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2 Specialties Rheumatology69 Musculoskeletal Research Group. Norfolk ArthritisRegister (NOAR) information. Manchester: University ofManchester, 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 of rheumatologyservices will occur in April 2013 in England, with theintroduction of clinical commissioning groups (CCGs).CCGs will commission locally the majority of workundertaken by rheumatology services. Some specialisedservices will be commissioned by the NationalCommissioning Board.Best practice tariff for earlyinflammatory arthritisIn April 2013 the Department of Health is introducing abest practice tariff (BPT) for early inflammatoryarthritis (EIA). This tariff is intended to support NHSproviders and their rheumatology services in thedelivery of high-quality, evidence-based, cost-effectivecare to people with EIA. The BPT should incentiviserapid assessment and diagnosis and facilitate intensivetreatment of rheumatoid arthritis and other EIA in linewith National Institute for Health and Care Excellence(NICE) clinical guideline CG79. The tariff is designed tocover all aspects of rheumatological care in the first yearafter referral (except for the costs of biologic drugs), andwill allow services to see patients according to theirclinical need, removing some of the difficulties aroundcommissioning of follow-up appointments andnew:follow-up ratios.Patients referred in to rheumatology services withsuspected EIA will attract one of three tariff payments:BPT2. DMARD therapy BPTA best practice tariff payment for those patients withsuspected EIA who: are seen within 3 weeks of referral have DMARD (disease-modifying anti-rheumaticdrug) treatment initiated within 6 weeks of referral receive regular follow-up and monitoring over firstyear of treatment with evidence of appropriatetitration of therapy.BPT3. Biologic therapy BPTA best practice tariff payment for patients withsuspected EIA who: are seen within 3 weeks of referral are diagnosed, with DMARD treatment initiatedwithin 6 weeks of referral receive regular follow-up and monitoring as perBPT2 over first year of 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 of care consistent withNICE CG79, using a mixture of 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 patients with new EIAreferrals in their first year of care. All otherrheumatology referrals, and patients 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 patients withsuspected EIA who are: seen within 3 weeks of referral diagnosed as not having EIA and discharged within6 weeks of referral.The Scottish Public Health NetworkIn Scotland secondary care services are not‘commissioned’ through primary care, but are providedby health boards. However, the principles of shared carewith primary care, early diagnosis and therapy ofinflammatory arthritis, and multidisciplinary care areconsidered equally important. The Scottish PublicC○ Royal College of Physicians 2013 249
Consultant physicians working with patientsHealth Network (ScotPHN) commissioned a needsassessment for rheumatoid arthritis which waspublished in 2012. The epidemiological section islargely based on data from the Norfolk ArthritisRegister (NOAR) and should thus be equally applicablein England, Wales and Ireland. The document includesan executive summary, epidemiological data,recommendations on the provision of core services forpeople with rheumatoid arthritis and cost implications(in draft form at the time of writing). These data may beof use to those commissioning services for rheumatoidarthritis in England, Wales and Northern Ireland as wellas rheumatologists and health boards in Scotland. Thewebsite for the ScotPHN is: www.scotphn.net/projects/previous projects/rheumatoid arthritis250 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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