Abstract
Background East Surrey Clinical Commissioning Group established a musculoskeletal triage service for primary care referrals in December 2017 in order to reduce pressure on secondary care.
Aim To analyse the processing of rheumatology referrals through the single point of access.
Method A total of 158 referrals over an 8-month period were triaged, 50 of which had available final outcome data. Using a standardised form for GPs, data including initial GP diagnosis, appropriateness for secondary care, any requirement for additional information, relevant blood tests needed before the appointment, and if the patient could be seen by a GP with an extended role in rheumatology were recorded. The resultant rheumatological diagnosis from secondary care was recorded.
Results Of 158 referrals, 86% were triaged to secondary care, the remainder were referred back to primary care or an alternative healthcare professional. Additional information from the EMIS record was added to 67% of all referrals and additional blood tests were requested in 26%. Of the 50 patients with outcome data, 40% were thought to have non-inflammatory conditions and could be seen in the community setting; this was confirmed in 85% after rheumatology assessment. The most frequent diagnosis in this group was fibromyalgia. Where an inflammatory condition was suspected by the referrer this was confirmed in 68%.
Conclusion A significant number of referrals could be seen by a specialist GP in a community setting, the biggest single sub-set of these patients have chronic non-inflammatory pain. The provision of community GP-led rheumatology clinics could improve patient experience, reduce costs, and reduce the burden on secondary care.