10 October 2019
Today we published the latest results of the National Early Inflammatory Arthritis Audit, the biggest and most comprehensive study into the condition.
The audit aims to improve patient care and treatment and has recorded the data of over 20,600 patients, with 98% of trusts and health boards within England and Wales participating. Trusts and health boards were measured against the NICE quality standards. Out of 146 that participated, 51 were defined as ‘outliers’ meaning they performed below average.
One of the outliers is Great Western NHS Foundation Trust, which is where society President Dr Elizabeth Price works. She believes the audit data is vital to support units like hers which need to make developments.
Dr Price says: “What it has done is provide data to help us improve our services. The audit covers all patients referred with suspected early arthritis, not just confirmed patients, so we’ve got a true picture of the broad spectrum. About a third of the people referred actually have early inflammatory arthritis.”
Dr Price says this helps to focus on how best to manage patients, looking at how long it takes GPs to refer, the wait for patients to get an appointment once they’ve been referred, and timescales to confirm a diagnosis and start treatment.
She explains: “Our audit data gives very comprehensive evidence that the earlier you diagnose and manage early inflammatory arthritis, the better the long-term outcomes. We hope in the future we should no longer see patients with deformities and disabilities as a consequence of this condition. If we treat them early, we prevent all the damage occurring.”
In terms of being an outlier, Dr Price says it’s helped focus the minds of the trust: “We’ve identified the problems we’ve got, and we know where we need to change things. For example, we know that we haven’t got the mix of appointments correct. We need to allocate more to this particular category to meet demand. Plus, we need to bear in mind that we have to see three patients to find one with inflammatory arthritis.”
Dr Price recognises that staff levels vary across the UK and that it is an issue for her units: “We’ve raised the levels of staffing with the trust and we are actively trying to recruit. The next big challenge is that there aren’t enough trained rheumatology staff available, which is something the society is campaigning on with the government and other relevant bodies.”
In her trust, Dr Price says that they’ll be adapting some processes to make improvements: “We’ve recognised that we need to be able to control the triage. We need to see the GP letters the minute they are produced so we can decide where they go. We feel that we can better put these patients into the correct slots and get them seen quicker.”
As soon as trusts and health boards were identified as being outliers, many came back within weeks with plans to make changes, which Dr Price believes shows the impact the data is having in progressing services.
She adds: “I think the message to other units is that you’ve got to take control of your pathways and look at the processes involved, because it’s likely that you can improve your outcomes. You can get quick fixes with pathway changes and reworking the resources you already have.”
Dr Price believes the variation seen in the data means that we can all learn from the good examples of where units are getting it right: “It’ll of course take our trust and others time to get back on track, but we know it can be done.”
You can find supporting materials such as driver diagrams and clinic prompts to help support units on our audit webpage. We’ll also be working hard with the rheumatology community in the coming months and we have developed a Quality Improvement Plan to help drive real change across the UK.
You can read the full audit report and look at the data from your trust here.