Window of opportunity for arthritis patients being missed due to delays in NHS treatment, says new report

According to a new report carried out by the British Society for Rheumatology (BSR), up to a million Britons are at risk of preventable, long-term disability and reduced life expectancy due to delays in referrals to specialist advice and treatment services.

The National Rheumatoid and Early Inflammatory Arthritis Audit report was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcome Programme (NCAPOP)* and carried out by the BSR, is the most comprehensive audit of rheumatology services carried out across England and Wales.

The report says that the first weeks and months following the onset of rheumatic disease symptoms are known as the ‘window of opportunity’, and it is crucial that patients get appropriate treatment in that time period to maximise their chances of avoiding lasting complication. However, the report reveals that for four out of five patients in England and Wales, this does not happen.

The report reveals that nationally just 20 per cent of patients who see a GP with suspected rheumatoid and early inflammatory arthritis are referred to specialist services within the three-day limit recommended by the National Institute for Health and Care Excellence (NICE). For some health providers, this wait is over 20 weeks for a quarter of their patients. Nationally, fewer than half of patients who are referred, are seen by a specialist within the three-week time limit recommended by NICE. For some providers, a quarter of patients are waiting more than 12 weeks.

The audit data points to several reasons for the delays in accessing services including the overall number of rheumatology specialists needed to diagnose and treat the disease. The BSR calculates that consultant levels are 21% below Royal College of Physicians recommended levels, and the number of additional consultants needed is likely to increase as the demand for rheumatology services increase. The latest report also shows a link between numbers of specialist nurses and an ability to commence treatment in a timely manner and achieve treatment targets.

The audit’s recommendations include:

• Increase awareness amongst the general public of the symptoms of inflammatory arthritis and the need for quick treatment to prevent it progressing

• Increase GP’s awareness of the varied symptoms and in particular the need for referral within the NICE guidelines in order to maximise the efficiency of treatment programmes and prevent the disease progressing into more serious, later stages.

• Analyse and understand variation in performance against the key standards.

• Review the adequacy of specialist nurse provision, given the strong association between staffing levels and timely delivery of intensive treatment.

• Support national audit data collection.

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