Direct Access – Information for healthcare professionals

Since 2011 the University Hospitals Plymouth Rheumatology Direct Access Service has delivered personalised, reliable, patient-centred, and largely patient-initiated care, with much delivered remotely by telephone or email.

Our current service has benefitted from the collaboration, expertise and experience of local patients, clinicians, the administrative team and managers, healthcare commissioners, and researchers. This is the NHSEI commissioned Direct Access case study which includes descriptions of how the services has developed since 2011. Since 2020 our experience has informed the development of the UK and NHS policy on Patient Initiated Follow Up and is contributing to the NHS recovery and Outpatient Transformation Programme.

Rheumatology Direct Access Standard Operating Procedure. We welcome constructive feedback as to how it might be improved.

Here are some patients thoughts about the Direct Access service.


In the following video Mark Perry describes some of the background to and evidence base for the development of the Plymouth Rheumatology Direct Access service.


Our service is based on current best available evidence. We are working with colleagues across the UK to improve our understanding of when and why Patient Initiated Follow Up is safe and effective.


  • Whear R. et al. 'Patient initiated appointment systems for adults with chronic conditions in secondary care’ Cochrane Systematic Review. 2020. 
  • Blog series around Cochrane Review about Rheumatology Patient Initiated Appointment Systems: from perspective of a service user, clinical nurse specialist, consultant, service manager, and health commissioner, and including authors of Cochrane Review.
  • NIHR PenARC (then PenCLAHRC) promotional video and material
  • Hewlett S, Kirwan J, Pollock J, Mitchell K, Hehir M, Blair PS, Memel, D, Perry, MG. Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial. BMJ 2005;330(7484):171.
  • Paudyal P, Perry M, Child S, Gericke CA. Evaluation of a patient-initiated review system in rheumatoid arthritis: an implementation trial protocol. BMC Musculoskelet Disord 2012;13(1):120.
  • Child S, Goodwin VA, Perry MG, Gericke CA, Byng R. Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation. BMC Health Serv Res 2015;15(1):157.
  • Goodwin VA, Paudyal P, Perry MG, Day N, Hawton A, Gericke C, Ukoumunne O, Byng R. Implementing a patient-initiated review system for people with rheumatoid arthritis: a prospective, comparative service evaluation. J Eval Clin Pract 2016.
  • Whear R, Abdul-Rahman AK, Thompson-Coon J, Boddy K, Perry MG, Stein K. Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction. BMC Health Serv Res 2013;13:501.
  • Whear R, Abdul-Rahman AK, Boddy K, Thompson-Coon J, Perry M, Stein K. The clinical effectiveness of patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review. PLoS One 2013;8(10):e74774.
  •  Kieft E, Day J, Byng R, McArdle P, Goodwin V. Bridging the second gap in translation: A case study of barriers and facilitators to implementing patient-initiated clinics into secondary care. 2017; Eur J Person Centered Healthcare; 5(1):129-137

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