Academic Rheumatology Unit, University Department of Clinical Medicine, Bristol, Avon, UK
Correspondence to:
J. R. Kirwan, University of Bristol Academic Rheumatology Unit, British Royal Infirmary, Bristol B52 8HW, UK. E-mail: john.kirwan{at}Bristol.ac.uk
SIR, Stimulated by the report from Dr Sathi and colleagues [1], I have looked again at the data from our regional out-patient survey [2] and reclassified the patients referred by general practitioners as far as possible according to their clinical prioritization categories A, B and C. (It is likely, because of the differences in our data recording, that category C is overestimated and category B underestimated, although category A should be very similar.) The mean and median new patient waiting times (in days) for each category are compared with those of Sathi and colleagues in Table 1. Clearly, in one way or another, rheumatologists in the south-west of England do prioritize their patients, but all the waiting times are much longer. Would Sathis very reasonable solution to prioritizing patient referrals help here?
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How can Lancashire deliver a well-ordered, prioritized service but the south-west of England cannot? In Lancaster in 1990, 28.8% of new patients had polyarthritis [3]. In 1994 the proportion in the south-west of England [4] was 37.0% and in 1988 the proportion at our rheumatology unit [5] was 42.8%. These differences in referral rates have a profound effect on how a service can be developed [6]. In particular, polyarthritis generates many follow-up appointments and fills up the out-patient clinics. In the south-west of England there are just not enough rheumatologists to meet the needs of the population.
We can do two things. The first is to lobby for more resources, and the second is to find new ways of working that allow us to treat patients more efficiently. The long-term follow-up of patients with rheumatoid arthritis is the single biggest demand on rheumatology out-patient services [2], and work is progressing on ways to make this both less demanding and more effective [7, 8].
References