Changes in rheumatology out-patient workload over 12 years in the South West of England.

Rheumatologists in the former South West Regional Health Authority (SWRHA) have undertaken regional audits of their out-patient workloads on five occasions from 1988 w1x to 1994 w2x. These spanned the introduction of the NHS reforms of 1991 w3x, for which proper evaluation was not undertaken either before or during their introduction. The rheumatology audits recorded all out-patient referrals during the month of November, together with the diagnostic category and (for new patients) the time waiting from referral to consultation. These data represent the NHS rheumatology service provision for approximately 3.2 million people. In essence, and contrary to fears expressed previously w4x, they showed that the rheumatology workload had increased substantially during the time of the surveys. Most of this increase had occurred following the introduction of NHS reforms in April 1991 and represented primarily an increase in the workload of existing consultants rather than the investment of new resources ‘following the patient’ w3x. Furthermore, there was a clear increase in the time patients had to wait between referral to a specialist and their first consultation w2x. Referral had increased, the opposite of what might have been expected w5x, and contrary to the intentions of providing a more accessible service w1x. In order to monitor the continuing trend, to verify the assumptions about changes in working practices and to test the hypothesis that variations in clinical practice might indicate opportunities for improving patient throughput, a further survey was undertaken in November 2000.