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This year, 51/146 Trusts and Health Boards participating in the National Early Inflammatory Arthritis Audit were identified as outliers for NICE Quality Statement 2 (time to first specialist appointment). We spoke to a trust's medical director, who explained their challenges, and explained their plans to support their rheumatology department in the future.

Our Trust was identified as an outlier for the first year of the NEIAA. There have been several factors involved in our performance against NICE Quality Statement 2.

What affected our performance

During the time of the audit, our capacity to see new patients was reduced by a full-time consultant and a speciality pharmacist being on maternity leave, with no applicants for the locum consultant post. We are one of three trusts in close proximity, and we are drawing more new EIA referrals from our neighbouring trusts (e.g. patients choose our trust ahead of others even if the latter are their nearest local hospital). Our referral numbers (including urgent/suspected EIA) have increased substantially, from 102 urgent referrals in 2015-2016, to 750 in 2018-2019, with similar consultant levels over this time period.

The improvements

Our full-time consultant returned to work in September 2019, and our application for the B8A Specialist Pharmacist post to become a Rheumatology Consultant Pharmacist has been approved by the division and Pharmacy Director. We also had two business cases approved, for a new full time B7 Rheumatology Specialist Pharmacist and two additional Rheumatology Specialist Nurse Posts. Moving forward, this will increase follow-up capacity significantly.

Additionally, we have started dedicated EIA clinics and plan to have a Consultant Lead for the EIA service. We have audited our EIA referrals to see how many patients actually had EIA (~only 50%). As a result, we have changed our referral form and pathway criteria to enable us to prioritise those patients most likely to have EIA. This has been done in collaboration with the two nearby trusts and primary care.

We have moved to a Referral Assessment Service on the Electronic Referral System, resulting in more stringent triaging and redirection of patients unlikely to have EIA to general rheumatology slots (and vice versa). We are also contacting our local NEIA audit champion to find out which trusts in the region are high-performing. This will then enable us to compare and contrast our services in order to look at ways we can improve locally.

In addition to the steps made, going forward we feel an additional consultant post is required based on current NICE standard/BSR NEIAA recommendation and the significant increase in referral rates. This will be a business case for the next financial year.

Looking to improve your own service? Find supporting materials such as driver diagrams and clinic prompts to help support units on our audit webpage.