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As the strain on NHS services brought by COVID-19 slowly reduces, we’ve started to look ahead at planning for recovery of core services. As part of this, BSR submitted evidence to the Health and Social Care Committee’s inquiry into Delivering Core NHS and Care Services in England during the Pandemic and Beyond. Here, our Head of Policy John Hopgood takes a quick look at what’s covered.


Within government, across the NHS, and here at BSR, the past three months have been focused on the response to the COVID-19 pandemic above all else. Our core guidance for clinicians has been updated maybe 12 times in eight weeks or so; things are moving fast and our members are adapting long-established practice at a previously unheard of rate. However, none of us have stopped thinking about the bigger picture – delivering the key services that patients rely on.


There are already many behind-the-scenes conversations going on regarding the so-called ‘recovery phase’ – adapting to restore healthcare delivery to something approaching normal, within the confines of an ongoing pandemic. Some of our initial work on this has informed our response to the Health Committee’s new inquiry – the full text of which can be found here.


It looks chiefly at five key areas – balancing COVID-19 and ‘ordinary’ care needs, meeting demand for delayed services, addressing mental health impacts, caring for vulnerable patients practicing shielding, and ensuring that new positive changes forced upon us aren’t lost as things return to normal.


Now, it’s important to say that things are still evolving quickly. There’s lots of regional variation in what’s happening, and there is absolutely not going to be a one size fits all solution. That said, there are a few key points that we wanted to highlight.


Service delivery


First, we’ve highlighted some aspects of rheumatology care that need to be maintained as close to normal as possible – things like referrals for suspected inflammatory arthritis or autoimmune connective tissue disorder, for example. Maintaining ready access to a rheumatologist is an absolute priority for patients in these categories.


For other patients, alternative service delivery methods can – and often have already – be considered. Things like telephone appointments for follow-ups and other virtual consultations can be incorporated into care pathways. Where monitoring is normally an integral part of treatment, some more flexibility may be needed – for example by reviewing cases on an individual basis and weighing up the risks of continuing without blood testing, as compared to the benefit of staying on DMARDS.


Ongoing treatment and care


In terms of ongoing treatment and care, and on managing delayed services, close alignment with primary care – and community care – settings is absolutely vital. While hospital departments are still under strain due to COVID-19 work, careful resource allocation and management can help ensure members are able to best focus their resources on patients in most need of their help.


Working to deliver services to patients who are shielding is a key area of concern, not least due to the risks of digital exclusion for those for whom virtual consultations might not be appropriate. This encompasses a large number of rheumatology patients, and combining online, telephone and face-to-face consultations as appropriate is going to be a major challenge. Again, resource allocation is going to be vital here, and we’re going to be pushing to make sure that members have all the support needed to get their vulnerable patients the best care possible.


Lastly – but perhaps most importantly – to say is that we’ve been constantly amazed at the fantastic adaptability that has already been on display. Members have been so innovative in finding new ways to deliver care, and we want to support these efforts going forward as much as possible. We’ve seen departments look at assessing their new patient slots, asking whether there are enough slots to meet waiting time targets, reviewing their triage processes and considering initial assessments by telephone.


We’ve seen all varieties of virtual consultations – including building on the work of our fantastic Best Practice Award winner in North Devon – and we’ve seen a tremendous focus on vulnerable patients.


Our message to the Select Committee is simple – BSR members – and indeed, clinicians from every specialty – are answering every question thrown at them. Now, we need to make sure that you all receive the best support possible over the months ahead.


Over the coming weeks and months we’ll carry on speaking with politicians about what the next steps look like, informed at every stage by our members. In the meantime, please continue to let us know about the challenges you’re facing, or the innovations you’ve developed either on our dedicated member forums, or by email to policy@rheumatology.org.uk.