03 August 2023
Health and Community Services (HCS) has now completed the audit of patient records that
was recommended by the Royal College of Physicians (RCP) as part of its recent review into
Jersey’s rheumatology service.
The RCP recommended that HCS conduct the audit to check the past treatment and diagnosis
of a group of 341 rheumatology patients. These were patients who were prescribed a group of
drugs known as “biologics” in the period before January 2022.
Preliminary findings from the audit indicate that over half of these patients did not meet the
accepted criteria for starting biologic therapy. It also indicates that for three out of ten of
these patients who were first diagnosed with a rheumatological condition in Jersey, there was
insufficient evidence in the patient case notes to confirm the accuracy of their diagnosis.
All the HCS patients in this audit group have since had a consultation with the new team of
professionally trained, specialist rheumatologists, in the period following January 2022, and
their present care and treatment has been reviewed.
The audit findings do not necessarily mean patients were misdiagnosed. Some of these
patients may have been accurately diagnosed but their patient records may not have
adequately recorded the reasons for their diagnosis. It is clear, however, that since January
2022 a number of patients who were previously on biologic drugs have now had that therapy
withdrawn following review by a qualified, specialist rheumatologist.
Patrick Armstrong, Medical Director at HCS said: “This audit clearly indicates that some of our
rheumatology patients on biologic drugs may not have been properly diagnosed or properly
treated in the period before January 2022. I am satisfied that in recent months these HCS
patients have been reviewed by specialist rheumatologists, but the audit suggests we now
need to review the care and treatment of a wider group of patients including our other
rheumatology patients. We will be doing this as quickly as possible.
“HCS will be starting this further review immediately and if there is a need for any patient to
be seen in person they will be contacted directly. In the meantime, patients should continue to
take their medication as prescribed and attend their hospital and doctor appointments as
normal.”
The Minister for Health and Social Services, Deputy Karen Wilson said: “The initial findings
from this audit highlight some serious problems in the rheumatology service and it is clear
these underlying issues may extend into other parts of HCS. As I have said previously – and as
this audit indicates – we have fallen behind “best practice” in a number of areas and we now
need to redouble our efforts to strengthen clinical governance and quality of care within HCS.”
The final report of the Royal College of Physicians review is expected in the autumn of this
year. The review was commissioned by HCS last year when questions were raised about clinical
record keeping for individual patients and case management in the rheumatology service in
the period before January 2022. Initial feedback from the RCP review noted a number of
service weaknesses at that time, including poor written patient notes, inappropriate
prescribing of biologic agents, and prescriptions that did not include the clinical condition
being treated.
The Chair of Jersey Arthritis Society, Maureen Parris, said: “Patients will understandably be
concerned about these audit findings, but it is reassuring that their care and treatment has
been reviewed and more reassuring to note that Jersey’s rheumatology service is now being
run by a specialist Consultant Rheumatologist on the General Medical Council’s Specialist
Rheumatology Register.”
The relevant regulators, including the General Medical Council, the Nursing and Midwifery
Council, and the Jersey Care Commission, are all being kept informed of developments and in
due course they will deal with any regulatory matters that may need to be addressed as a
result of this audit and the RCP review.
Any patient requiring further information about this matter can contact the HCS PALS
information service by email on pals@health.gov.je or by telephone on 01534 443515.
gov.je