NASS Freedom of Information request uncovers areas for improvement in secondary care

NASS Freedom of Information request uncovers areas for improvement in secondary care


A Freedom of Information (FOI) request by NASS has uncovered inconsistencies in secondary care referral pathways for patients with suspected axial Spondyloarthritis (axial SpA). Early identification of these patients within secondary care, and urgent referral to rheumatology, is essential to ensuring timely diagnosis and treatment.

Released today, the research found that in many areas, specialties associated with the Extra Musculoskeletal Manifestations (EMMs) of axial SpA are able to routinely refer patients directly to rheumatology for suspected axial SpA. However, in other UK acute care settings, referrals are mostly reliant on consultant-to-consultant letters or calls.

119 Trusts and Health Boards responded to the survey, which revealed:

  • All responding UK NHS Trusts and Health Boards reported that they accept direct internal referrals between specialties into rheumatology
  • No Trusts or Health Boards reported requiring patients to be referred back to primary care rather than allowing direct referral
  • Only 48% reported using screening tools to help with referrals for suspected axial SpA, mainly from dermatology
  • 54% told us that they can track internal referral volumes on their systems.

The analysis shows that, across the UK, it is possible for clinicians to refer directly to rheumatology when they suspect axial SpA, without the need, in the most part, for referral back to primary care.

In order to reduce the time to diagnosis in axial SpA, NASS has set out four recommendations:

  1. Recommendation one: The Gold Standard for internal referrals to rheumatology for axial SpA should be via a formal internal referral pathway.
  2. Recommendation two: Standardised screening tools should be available and routinely utilised in assessing the appropriateness of a referral and accompany any referral to rheumatology.
  3. Recommendation three: It should be possible for Trusts and Health Boards to track internal referrals in sufficient detail on patient information systems to enable measurement of referral volumes.
  4. Recommendation four: There needs to be a consistent effort to raise awareness of axial SpA in secondary care to ensure clinicians know the signs of axial SpA, and when and how to refer.

Commenting on the findings, Dr Dale Webb, CEO at NASS said:

“This analysis is a key part of our ambition to see a one-year time to diagnosis for axial SpA. It highlights the need to increase awareness with other specialties of axial SpA and the need to refer patients urgently to rheumatology for assessment.

To ensure that it is easier in future to identify the number of internal direct referrals being made, we call for more widespread development and uptake of internal referral processes, use of screening tools and the ability to track referrals.

There are examples of areas of best practice which is positive and shows that it is possible to ensure that secondary care clinicians know the signs of axial SpA, when and how to refer. We are working with clinicians to develop tools to raise awareness and support health care professionals to identify and refer appropriately.”

The FOI request was implemented as part of the Act on Axial SpA campaign, which aims to reduce diagnosis times of axial SpA from the current average of 8.5 years, to just one. The Act on Axial SpA campaign is fully funded by UCB.

You can read the full report here.

For more information on the pilot please contact

Symptoms starting slowly

Pain in the lower back

Improves with movement

Night time waking

Early onset (under 40)