10 October 2019
Latest figures released from the society's National Early Inflammatory Arthritis Audit reveal that more than 50% of early inflammatory arthritis patients wait too long for GP referrals and specialist appointments.
The audit, published today, is the largest and most comprehensive study into the condition. It aims to improve patient care and treatment and has recorded data from over 20,600 patients, showing high trust and health board participation rates (98%) in England and Wales.
The audit measures performance against NICE’s quality statements, which include time taken for referral from a GP, to see a specialist and to receive appropriate treatment.
The report has revealed that 41% of patients met the three-day standard for referral from their GP, while 38% referred to a rheumatology unit were seen within the three-week guidelines. The average wait for the first appointment was 28 days.
The audit data shows considerable variation in performance across England and Wales. It identifies 51 trusts or health boards out of 146 performing significantly less well than the rest in the time they take to see a patient after referral.
The report highlights many examples of units performing well, while regional champions have been used by BSR to help others learn from their good practice.
Dr Jo Ledingham, the audit’s Clinical Director, said: “It’s clear from the audit that great treatment and care is achieved by some units but that many are struggling to achieve the standards set by NICE. With 98% of trusts and health boards in England and Wales participating, there’s evidence of excellent engagement within the rheumatology community and enthusiasm to learn and improve. The data supports the requirement for more resource and focus on rheumatology services within trusts and health boards.
“This audit clearly shows the positive impact rheumatology services have on people’s lives. Within three months of specialist care, the majority of patients had meaningful improvements in measures of their disease activity, and patients reported improvements in all outcome measures, including reduced impact on ability to work and less depression and anxiety.
“The audit is already being shown to have an impact on the care provided to patients, with progressive improvement in the time taken to start treatment over the last 12 months. The importance of this is emphasised by the finding that achievement of timely treatment associates with achieving a good response in clinician measured disease activity.”
Other key findings from the data include:
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54% of patients with a diagnosis were prescribed medication within the NICE-recommended timelines
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84% of patients had targets for improvement in their arthritis set and agreed
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93% of patients received education about their condition
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92% of patients were given access to a rheumatology specialist advice line as a means of support
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37% of patients were in remission within three months of being seen by a rheumatology team
Dr Ledingham continues: “We know that there will be multiple factors contributing to how trusts and health boards perform against the NICE quality standards, and we recognise that staff shortages are a big part of the problem. There’s a clear disparity in levels of staffing across England and Wales which needs to be addressed. How resources are allocated will be another factor and we are doing our best to learn from the trusts and health boards that are performing well.”
Ali Rivett, the society's Chief Executive, said: “As the leading organisation representing rheumatology professionals throughout the UK, we know how hard you are all working to meet the needs of the growing number of people who need your help.
“Although things won’t change overnight, there are improvements being made so that all units can reach the standards. This audit is vital in raising awareness of the condition, helps to bring the issues to the attention of decision-makers and encourages us all to strive for more.”
Dr Ledingham adds: “We’ve developed a Quality Improvement Programme which sets out specific improvement targets for three of the quality statements and set up a Special Interest Group to help develop QI work within the rheumatology community. We are encouraging all trusts and health boards to use the tools we’ve developed to allow downloading of their data for further analysis and to support QI work, including driver diagrams and clinic prompts.
“We’re also looking into developing further tools to support GPs with referring the right patients quickly. With this and other work ongoing, we’re confident we’ll continue to drive real improvements in the care provided to patients with early inflammatory arthritis across the UK, and are grateful to all rheumatology staff and patients for their contributions to this audit.”
You can view the full report and download individual trust and health board data here
Read our President Dr Liz Price's blog on what her trust can learn from being an outlier, and her advice to others in a similar situation