by Dr Peter Lanyon, Consultant Rheumatologist, Nottingham University Hospital;
President, British Society for Rheumatology
Two months ago, at our annual national conference on the banks of the Clyde, it was a privilege to start my elected term of office as President of the British Society for Rheumatology. And I’m very excited to be serving BSR in this role. Our members are front-line clinicians, nurses and allied health professionals working across the health community. Every day, and sometimes 24/7, they deliver care to try and improve the lives of people living with rheumatic and musculoskeletal diseases. I’d like to share with you some of the ways in which we are working to support our members to deliver this care, in collaboration with the wider community.
I believe strongly that in a rapidly changing NHS, all professional member associations need to ask themselves this question: How can our organisation “shape up” to be in the best position to help deliver the future vision, not only of the 5 year forward view, but of other national healthcare commitments, such as the UK Strategy for Rare Diseases?
So in response to this, BSR is in the vanguard of breaking down some of the traditional, artificial, boundaries between healthcare settings and teams. As a Society, we’ve integrated with the professional associations for rheumatology nurses and allied health professionals (BHPR) and for child and adolescent rheumatology (BSPAR). Our members now comprise multidisciplinary teams providing care across the whole life course of rheumatic disease. And in a further step, BSR and the Primary Care Rheumatology Society are working towards integration, bringing additional synergies between primary and secondary care across the domains of commissioning, guidelines, early diagnosis and education. Having previously worked as a GP, and now as a Consultant Rheumatologist in Nottingham, I can see the tremendous potential here.
But as we appropriately blur traditional professional boundaries in the delivery of healthcare, we need to be absolutely clear about one thing. We have to continue to ensure that people living with (or those suspected to have) rheumatic and musculoskeletal diseases are seen by appropriately trained and skilled healthcare professionals. This is why the emerging NHS England Competencies Framework, which BHPR at BSR is helping to lead as part of the ARMA project, is so important. As is the role that societies like BSR play in their affiliation with the Medical Royal Colleges, in devising training curricula and the quality assurance of training.
BSR’s portfolio of NICE-accredited clinical guidelines leads the way in setting the national standards of care for many rheumatic and musculoskeletal diseases. This support to our members and the wider community is complemented by a range of other educational activities, including e-learning. We’ve also expanded the national BSR Biologics Registries; data from these underpins the evaluation of safety and effectiveness of new biologic drug treatments for rheumatic disease. It’s the largest programme of its kind in Europe.
But if we are going to improve the outcomes of care for people living with rheumatic and musculoskeletal diseases, setting quality standards in isolation is not enough. We must evaluate their implementation, and their impact, so that we can start to address variations in care and outcomes. The BSR National Audit of Early Inflammatory Arthritis is the largest project of this nature ever undertaken in Europe (view the recent Health Services Management Centre report). The results of the second year of the audit are being launched on 25th July 2016. These are exciting times and if you want to be amongst the first to hear these results, register to attend by contacting the BSR Clinical Affairs team.
So what does the future hold? Well, I think that many of us recognise the need to look beyond the single, simple, construct implied by the abbreviation “MSK”. The concept of single-system medicine is fading fast in an ageing society living with multimorbidity. And it also doesn’t perhaps truly reflect the needs of people living with chronic, complex conditions.
I am thinking particularly of the needs of people living with rare rheumatic diseases, such as Vasculitis, Lupus, Scleroderma and Myositis. But the individual condition names perhaps don’t matter as much as what they share in common; often overlapping clinical features, similar treatment needs, and the potential for multi-organ involvement. And the need for person-centred coordination of care across many different medical specialties, not just rheumatology.
However, the priority of these conditions within the wider NHS has been very low. But this is now changing. BSR and its members are working very closely with patient and carer members, commissioners, and public health doctors within the NHS England Clinical Reference Group for Specialised Rheumatology. It’s fair to say that the CRG has had many notable achievements, including enabling access to high cost drugs – I’ll expand on this in a future blog. We’ve also created national commissioning products (QIPP and CQUIN) to help support the development of coordinated networks across rheumatology and other medical teams, to help deliver the complex medical care that’s sometimes needed, directly supporting the UK Strategy for Rare Diseases. Much more needs to be done, but there are new opportunities; read our national workshop report “A collaborative approach to improving outcomes in rare rheumatic and musculoskeletal diseases” to find out more.
So I’ll close where I started: on the banks of the Clyde, where the nations’ greatest shipbuilders once stood. It’s time to build again; not for war or empire, but in the vision we all share to improve the lives of people living with rheumatic and musculoskeletal diseases – and we need “all hands on deck”. So to hear more about BSR and our work, please get in contact with us at email@example.com We’d love to hear from you. And I look forward to working collaboratively with all our community and ARMA over the next two years.