© 1994 British Society for Rheumatology
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EFFECT OF NATIONAL HEALTH SERVICE REFORMS ON OUTPATIENT RHEUMATOLOGY WORKLOAD
Rheumatology Unit, University Department of Medicine, Bristol Royal Infirmary Bristol BS2 8HW
In order to compare the rheumatology outpatient workload in the South West Regional Health Authority in the years before and after implementation of the NHS reforms in April 1991, surveys were undertaken to collect and compare data from all NHS outpatient consultations during November in 1988, 1990, 1991 and 1992. All patients seen in consultation at all hospital rheumatology outpatient clinics in the South Western Regional Health Authority were included. Results were adjusted for both the number of working days in each month and the inclusion of one new centre in 1992.
There was an increase of 33% in total consultations (2663 to 3551) between 1988 and 1992, mostly occurring following implementation of the NHS reforms. This increase related to both follow-up consultations and new patient consultations which increased by 26%. Conversely, waiting time from referral to a new patient consultation increased by 22% (65 days to 79 days). The case mix in most centres showed a proportional reduction in new patients with polyarthritis (43 to 34%) and an increase in back problems (10 to 15%) and OA (14 to 18%) but polyarthritis continued to dominate follow-up cases (75 and 72%). The overall follow-up: new ratio increased from 3.7 to 4.1.
Contrary to early fears amongst rheumatologists, their workload has substantially increased during the time of this survey, and the waiting time for new referrals has also increased. While the proportion of new referrals with polyarthritis was reduced, the absolute number of such referrals has increased. As these patients are currently managed by long-term follow-up they make increased demands on hospital resources. These results suggest that there has been an increase in rheumatology referrals in the first 18 months following the introduction of the NHS reforms.
KEY WORDS: Audit, Region, Waiting time, Referrals
*South West Regional Advisory Committee for Rheumatology: T. Palferman (Chairman), P. Creamer, M. Davies, P. Dieppe, E. George, P. Hickling, P. Hollingworth, C Hutton, R. Jacoby, J. Kirwan, V. Kyle, J. Woodland, A. Woolf, D. Yates.
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