You are here: Home Page > News
Press Release - 22 January 2009
GULF IN PATIENT ACCESS TO MULTI-DISCIPLINARY TEAMS ‘STRIKING’ AND ‘ALARMING’ ACCORDING TO RHEUMATOID ARTHRITIS EXPERTS
A major new report by the King’s Fund, commissioned by the Rheumatology Futures Project Group has identified an “unacceptably wide variation” in the levels and quality of access to specialists available to the 450,000 people with rheumatoid arthritis (RA) in the UK.
The report analyses the views of over 900 patients and 500 medical professionals and NHS staff. It revealed that some patients get “no support” from a multi-disciplinary team who provide specialist services that are vital to help patients manage their condition and cites clinicians who say that the disparity of access is ‘striking’ and ‘alarming’.
King’s Fund report author Martin Land said:
“This report shows that despite the chronic and debilitating nature of rheumatoid arthritis, patients frequently struggle to get the appropriate care they need. There are stark differences across the country in the support patients receive from specialist services, such as specialist nursing, physiotherapy and podiatry, which are crucial to helping patients manage their own conditions. This suggests that the care needs of many patients are not being met. Our report demonstrates the need for more consistent provision of specialist care for people with rheumatoid arthritis and better implementation of guidance and best practice.”
Susan M Oliver, Nurse Consultant Rheumatology and Joint Chair of the Rheumatology Futures Group, said:
“Many patients who experience a flare of their disease and need healthcare advice use the nurse specialist telephone advice line service to seek help and access to prompt management. Yet access to a prompt appointment with specialist rheumatology practitioners is variable. A proactive and strategic approach to commissioning should be undertaken if patients are to receive a fair deal.”
Dr Chris Deighton, Chairman of Clinical Affairs Committee at the British Society for Rheumatology and Clinical adviser to the NICE Rheumatoid Arthritis Management Guideline, said:
"The Rheumatology Futures Project Group has revealed disturbing variations in the quality of care to patients in England. All patients with RA deserve a local service that can monitor their disease and treatment closely, respond rapidly to flares and other problems, and provide access to a specialist multidisciplinary team. Rheumatoid arthritis is a complex disease that impacts on all areas of people's lives, so that it is vital that all patients have access to the knowledge and skills of specialist nurses, physiotherapists, occupational therapists, podiatrists, and other experts on occasions."
Key findings from the King’s Fund report:
- Variations in the standards of care for RA sufferers
- Knock-on effects of Government’s 18 week referral target
- Poor clinical understanding about RA
- Need for more clinician involvement in the commissioning process
The Rheumatology Futures Project Group, who commissioned the research, has called on the Government to improve integration between primary care teams and specialist professionals, including specialist nurses. They called for more innovative clinician driven leadership by specialists in the commissioning process to ensure that patients are seen by multi-disciplinary teams at the earliest opportunity.
Ailsa Bosworth, Joint Chair of the Rheumatology Futures Project Group Project, said:
“Patients with rheumatoid arthritis are well aware of the alarming gulf in access to best care and treatment in many areas. Much needs to be done to raise awareness of the seriousness of this disease with the general public and to address the lack of clinical knowledge about RA in primary care as well as improving access to on-going care and management.”
ENDS
NOTES TO EDITORS
1. RHEUMATOID ARTHRITIS (RA): FAST FACTS
- RA is a chronic, progressive, disabling condition affecting appx. 450,000 people in the UK with 12,000 newly diagnosed p/a
- When untreated, the disease can progress rapidly, causing swelling and damage to cartilage and bone around the joints. Any joint may be affected but it is commonly the hands, feet and wrists. It’s an auto-immune disease with no known cause or cure.
- The main symptoms of RA are severe pain, stiffness, fatigue and loss of mobility.
- 42% of RA patients are registered disabled within 3 yrs of diagnosis. 80% are moderately to severely disabled within 20 yrs.
- RA affects approximately 3 times more women than men.
- The onset of RA can occur at any age with around 12,000 children under the age of 16 with a juvenile form of the disease.
- RA is more common than Leukaemia and Multiple Sclerosis, however, awareness of the severity of the condition tends to be restricted to those who are directly or indirectly affected.
- The total costs to the UK economy of RA including indirect costs and work related disability have been estimated at between £3.8billion and £4.75 billion each year.
2. CRITICISMS OF RA SERVICES IDENTIFIED BY THE KING’S FUND REPORT
- Variations in RA care standards and access to multi-disciplinary teams:
“Descriptions of the range from a single-handed consultant with no support to full multi-disciplinary teams providing rapid and even patient-directed access were striking and claimed by some professionals as alarming.” (p13)
- Knock-on effects of Government’s 18 week referral target
The 18 week waiting time target between diagnosis and referral has, according to clinicians cited in the report caused “greater delays in seeing patients with existing disease (follow-up attendances). It was suggested by many interviewees that policy drivers which focus on increasing the ratio between new and follow-up patients can leave those with long term disease unable to get follow-up appointments.” (p14)
- Poor clinical understanding about RA
“Many GPs are not sufficiently aware of the indicators that may suggest RA or recent evidence that has identified the importance of rapid therapy to prevent damage to joints.” (p10)
“The role of primary care clinicians could be enhanced across the pathway, from ensuring more rapid referral for specialist assessment to supporting the ongoing management and treatment of people with RA.”(p22)
- Importance of clinically-led commissioning of RA services
The report cited “the importance of local clinical leaders who have led service improvements and are knowledgeable about what different specialists can do for RA” in shaping services that reflect patient needs.” (p14)
3. CALLS TO ACTION MADE BY THE RHEUMATOLOGY FUTURES PROJECT GROUP
1. Department of health must improve education on RA for primary healthcare professionals to ensure early diagnosis, rapid referral for treatment and supportive long term care.
- DoH to foster a strong ethos that encourages individualised care plans, as recommended by Lord Darzi’s Next Stage Review, to provide social, psychological and lifestyle advice in addition to clinical support.
- Greater integration of knowledge about patient treatment between primary care teams and specialist professionals to enable and support patient self management.
2. Department of health must develop a commissioning pathway for RA with supporting toolkit to ensure robust and consistent standards of care throughout the patient journey.
- Full implementation of the forthcoming NICE guideline to end the striking gulf in quality of RA care and access to multidisciplinary teams and ensure universally high standards of care, enable patient self management and reduce the long term costs of RA to individuals, the NHS and society.
- A more comprehensive system of recording activity and coding data on RA patients that receive care to capture the number of admissions through different specialist areas of the NHS for co-morbidities such as CVD. This will provide a greater understanding of the true economic and social costs of RA to the NHS and patients.
- This could be complimented by more widespread and innovative clinician driven leadership by specialists in the commissioning process to improve the patient journey for RA patients.
The Rheumatology Futures Project Group
The Rheumatology Futures Project Group is an organisation that is made up of patient organisations (including National Rheumatoid Arthritis Society, Arthritis Care, and the Arthritis and Musculoskeletal Alliance), medical (British Society of Rheumatology and Primary Care Rheumatology Society) nursing (Royal College of Nursing) and allied health care professional groups (British Health Professionals in Rheumatology). The pharmaceutical industry are supporting this project with lead political and government affairs advisers representing Abbott, Bristol Myers Squibb, Roche, Schering Plough, UCB and Wyeth.
Contact: Olly Kendall 020 7824 1866 / 07793 224749 / olly@insightpa.com
Soc Chiropodists & Podiatrists 23rd January 2009
Categories: Footnote
Story read 11624 times
