Determining local service levels for a service for the diagnosis and management of rheumatoid arthritis in adults

Benchmarks for a standard population

Available data suggest that the indicative benchmark rate for new referrals to a service for the diagnosis and management of rheumatoid arthritis (RA) in adults is around 0.1% or 100 per 100,000 population aged 18 years and older, per year, of whom around 25 will go on to be diagnosed with RA. The indicative benchmark rate for ongoing management within such a service is 0.8% or 800 per 100,000 population aged 18 years and older, per year.

For the purpose of this commissioning guide the adult population has been defined as people aged 18 years and older. Approximately 80% of the population in England is aged 18 years and older. Ongoing management is used within this commissioning guide to describe care for people with established RA after an estimated 1 year of monthly monitoring until active disease is stabilised.

For a notional primary care trust population of 250,000 (of whom around 200,000 will be aged 18 years and older), the average number of new referrals to a service for the diagnosis and management of RA in adults would be around 200 per year (100 per 100,000 of the population aged 18 years and older), of whom around 50 will go on to be diagnosed with RA. The average number of people requiring ongoing management within such a service would be around 1600 per year (0.8% of the population aged 18 years and older).

For an average practice with a list size of 10,000 (of whom around 8000 will be aged 18 years and older), the average number of new referrals to a service for the diagnosis and management of RA in adults would be around 8 per year (100 per 100,000 of the population aged 18 years and older), of whom around 2 will go on to be diagnosed with RA. The average number of people requiring ongoing management within such a service would be around 60 per year (0.8% of the population aged 18 years and older).

Examine the assumptions used in estimating these figures.

This service is likely to fall under the programme budgeting category 215X (problems of the musculoskeletal system).

Use the RA service commissioning and benchmarking tool to determine the level of service that might be needed locally and to calculate the cost of commissioning the service using the indicative benchmark and/or your own local data.

Further information

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

• Annex A of the Commissioning framework for health and well-being outlines the process and data needed to undertake a joint strategic needs assessment.
• Department of Health Delivering quality and value - focus on benchmarking.
• NICE Health equity audit - learning from practice briefing.
• NHS Comparators provides comparator data for NHS commissioning and provider organisations to enable users to investigate aspects of local activity, costs and outcomes.
• The Disease management information toolkit (DMIT) is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
• PARR (Patients at risk of rehospitalisation) is a risk prediction system for use by primary care trusts to identify patients at high risk of hospital re-admission.
• PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.