title: Provisional guidelines for applying the Department of Health (England) 18-week-patient pathway to specialist rheumatology care.
abstract: OBJECTIVE
  The Government Department of Health (England) has set a target that by 2008 patients on pathways that do or may involve medical or surgical consultant-led care should wait no longer than 18 weeks from referral to start of definitive treatment. Department of Health guidance must be interpreted and applied to patients with rheumatological problems.
  
  
  METHODS
  Provisional guidelines have been prepared in collaboration between the British Society for Rheumatology, British Pain Society, Department of Health (England) and other key stakeholders.
  
  
  RESULTS
  Definitive rheumatological treatment comprises a package of care rather than a single action. The care package usually requires input from a multidisciplinary team using several modalities in parallel. Actions within the care package that must be taken before treatment can be said to have started, are definitive actions. Definitive actions should be based on evidence of cost-effectiveness, tailored to the individual patient and offered irrespective of local availability or accessibility. They should be agreed between partners in the patient's care. This requires face-to-face consultation between the patient and a health care professional with appropriate expertise and knowledge. All definitive actions specified at the outset of management within specialist care must be initiated or removed by agreement from the patient's care package before the clock can be stopped in the 18-week-patient pathway.
  
  
  CONCLUSIONS
  Service redesign may be necessary in order to achieve an 18-week-patient pathway for all patients. A consistent and appropriate definition of clock-stops should ensure that patients will benefit from excellent rheumatology specialist care without unnecessary delay.
authors.affiliation: Honorary Consultant Rheumatologist, King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton-in-Ashfield, NG17 4JL, UK. David.Walsh@nottingham.ac.uk
authors.forename: D A
authors.initials: DA
authors.lastname: Walsh
authors.forename: C
authors.initials: C
authors.lastname: Kelly
authors.forename: A
authors.initials: A
authors.lastname: Bosworth
authors.forename: C
authors.initials: C
authors.lastname: Price
authors.forename: G
authors.initials: G
authors.lastname: Burbage
mesh_terms: D003362:Cost-Benefit Analysis; D004739:England; D006801:Humans; D018579:Patient Selection; D012017:Referral and Consultation; D012219:Rheumatology / Q000191:economics; D013222:State Medicine / Q000191:economics / Q000458:organization & administration