Rheumatology out-patient workload increases inexorably

Rheumatology out-patient consultations in the south-west of England from 1 to 30 November 1994 were recorded by standard methods and compared to 1988, 1990, 1991 and 1992. Historical records at one centre provided additional detailed information. There has been an overall increase of 31% in the number of patients seen (30% for follow-up cases, 36% for new referrals), but the mean waiting time for new patient consultations increased from 65 to 108 days. The proportion of new patient consultations with non-arthritic diseases increased by 8.2%, and those with rheumatoid arthritis and polyarthritis decreased by 9.0%. Variation in discharge rates and length of follow-up appointments occurred, but mostly in uncommon diagnostic categories. Referral rates have been rising faster since the introduction of National Health Service reforms than can be accommodated by the increased workload undertaken.