Blog: impacts on access to care

Access to care

In case you missed the recent publication of our ‘Access to Care’ factsheet, here are some of the key points. It:

• Focuses on areas we believe currently prevents rheumatology teams providing high-quality care, such as workforce capacity, rural barriers and the impact of COVID-19 on services

• Gives an overview of the importance of developing sustainable services that deliver equitable outcomes for everyone

• Accounts for individual, organisational and geographical barriers to care; COVID-19 has led to a treatment backlog across the UK, with some services struggling to get their clinic space back.

We believe a good indicator of how services are operating is wait times, which can reflect staffing levels and service provision demands. You’ll know that we support various trusts and local health boards who are struggling to meet standards of care when the National Early Inflammatory Arthritis Audit (NEIAA) is published each year, writing to their management teams and lobbying local parliamentarians for support.

So what’s next?

Policy work has naturally been dominated by COVID-19 this year, but with the NHS People Plan now published and services starting to resume, we believe it’s time to start refocusing on improving care in rheumatology while continuing our COVID-19 recovery work (although the two are closely linked).

We’re already running a campaign to help services post-COVID-19, which you can submit to here (link to campaign). At BSR, we want to help services who are struggling, and can supply a range of resources outlining why local decision-makers must revisit any delays restarting rheumatology services.

Rural rheumatology issues

It’s important that we don't simply frame access to care as a rural issue. Many services in urban areas have deep-rooted issues that cause difficulties when a patient needs timely care. In order to fully dive into the problems associated with access to care in rheumatology, the rural population need a much stronger focus from a host of bodies.

Just some of the challenges rural rheumatology faces: 

• The rural population skews older and is growing at a faster rate compared to urban areas; up to one third of the UK population lives rurally

• Musculoskeletal diseases are the most common cause of disability in the elderly, but most specialist services are found in urban areas. This presents a significant challenge to the delivery of timely and equitable healthcare services

• Physical distance, poor local infrastructure and high-speed internet are major factors for a patient in a rural setting accessing their rheumatology team 

• In a report focusing on rheumatology in Scotland, 88% of health professional respondents believed rural or island-based patients had difficulty accessing services, travelling excessive distances for clinics and diagnostic services; services themselves often don’t have a full multidisciplinary team (MDT) or have long-lasting vacancy rates

• For instance, NHS Grampian and Highland has seven FTE (full time equivalent) consultants for a population of almost 900,000 across 40,000 sq kms. If we use the RCP 2007 recommended levels of provision as one FTE consultant per 86,000 population, they should have 10 consultants, meaning a shortfall of three exists

What are we doing to help?

From NHS workforce programmes such as the NHS People Plan to the All-Party Parliamentary Groups on rural health services in Westminster, we want to highlight the problems our members living and working in rural communities are facing and work with the government to ask how the problems rheumatology faces are being tackled.

We’re lobbying senior decision-makers and local politicians to highlight these issues, provide them with data and give our recommendations on how improvements can be made.

We want to work collaboratively with local health boards and trusts to review their current workforce plan or system to come up with new, innovative ways of recruiting and sustaining workforce. Attraction and retention of trainees in the geographies and specialties with the greatest shortages must be a health priority for UK governments.

This, along with helping services restore post-COVID-19, is our focus right now, as well as implementing recommendations from our other State of Play reports. We’re always open to suggestions for how we can support you, so please get in touch on policy@rheumatology.org.uk if there are any key issues you’d like us to take a look at.