Background of NLCs: The emergence of Nurse-led clinics (NLC) has given nurses a pathway for innovation and excellence towards providing safe, efficient, cost-effective and quality healthcare service.
Reasons for setting up a Thyroid NLC in Oxford: Patients were waiting up to 3 months before seen by a consultant. Funding was available for a part-time endocrine nurse.
Aims of the Thyroid NLC: To set up and provide a safe, efficient, cost-effective service for patients with uncomplicated hyperthyroidism (Graves disease, nodular goitre and thyroiditis). To reduce patient waiting time and to audit the service provided.
Components for setting up the NLC: Approval was obtained from the ORH NHS Trust. Appropriate knowledge and skills on the subject were acquired by the nurse. A clinic consultation room for the NLC and an endocrine consultant was made available to work along side. A clinic code was given for the purpose of documenting and monitoring patients attendances. Proformas were prepared for history taking, physical examination, monitoring/evaluating results and patient/GP correspondence. Slots were allocated to see 2 new and 4 follow-up patients per week and a direct access support-line was provided for patients.
Outcomes: Clinic has been running since 2005. Nurse prescribing course has enabled medications to be prescribed and drug dose adjustments to be made by the nurse. Between 9/09-9/10, there were 81 new and 185 follow-up attendances. The income generated during this time was £34,316. Non-face to face communications also generated income of around £3,000 per month. Two audits concluded the benefits of the NLC.
Challenges & future developments: To maintain professional competence and expertise of the nurse to run an efficient and high quality clinic through regular auditing. To expand the service by setting up a Nurse-led post-radioactive iodine clinic.