Patients experiencing long waiting times, says new report by the British Society for Rheumatology

The first rheumatoid and early inflammatory arthritis audit has shown that two thirds of patients wait too long for a specialist assessment.

The report by the British Society of Rheumatology (BSR) shows that while early referral and assessment by rheumatology services is vital in preventing disability, many patients in England and Wales are experiencing long waiting times, which fall outside of the guidelines and standards developed by the national Institute for Clinical Excellence.

The report, which was commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcome Programme, says that although most services offer prompt educational support and agree targets for treatment with their patients, only one quarter of services achieve the agreed targets within three months of follow-up.

Key finding in the report include:

• 1 in 6 patients were referred by their GP to rheumatology services with three days. However, one quarter of patients, waited more than three months to be referred;
• 38% of patients were seen by rheumatology services within three weeks of referral;
• More than half of patients were treated with disease modifying drugs within six weeks, irrespective of whether they were seen within three weeks of referral.

The audit used dated from 6,354 patients collected from 143 trusts and health boards, representing almost all NHS rheumatology providers in England and Wales. The report examined the assessment and early secondary care management of all forms of peripheral joint early inflammatory arthritis.

Clinical Audit Director, Dr Jo Ledingham says, “Inflammatory arthritis, and in particular rheumatoid arthritis, is a common cause of disability in adults and can reduce life expectancy. Early initiation and rapid escalation of disease modifying treatments can prevent disability and reduce long term complications, but rapid access to specialist services is needed to facilitate this as part of a care package in partnership with the patient.”

There were a number of recommendations from the BSR report including:

• Training and support should be given to primary care in order to raise awareness of the early symptoms and signs of inflammatory arthritis and importance of early referral;
• Rheumatology services and providers should assess how to increase clinical capacity, ensuring quicker access to rheumatologists and building suitable care packages in partnership with patients;
• The NHS should develop better systems for capturing, coding, and integrating outpatient information from clinics, including measures of patient experience and outcome.

Following their participating in the audit, a number of trusts and health boards have already successfully reconfigured their services in order to improve patient care.  Data from the 2nd year of the audit, which will be published in due course, should quantify these changes in more detail.

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