Indicator (NICEQS from 2013 guidance6) | Criteria for each score | ||
2 | 1 | 0 | |
Effectiveness of referral process (NICE QS 2) | Standardised process with agreed criteria (not too many/rigid) Separate EIA referral daily triage | Referral to service with or without proforma Complex criteria Goes through double process through external booking platform | Letter/Non-template information Non-direct referrals (eg, via CCG) No triage or infrequent triage |
Effectiveness of appointment booking process (NICE QS 2) | Team control Admin dedicated EIA slots | Team control, but no dedicated admin EIA slots but overbooked Discrepancy in main and peripheral sites | Centralised admin/limitations on choose and book; no EIA dedicated slots |
Waiting time for first appointment (NICE QS 2) | Patients with suspected EIA are seen within 21 days of primary care referral | Patients seen >3 but up to 6 weeks of primary care referral | Delays over 6 weeks |
First appointment quality | Sufficient time for diagnosis and disease counselling One stop shop More than one doctor sharing EIA workload—team responsibility | Clinic shared across team, but diagnosis and treatment in same clinic slot | Time limit—not shared appointments EIA all on one doctor Diagnosis and treatment all in one slot |
Speed of diagnosis (NICE QS 3) | Good access to diagnostics—bloods, ultrasound—within a week | Varied timings for blood/X-ray and ultrasounds Having to wait for some results—not all on same day | 2 weeks plus delays |
Timeliness of DMARD initiation (NICE QS 3) | Within 2 weeks consultant/nurse controlled | Most at first appointment but some situations untimely appointments | GP control |
Quality of DMARD4 initiation (NICE QS 4) | DMARD support (education) separate appointment/counselling | Prescription on day of diagnosis but nurse counselling 2–3 weeks later | Prescription on same day as diagnosis only |
Typical follow-up appointment pattern (NICE QS 5) | Systematic/Planned approach (with flex) Monthly in person or on phone with doc or nurse review with consultant around 6 months; annual review Nurse DMARD clinic | Inconsistencies in follow-up appointments Good protocol but not followed due to insufficient staff capacity Varied/Ad hoc appointments | Losing track of patients Less nurse/more consultant involvement (relates to MDT) |
Treat to target escalation decisions (NICE QS 5) | Nurse involvement; autonomy; protocol (consistently followed); timely decision | Nurse involvement with protocol but appointment delays | Delays due to lack of autonomy or lack of protocol/training Process not supporting it to happen |
Quality of patient education (NICE QS 6) | Variety of approaches; integral to process; multiple timepoints; rapid accessibility (eg, helplines) | Education only in appointments with nurses/doctors and allied health professionals | Lack of structure-limited options Ad hoc—relies on individual clinician input in appointments Relies on patients being proactive |
Support between appointments | Multiple options-rapid accessibility-staffed well; get back within 24 hours Patients are well informed of the options secretaries/admin support Rapid access in clinics Emergency slots available | Calls returned within 24–48 hours with no access to quick appointments | Patients lack clarity regarding options Limited options Restricted hours Not staffed well Unable to prioritise answering calls No mechanism for rapid assessment/treatment |
CCG, Clinical Commissioning Group; DMARD, disease-modifying antirheumatic drug; EIA, early inflammatory arthritis; GP, general practitioner; MDT, multidisciplinary team; NICE, National Institute for Health and Care Excellence; QS, quality standard.