Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
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2 Specialties Rheumatology69 Musculoskeletal Research Group. Norfolk ArthritisRegister (NOAR) information. Manchester: University <strong>of</strong>Manchester, 2010. www.medicine.manchester.ac.uk/musculoskeletal/research/arc/clinicalepidemiology/outcomestudies/noar/noarinfo/ [Accessed 1 July 2011].Appendix (2013 update)Major changes in the commissioning <strong>of</strong> rheumatologyservices will occur in April 2013 in England, <strong>with</strong> theintroduction <strong>of</strong> clinical commissioning groups (CCGs).CCGs will commission locally the majority <strong>of</strong> workundertaken by rheumatology services. Some specialisedservices will be commissioned by the NationalCommissioning Board.Best practice tariff for earlyinflammatory arthritisIn April 2013 the Department <strong>of</strong> Health is introducing abest practice tariff (BPT) for early inflammatoryarthritis (EIA). This tariff is intended to support NHSproviders and their rheumatology services in thedelivery <strong>of</strong> high-quality, evidence-based, cost-effectivecare to people <strong>with</strong> EIA. The BPT should incentiviserapid assessment and diagnosis and facilitate intensivetreatment <strong>of</strong> rheumatoid arthritis and other EIA in line<strong>with</strong> National Institute for Health and Care Excellence(NICE) clinical guideline CG79. The tariff is designed tocover all aspects <strong>of</strong> rheumatological care in the first yearafter referral (except for the costs <strong>of</strong> biologic drugs), andwill allow services to see <strong>patients</strong> according to theirclinical need, removing some <strong>of</strong> the difficulties aroundcommissioning <strong>of</strong> follow-up appointments andnew:follow-up ratios.Patients referred in to rheumatology services <strong>with</strong>suspected EIA will attract one <strong>of</strong> three tariff payments:BPT2. DMARD therapy BPTA best practice tariff payment for those <strong>patients</strong> <strong>with</strong>suspected EIA who: are seen <strong>with</strong>in 3 weeks <strong>of</strong> referral have DMARD (disease-modifying anti-rheumaticdrug) treatment initiated <strong>with</strong>in 6 weeks <strong>of</strong> referral receive regular follow-up and monitoring over firstyear <strong>of</strong> treatment <strong>with</strong> evidence <strong>of</strong> appropriatetitration <strong>of</strong> therapy.BPT3. Biologic therapy BPTA best practice tariff payment for <strong>patients</strong> <strong>with</strong>suspected EIA who: are seen <strong>with</strong>in 3 weeks <strong>of</strong> referral are diagnosed, <strong>with</strong> DMARD treatment initiated<strong>with</strong>in 6 weeks <strong>of</strong> referral receive regular follow-up and monitoring as perBPT2 over first year <strong>of</strong> treatment; biologic therapyprescribed and initiated in year 1.The precise costing for the BPT has yet to be finalised,but the tariff levels are intended to allow rheumatologyservices to provide intensity <strong>of</strong> care consistent <strong>with</strong>NICE CG79, using a mixture <strong>of</strong> nurse- andconsultant-delivered care.If services are unable (or choose not) to implement theEIA BPT, they will continue to be paid the standardrheumatology new and follow-up tariff. However, it ishoped that the financial incentives built into the BPTwill encourage providers to develop rheumatologyservices to have sufficient clinical capacity to providetimely assessment and intensive treatment.The BPT will apply only to <strong>patients</strong> <strong>with</strong> new EIAreferrals in their first year <strong>of</strong> care. All otherrheumatology referrals, and <strong>patients</strong> already underfollow-up will continue to attract the standard new andfollow-up payment-by-results tariffs.BPT1. Diagnosis and dischargeA best practice tariff payment for those <strong>patients</strong> <strong>with</strong>suspected EIA who are: seen <strong>with</strong>in 3 weeks <strong>of</strong> referral diagnosed as not having EIA and discharged <strong>with</strong>in6 weeks <strong>of</strong> referral.The Scottish Public Health NetworkIn Scotland secondary care services are not‘commissioned’ through primary care, but are providedby health boards. However, the principles <strong>of</strong> shared care<strong>with</strong> primary care, early diagnosis and therapy <strong>of</strong>inflammatory arthritis, and multidisciplinary care areconsidered equally important. The Scottish PublicC○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013 249