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
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 heada
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.