visiting consultant sessions in Moray, Orkney and Shetland or Western Isles, these centres link into existing services at other centres as per map above

Other Occupational Therapist

Named Ophthalmologist

Visiting consultant network clinics

N/A

N/A