Monday, 25 February 2008

Rheumatoid Arthritis Patients Face Unofficial Postcode Lottery for Treatment

As some NRAS Members have experienced, people suffering from rheumatoid arthritis (RA) can face a postcode lottery over whether they have access to a treatment known to improve their condition significantly. New research shows the extent of the problem.
The research which was published on 11 October in the medical journal, Rheumatology, reveals that, despite the National Institute for Health and Clinical Excellence (NICE) approving anti-tumour necrosis factor alpha (TNF) therapy for RA in 2002, many primary care trusts are refusing to fund it adequately or are putting a cap on the numbers of patients that can be treated.
As a result of these findings, rheumatologists are calling on the Government and primary care trusts to end the unofficial postcode lottery and ensure that every patient who meets the NICE criteria can receive anti-TNF therapy if their consultants consider it appropriate.
Dr Lesley Kay, co-author of the research
Dr Lesley Kay, consultant rheumatologist, member of the British Society for Rheumatology Biologics Register (BSRBR) management committee and co-author of the research, said: “The BSRBR urges the Government and primary care trusts to put an end to this patently unfair situation, which is in direct contravention of government policy. The postcode lottery continues to operate, even though NICE aims to stop this happening. It's unfair on patients ...”
Questionnaires were sent on behalf of the BSRBR (which monitors the use of anti-TNF therapy) to 509 consultant rheumatologists in the UK: the responses on behalf of 252 consultants revealed a wide disparity in the provision of anti-TNF therapy across the country.
Dr Kay said: “Nearly half of the consultants (46%) indicated that they had some form of limitation in their prescribing of anti-TNF agents for RA according to NICE guidance. Of these, 70% said these limitations were mainly in the form of capped funding or capped numbers of patients; staffing or lack of other facilities was a problem for 21% and 9% respectively.
“The consultants said they faced problems such as a fixed number of patients that they were allowed to treat each month, fixed financial caps, bans on treating any more patients until the next financial year, and the fact that different primary care trusts had different financial limits. Waiting lists were also a means of controlling access to treatment, with some patients waiting as long as 156 weeks.”
“The fact that different funding organisations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live.”
….. NRAS Can Help You
The impact of so many Trusts being in deficit is being felt all around the UK by people who have been assessed for TNF and meet the NICE guidance criteria, yet are being denied access to the drugs due to lack of funding.
It is very important that we are informed if you are affected in this way. Please write to us, email us or call us if you have been put forward by your consultant for anti-TNF treatment but have been told you cannot have it at the moment due to funding restrictions.
We can write to the Chief Executive of the PCT (Primary Care Trust), your local MP and other key organisations to remind them of their legal obligation to provide treatment in accordance with NICE guidance.
At some point, someone being denied treatment is going to go to judicial review and when that happens they will have the support of NRAS and many frustrated and dedicated rheumatology health professionals who simply want to provide the best care for their patients.