Good MSK services must include rheumatology, mental health and pain

Rheumatoid Arthritis (RA) is very much on my mind as I write this during RA Awareness Week. Yesterday I attended a roundtable discussing the NHS Long Term Plan (LTP) and RA. Rheumatology doesn’t get a specific mention in the plan, but there is plenty of content on related issues. There is mention of chronic pain, for instance, which is very relevant to ARMA and to RA. Access to integrated pain services is something ARMA members have identified as a priority following the publication of our mental health report last month, and by the time this is published I will have presented at a meeting of the Chronic Pain Policy Coalition.

MSK gets a number of mentions in the Long Term Plan but it’s easy to get the impression that this is all about osteoarthritis. ARMA is very clear that rheumatology is part of MSK, and just as important a part of our work as orthopaedics. I am part of an advisory group for the NHSE review of elective care access standards (waiting times in plain English) and I know that this is a vital issue for rheumatology. There are delays in patients recognising that their symptoms might be serious, and often further delays in GPs making a referral to rheumatology so, once referred, it’s vital that there isn’t a long wait to see a rheumatologist. But the roundtable heard that only 32% of RA patients are seen in a time recommended by NICE and almost 10% wait longer than the general waiting time target of 18 weeks.

The roundtable heard that three things impact on remission rates for RA and one of them is rapid access to specialist assessment.  Another is starting therapies quickly. The Long Term Plan talks about reducing delays in access to evidence based treatment. The example it gives is joint replacement surgery, but access to biologics in RA is another excellent example.

The final factor increasing chances of remission is a person centred holistic approach to care. The roundtable heard about unmet needs of RA patients, including pain, anxiety and depression. ARMA’s roundtable report on mental health and MSK has been well received in both MSK and mental health sectors. It’s very relevant to RA patients, and we will be pursuing the recommendations over the coming months.

After the meeting I was asked what would help rheumatology get the best out of the Long Term Plan. Part of my answer was that it needs to be clearly part of MSK, which is included in the plan. Which is why ARMA’s core offer for local NHS Plans includes rheumatology. Let’s be clear, no CCG, STP or ICS can say it is delivering good MSK services if it hasn’t included rheumatology, pain and mental health in their plans.