Services for people with rheumatoid arthritis - Public Accounts Committee Contents

Conclusions and recommendations

1.  Prompt diagnosis of rheumatoid arthritis is crucial in preventing irreversible damage yet delays arise from people failing to present promptly to GPs with symptoms. The Department should run a campaign during 2010 to raise people's awareness of the symptoms of rheumatoid arthritis, highlighting the need to seek prompt medical attention.

2.  GPs often fail to recognise the symptoms of rheumatoid arthritis, causing delay in referring to a specialist for a diagnosis. The Department should, as a priority, launch a targeted campaign or guidance to raise the awareness of GPs and other primary care professionals of the importance of referring people promptly to a specialist, if rheumatoid arthritis or other forms of inflammatory arthritis are suspected.

3.  GPs receive on average only two hours of teaching on musculoskeletal conditions during their training, including minimal coverage of inflammatory arthritis. The Department should encourage the Royal College of GPs to provide more training on rheumatoid and inflammatory arthritis when it implements its plan to extend the duration of training for GPs. Such training should help trainee GPs identify the early signs of inflammatory arthritis and emphasise the importance of early referral to specialists.

4.  In July 2009 a Commissioning Pathway for Inflammatory Arthritis was introduced but current services fall far short of this ideal. The Department should write to this Committee by March 2010 setting out what it is doing to encourage take up of the Commissioning Pathway by Primary Care Trusts, and how it intends to evaluate its impact on patients.

5.  People with rheumatoid arthritis can experience intense pain when they suffer a flare-up but rapid access to specialist care is not always available when they most need it. The Department should review the evidence on the need for better access to flare-up and pain management services for people with rheumatoid arthritis and produce an action plan by March 2010.

6.  Rheumatology specialists do not have sufficient flexibility to prioritise appointments for patients according to clinical need. Strategic Health Authorities should clarify how they expect commissioners in primary care to ensure that sufficient follow-up appointments are available for people with rheumatoid arthritis in their local area, and should audit whether acute trusts are providing the number of follow-up appointments required to meet clinical need.

7.  We are concerned about significant variations in the cost of providing services for rheumatoid arthritis. Data presented by the National Rheumatoid Arthritis Society identified variations in spending by Primary Care Trusts on rheumatoid arthritis services of between £5.68 and £17.58 per head—a greater than threefold difference. The Department should identify the reasons for variations in Primary Care Trusts' spending, set national benchmarks, and require Strategic Health Authorities to hold Primary Care Trusts to account for the cost effectiveness of the services they provide.

8.  The National Audit Office Report identified inconsistency between Primary Care Trusts in the provision of certain drugs for rheumatoid arthritis and the extent of multidisciplinary services. For example, access to biological drugs varies widely and while depression is common with rheumatoid arthritis, there is often no access to psychological services. Primary Care Trusts should obtain much better information about the numbers of people with rheumatoid arthritis, decide what services, including psychological services, they need to provide, and take action to ensure their services are configured cost-effectively.

9.  Support for people with rheumatoid arthritis to remain in or return to work is totally haphazard. The Department should publish clear standards covering the support people can expect from the NHS to help them remain in or return to work. It should agree with the Department for Work and Pensions how they will ensure that assessors have the knowledge they need to make proper judgements about the ability of people with rheumatoid arthritis to work.

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Prepared 23 February 2010