I5. Challenge 2: Defining Strategy: Different Practices Across Devolved Nations

Abstract

Devolution across the home nations of the UK has resulted in differing patterns of healthcare provision. England has progressed healthcare via financial governance held by Primary Care through CCGs whereas in Scotland and Wales there has been less of a competitive market approach to provision of healthcare services. This has resulted in a subtly different ethos across the home nations. In Scotland, the Scottish Medicines Consortium has allowed a fast-track assessment of pharmaco-economic models with a result that new therapeutic options, both new agents and new indications for existing agents, can be considered in a more timeous manner than is available through the Technology Appraisal systems used by NICE in England. As a result, differences now exist in a number of therapeutic options in the management of inflammatory joint diseases between Scotland and the rest of the UK. Examples include more acceptance of switching TNF inhibitor therapies in RA in primary and secondary TNFi failure and adoption of tocilizumab monotherapy in treatment of moderate to severe RA. There would now appear to be differences in practice in the management of rheumatic diseases in the UK and further variation is likely to extend as devolution (and possible independence) moves forward. Greater understanding of the differences in practice is required.