British Society for Rheumatology (BSR) launches a new UK-wide  accreditation service, the Quality Review Service (QRS).

This quality improvement accreditation service open to all rheumatology services across the UK. It aims to raise standards, improving patient service and experience.

QRS aims to promote excellence in all aspects of rheumatology and targets improvement in patient care and experience. It does so by offering a professionally-led accreditation service giving independent external validation and a continuous quality improvement development through a three-year quality review cycle.

Developed to cover the full range of rheumatology services, it can review services covering all rheumatology conditions, including lupus, scleroderma, and Sjögren’s syndrome.

The scheme uses the first UK-wide rheumatology-specific best practice standards to review a service’s performance, which set out good practice for services to follow to achieve the best service and experience for patients.

To ensure the standards are robust and meet the needs of patients and staff, a multi-disciplinary approach was needed. We brought together rheumatologists, specialist nurses, allied health professionals and patients from across the UK; this working group has spent more than two years developing and testing standards to bring you and your rheumatology services a set of achievable ‘best practice’ standards.

Ailsa Bosworth, founder, and National Patient Champion for the National Rheumatoid Arthritis Society (NRAS) has been a patient representative for QRS from the beginning of the project. She says: “BSR works to the highest standards in rheumatology practice and always ensures a multidisciplinary approach to developing programmes such as QRS. It follows strict protocols, terms of reference and monitoring. NRAS has always supported the BSR standards and is very happy to recommend these to patients.”

Services achieving accreditation commit to a three-year quality review cycle and to develop best practice into their daily processes. The results will be that patients will see improvement in their care and experience and have more confidence in their service.

Rheumatology services undergoing the process will do so because they want the opportunity to improve patient, family, and carer experience and because they want to improve stakeholder confidence in the service.

To gain accreditation, a service undergoes an on-site review, which is carried out by a team

 of five assessors. Each assessment team has at least one rheumatologist, one nurse or allied health professional, one patient and a BSR representative.  During the visit, the assessors will interview the service managers, non-managerial staff, and a selection of patients. It was important to the scheme that patients had the opportunity to have their say on the service they receive.

A report is drawn up based on the evidence collected during the inspection process. This report is submitted to the accreditation panel, which is independent of the assessors but also made up of rheumatologists, nurses, allied health professionals and patients, who take the decision to award accreditation.

When a service demonstrates it meets the standards, it is awarded accreditation and enters the three-year quality review cycle. The service is awarded an accreditation certificate as well as use of the accreditation quality mark. They will also be listed on the BSR website along with a summary of their report.

At the end of the first and second years, a review is undertaken of the service to confirm the best practice standards are being maintained. A report is provided to highlight strengths and any further actions needed. At the end of the three-year cycle, the service can choose to renew its accreditation by undergoing a new full inspection.

The standards are reviewed annually; they draw on new best practice identified throughout the year, such as new approaches to treatment methods, as well as the experience and knowledge of working group members, to ensure they remain relevant and effective.

For the patients, an accredited service will bring better care.  Ailsa says: “Improved care, improved patient outcomes, better experience of accessing the service and faster access to help when needed between appointments.” Patients using an accredited service can have the confidence that the service puts their care and experience at the forefront of its activities.

Dr Liz Price, rheumatology consultant, notes: “Patients will have reassurance that their service is accountable and works to UK-recognised standards. It will have been inspected by patients themselves and patients’ views taken into account during the process.”

Accreditation services are utilised in many different sectors across the world and studies show that when a service incorporates accreditation standards into its activities, there is discernible improvement in output as well as working environment.

We believe QRS will help disseminate best practice across the UK, highlighting effective initiatives that improve patient care and experience. It will raise standards and help standardise the level of service received by patients across the UK. 

Lynne Kerton, Rheumatology Clinical Nurse Specialist, explains why she supports QRS: “I have been in rheumatology for many years and when speaking to peers working at different centres, I find that each centre works very differently. I feel it is now time for the UK to have a more cohesive approach to best practice and treatments for rheumatology patients.

I’m passionate that all centres reach best practice standards and by using an accredited peer review process this, gives a professional robust and clear route to providing high quality care throughout the UK.”

The COVID-19 pandemic has put the NHS under a lot of stress and services, such as rheumatology, have suffered as staff and money have been re-deployed to fight this crisis. This crisis raises the question of whether now is the right time to be launching.

However, now more than ever, an accreditation service is needed to help support those services by bringing external validation to the good work they do. Where a service needs development, our view will highlight this and provide the service with evidence on why changes need to be made.

We have adapted our review process to be a blend of online and onsite review to reduce the impact on a service undergoing an inspection, as well as to ensure the safety of the assessors.

We expanded the scheme by adding new standards to reflect the new practices of remote consultations, providing guidance to UK rheumatology services on how to adapt to the needs of the times.

Liz Price on the goal of QRS: “Our vision is that eventually all departments will aspire to be accredited and that this will raise standards uniformly across the UK and reassure patients that they are getting the best possible care”.

Patient input is key, and we welcome you all to get involved. We will need patients to be assessors, to be on the accreditation panel and to be part of the working group which is responsible for the service to ensure the service aims of improving patient care and experience are met.

To become an assessor, a candidate undergoes a day’s training and will shadow assessors conducting a full inspection. Training is currently suspended due to COVID-19, but hopefully will resume in 2022.

We will keep patients up-to-date on when we need volunteers to join the QRS service via our website, social media, and patient publications such as this one via LUPUS UK. We are always happy chat to you about the QRS service and other quality improvement programmes offered by BSR and we can be contacted via email at qrs@rheumatology.org.uk