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Bone and Joint Diseases Around the World.
The UK Perspective
TOM G. PALFERMAN
ABSTRACT.
Rheumatology is a discipline that has evolved through the influence of physical medicine, with the aid of advances in immunology and epidemiology. An ageing population has seen osteoarthritis and osteoporosis, among other rheumatic diseases, flourish. Health provision relies on the National Health Service (NHS), funded largely, but no longer exclusively, through direct taxation. Access to specialist rheumatology services (secondary care) is achieved by referral through a general practitioner (primary care). Increasingly, primary care is charged with planning clinical services supported by budgets devolved from central government. Rheumatology is a popular discipline for trainee specialists, but consultant numbers are inadequate. One rheumatologist per 85,000 population is deemed desirable, whereas in practice the number is less than one per 120,000. These figures belie the uneven distribution of services. The National Institute for Clinical Effectiveness assesses all new therapies according to their clinical- and cost-effectiveness. Those approved should, in theory, be funded, but this system remains imperfect. A unique initiative in the UK is the central register for those taking biologic agents. Regrettably, the NHS has been underfunded and steps are under way to reverse this in order to match the proportion of gross domestic product spent on health care by other major European economies. The delivery of medical services will have to change to accommodate increasing numbers of women graduates, now exceeding 50%, by increasing job sharing and part-time posts. UK rheumatology has close links with Europe and the US, while increasingly its horizons are broadening, to great advantage. (J Rheumatol 2003;30 Suppl 67:33-35)
Key Indexing Terms:
RHEUMATOID ARTHRITIS
BIOLOGIC AGENTS
MORTALITY
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
MORBIDITY
From the Department of Rheumatology, Yeovil District Hospital, Yeovil, Somerset, United Kingdom.
T.G. Palferman, MD, Consultant Rheumatologist, Yeovil District Hospital; Chairman, Clinical Affairs Committee and Council Member, British Society for Rheumatology.
Address reprint requests to Dr. T.G. Palferman, Department of Rheumatology, Yeovil District Hospital, Yeovil, Somerset BA21 4AT, UK. E-mail: pluch@est.nhs.uk
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