The State of Play in UK Rheumatology report, published by the British Society for Rheumatology (BSR), captures for the first time the major challenges currently facing rheumatology services and the patients they serve, setting out a range of measures to address these at a national and local level.
The BSR is a clinical membership body representing the diverse range of healthcare professionals working in services for people rheumatic and musculoskeletal disorders (RMDs), including rheumatologists, nurses, allied health professionals and GPs. The State of Play report, launched on the eve of the BSR annual conference Rheumatology 2015, was developed in partnership with its membership, gathering views through a survey to over 2,000 members, alongside a series of focus groups with clinicians and patients.
The key findings of the survey include:
- 8 out of 10 respondents felt that rheumatology services were no better now than in 2010 when there was a national audit highlighting deficiencies
- two-thirds rated their relationship with primary care colleagues as five out of ten or below, citing poor communication and lack of GP condition awareness as main factors
- 9 out of 10 consultants collected data on people ability to return to work despite there being no national requirement to do so - evidence that there needs to be more accurate measurement of things important to people with long term conditions
- 9 out of 10 respondents were concerned that training on early identification of symptoms should be spread to a wider range of healthcare professionals
- Only 14% of respondents believed that there was sufficient clinical input and 7% that there was adequate patient input in tendering processes
- 85% reported that education, training and research not given proper consideration in tenders for new services
- three out of five reporting that their units were experiencing significant recruitment gaps across all professions
In addition, pressure on demand for rheumatology grew, by 25% over the past 4 years, waiting lists for rheumatology services in England grew by 32% in three years, almost twice the national average of 18%. Despite this increase, services had managed to keep average waiting times for treatment to four weeks although this still falls short of NICE standards of three weeks for rheumatoid arthritis.
These findings have informed the report's final recommendations, termed BSR's '15 for 2015', as they represent the 15 key challenges that need to be addressed across the UK to ensure that patients with RMDs experience the highest quality care possible.
Amongst its recommendations, the BSR calls for:
- greater recognition of RMDs in national strategies, due to their major health and socio-economic impact, complemented by new measurements for people with chronic complex conditions inclusion in commissioning frameworks
- acceleration of best practice in care-coordination across the NHS through specialist nurses
- expansion of training to identify early onset of rheumatic conditions to a wider range of health professionals including GPs, practice nurses, community nurses, AHPs and pharmacists
- prioritisation of personalised, care and support plans for all patients with long term conditions
- local investment in patient education and self-management programmes for people with long term conditions, in line with NICE guidance
- review of medicines approval processes, to improve access to biologics for all patients including those at the mild stage of the disease and those with rarer conditions
Commenting on the publication of the State of Play report, BSR President, Prof. Simon Bowman, stated:
"Despite the pressures facing services in recent years in terms of rising demand, drives for efficiencies and diminishing resources, our members have managed to maintain the highest standards of care for their patients. However, they have also made it clear that so much more could be achieved if they and their patients were given the proper support to develop services. This report reinforces the need for collaboration over competition in the health service. Whether it's collaboration between healthcare professional and patient, closer working across professional boundaries or better co-ordination between care settings, patients will only ever benefit from a more collaborative approach."
These views were echoed by the BSR's Chief Executive, Laura Guest, who said:
"This report is both a testament and warning. A testament to the hard work of services up and down the country in continuing to deliver high quality services to patients during this challenging times for the NHS. But also a warning, that this is not sustainable without proper planning to meet the challenge of the rising tide in developed countries such as the UK in people with chronic lifelong conditions. Resources in the shape of patients informing the design of responsive services, professionals ensuring that services are clinically effective, or the vast untapped resources of data on rheumatic and musculoskeletal disorders. We believe that if the range of measures laid out in State of Play report were implemented, this would provide greater clarity to the delivery of rheumatology services during these challenging times, ensuring that our patients experience the best health outcomes possible within the resources available. We urge policymakers, commissioners and providers to take heed of these measures."