21 April 2019
Earlier this month NHS England introduced a new best practice tariff for early inflammatory arthritis. It will provide an extra top-up payment for units seeing new patients who are then enrolled onto the audit and whose care meets six standards.
This welcome development is the result of extensive lobbying by BSR and represents a huge step forward in fostering best practice, which will ultimately help improve care for thousands of patients.
Here are Ali Rivett, our Chief Executive, and Dr James Galloway, Senior Lecturer at Kings College London, talking about the tariff, how trusts can benefit from it and what it means for quality of care.
What is the early inflammatory arthritis best practice tariff?
Dr James Galloway: "It's a top-up fee to what is currently already in place. Currently the NHS 410 treatment code for rheumatology is a fixed fee of £270 for a first appointment and £92 for a standard follow-up appointment. The new early inflammatory arthritis best practice tariff offers an additional £130 for a patient who is seen with a new diagnosis. The trust must enrol the patient in the audit and meet the standards set out in the tariff. It's a great step forward... it's evidence that the NHS values rheumatology services."
How did it come about?
Ali Rivett: "It started when the Healthcare Quality Improvement Partnership (HQIP) commissioned us to oversee the early inflammatory arthritis audit. There were lots of conversations at the time about how we could incentivise the audit to ensure all trusts in England participated.
"We've been working alongside NHS England to explore whether there could be any financial incentives and what that might look like. It's taken more than 12 months of meetings, engagement exercises and a statutory consultation, so lots of work behind the scenes. We're thrilled the best practice tariff has now been formally launched."
DJG: "BSR has been central in negotiating this tariff. They're committed to helping rheumatologists across the country deliver the best possible care for people with long-term inflammatory arthritis."
Why is it needed?
AR: "The audit is vital for us to improve waiting times, treatments and outcomes for early inflammatory arthritis patients," says Ali. "We know there is a wide variation in care and practice across the UK. The best practice tariff acts as an extra incentive for units in England to recruit patients to the audit and ensure they receive the best possible care.
"We know that some units just can't configure their services appropriately because they don't have the finances to do so. We hope this additional payment will help them do that. If introduced a year ago, analysis shows that over 350 patients would have been treated who met these criteria. That would've equated to around £50,000 extra being invested into rheumatology units across England. So units could put the top-up towards more staffing, more clinics to treat patients quicker or help to reconfigure services."
What criteria need to be met?
The trust must meet six standards, which are:
Referral: the patient must be seen within three weeks of referral
Audit: the patient must be enrolled in the audit within three weeks of diagnosis
Treatment: must start DMARDs within six weeks of referral
Education: disease education must be offered within one month of diagnosis
Outcomes: documented DAS28 score within audit by three months (no requirement to achieve a target)
Outcomes: documented Patient Reported Outcome within audit by three months
DJG: "The key things to think about are enrolling the patient with the audit, seeing them quickly, treating them quickly and recording clinical outcomes."
Which trusts can benefit?
DJG: "Every trust in England has the potential to benefit. The message for those not currently engaged with the audit is that there is now an extra incentive to do so. This additional financial support could potentially be invested in administrative help to run the audit, covering the cost of participation."
AR: "Currently 96% of trusts are participating in the audit, but our target is 100%. One of the main barriers to trusts not getting involved is a resource one, so hopefully releasing additional funds will help those last few remaining units take part."
How will it improve outcomes for patients?
AR: "It should mean that patients are diagnosed and treated as quickly as possible and reduce variation. There is lots of evidence around the importance of patients being treated quickly – like improvements in quality of life and their ability to work. There are also benefits to the NHS and the wider economy as a whole in terms of reduced costs. In theory these extra payments should be recovered several times over if more and more patients are treated in line with best practice."
What about elsewhere in the UK?
AR: "The audit currently covers England and Wales, whilst the new best practice tariff is England only, We would, however, like to see improvements to patient care across the UK, with conversations already happening in Scotland."
You can find out more about the early inflammatory arthritis audit here