Project Name: Mile End Whipps Cross Service Alignment Joint Working

Project Summary: 

Axial spondyloarthritis (“AxSPA”) is a form of inflammatory arthritis that most commonly affects the spine. It is a painful and progressive long-term condition affecting approximately 220,000 people in the UK (1 in 200), for which there is currently no cure. In the UK, it takes on average 8 ½ years for someone living with AxSPA to be diagnosed. NICE has developed a care pathway that includes physiotherapy as one of the steps in the management of AxSpA1.

Whipps Cross hospital has developed a nationally recognised and award winning AxSpA service (British Society of Rheumatology Emerging Service award 2016). The Whipps Cross model includes the creation of a physio and consultant led Early Inflammatory Back Pain Service (EIBPS)

The creation of the EIBPS resulted in a 5 year decrease in the time it takes to diagnose a patient with AxSPA (8 to 3 years), the time to treat a patient with a biologic medicine was reduced from 12 months to 6 months from the first outpatient appointment, Additionally the implementation of the service also identified 360 new AxSPA patients. 

This is different from the other AxSpA services across the rest of the Barts Trust, including Mile End. These have a lower level of service and are not as well resourced. The delay to diagnosis has not been identified at this time. Therefore the objective of the project is to reduce the time to diagnosis at Mile End, thus bringing Mile End in line with Whipps Cross through the creation of a EIBPS and dedicated MDT.

Planned Milestones:

Planned Milestones Table

Expected Benefits:

Benefit to patients

  • Reduction in waiting times to identify AxSpA, and therefore reduction in time to access biologic therapy at Mile End Hospital.
  • Improved treatment outcomes for AxSpA patients at Mile End Hospital
  • Earlier diagnosis of condition leading to halting of irreversible damage and potential disability at Mile End Hospital

Benefit to the NHS

  • Reduction in inappropriate referrals from primary care
  • Reduction of patient backlog through faster time to diagnosis
  • Demonstrate parity of care across the Trust
  • Improvement in the AxSpA patient pathway at Mile End
  • Development of a cross functional AxSpA MDT at Mile End

Benefit to Novartis

  • Improvement in reputation
  • Improved patient access to innovate medicines including medicine promoted by Novartis

Start Date & Duration: October 2022


[1] Spondyloarthritis in over 16s: diagnosis and management; NICE guideline [NG65]; Accessed Oct 2022