Many patients with rheumatoid arthritis have to see their GP four times before their doctor refers them to a specialist for diagnosis and treatment, according to a report from the National Audit Office (NAO).
The NAO report Services for people with rheumatoid arthritis published today, says that too many people with the condition are not being diagnosed or treated quickly enough and some services are poorly coordinated.
Rheumatoid arthritis costs the NHS an estimated £560million annually. The NAO estimates that approximately 580,000 adults in England currently have the disease with a further 26,000 new cases diagnosed each year.
Delay in treatment is detrimental to patients’ health, their quality of life and, with three quarters of people of working age when diagnosed, the economy.
The report says the disease is difficult to diagnose and requires specialist knowledge, something that few GPs have in this field.
Patients, on average, visit their GP four times before being referred to a specialist for diagnosis and treatment, says the report, and the average length of time from symptom onset to treatment is nine months, compared to the clinically recommended period of three months. This has not improved in the past five years.
The report says that early diagnosis is important to successful treatment of rheumatoid arthritis (ideally within three months of symptom onset), but public awareness of the disease is low.
Between half and three quarters of people with rheumatoid arthritis delay seeking medical help from their GP for three months or more following symptom onset and around a fifth delay for a year or more.
The NAO said that better coordinated services would lead to earlier identification of new cases, productivity gains for the economy, and improved outcomes for patients.
The NHS did not consistently provide support for people with the disease to remain in, or get back into, work, with a lack of local links between the NHS and Jobcentre Plus services.
There was also inconsistent coordination of the roles and activities of staff in different parts of the NHS, such as between GPs and hospital specialists.
Current services did not always match the government’s vision of a “systematic patient-centred approach” and the majority of PCTs were not commissioning as effectively as they could because they did not know the numbers of people in their area with the disease.
Amyas Morse, the Head of the NAO, said: “Patients with this debilitating and distressing disease are not identified or treated quickly enough and this dramatically affects long-term outcomes and people’s ability to remain in work.
“The NHS should take a more coordinated approach to identifying people with symptoms of early rheumatoid arthritis, so that they get access to specialist care quickly and receive support and advice to help them manage and live with the disease.”
Arthritis Care said the report highlighted “minimal” GP training in rheumatoid arthritis (RA) and poorly coordinated services.
The charity’s Chief Executive Neil Betteridge said “We applaud the audit’s recommendations that the Department of Health and PCTs replace their often scattergun delivery with joined-up services.”