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Information for GPs and Healthcare Professionals

Rheumatology referrals

All referrals should be made using the e-Referral service.

Patients can be referred to the:

• General rheumatology service
• Early Inflammatory arthritis service
• Giant cell arteritis fast track clinic

British Society for Rheumatology (BSR) responses to referrals and requests

The British Society for Rheumatology (BSR) has developed standard responses to referrals and requests for specialist advice based on NICE and BSR guidelines.  This includes osteoporosis advice and guidance. 

Read the specialist advice, referral and triage information here

The documents are intended to support adult rheumatology departments in responding to common advice requests from referrers and are to be adapted to reflect local service provision and individual patient circumstances as needed.

Early Inflammatory Arthritis

It is now recognised that the best outcomes for rheumatoid arthritis (RA) are achieved when it is treated early. An early inflammatory arthritis (EIA) service has been established at Worcestershire Acute Hospitals NHS Trust to rapidly assess, and if appropriate, start treatment for patients with suspected inflammatory arthritis.

The clinic is for patients with new onset persistent suspected synovitis and patients should be seen within 3 weeks of referral, as per 2013 NICE RA Quality Standards. Patients who meet the eligibility criteria should be referred directly by e-Referral with a completed EIA referral form.

Please note any referrals received without an accompanying referral form will be rejected and returned.

For more information on referring a patient to this service please read our section – patient referrals.

Giant Cell Arteritis

Patients with suspected giant cell arteritis (GCA) without visual symptoms should be urgently referred by e-Referral to the GCA fast track service with a completed  GCA referral form.

Please note any referrals received without an accompanying referral form may be rejected and returned.

Patients with visual symptoms should be referred to the Ophthalmology Acute Service (01562 512382).

Mandatory Blood Tests: Inflammatory markers are extremely useful in accurate GCA diagnosis, and initiating steroids can affect the result obtained. All patients should have the following blood tests taken immediately: ESR, CRP, FBC, U&Es and LFTs.

Treatment: GCA is a medical emergency. All suspected cases should receive treatment without delay. Guidelines recommend: 

Prednisolone (non-enteric coated) 60 mgs daily if visual symptoms, 40 mgs daily if no visual symptoms.

Addition of a PPI and bone protection should be considered. 

Advice and guidance

We are delighted to provide an Advice and Guidance service for General Practitioners. All Advice & Guidance requests must be submitted through e-Referrals. The Advice & Guidance Service has been established to offer advice on rheumatology queries when direct referral into secondary care may not be necessary. The service will advise on management and treatment options for GPs to consider prior to referral where appropriate, with the aim of reducing the number of patients who need to be seen face to face. If the patient is already under the care of a Consultant Rheumatologist, please detail this in the request. Conversion of Advice & Guidance requests to referrals will be made when appropriate if approved by the requester. Clinical responsibility remains with the GP until the patient is seen within secondary care. 

Disease Modifying Anti-Rheumatic drugs (DMARDs)

DMARD shared care guidelines can be found on the Herefordshire & Worcestershire Medicines and Prescribing Committee Clinical policies and guidance website  (https://herefordshireandworcestershireccg.nhs.uk/policies/medical/clinical-policies-guidance/musculoskeletal).

The rheumatology department provides a DMARD advice email service for GP’s and AHP’s (wah-tr.dmardadvice-rheum@nhs.net). Email enquiries will be responded to within 24hr working hours (usually same day Monday to Friday).

Urgent advice for Rheumatology Service Referrals

For urgent rheumatology advice contact the Consultant Rheumatologist on-call via the rheumatology secretaries, 01905 760454 (internal 33435) (available 9am-4:30pm Monday-Friday).