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Rheumatologists in the former South West RegionalHealth Authority (SWRHA) have undertaken regionalaudits of their out-patient workloads on ve occasionsfrom 1988 w1x to 1994 w2x. These spanned the introduc-tion of the NHS reforms of 1991 w3x, for which properevaluation was not undertaken either before or duringtheir introduction. The rheumatology audits recorded allout-patient referrals during the month of November,together with the diagnostic category and (for newpatients) the time waiting from referral to consultation.These data represent the NHS rheumatology serviceprovision for approximately 3.2 million people. Inessence, and contrary to fears expressed previously w4x,they showed that the rheumatology workload hadincreased substantially during the time of the surveys.Most of this increase had occurred following the intro-duction of NHS reforms in April 1991 and representedprimarily an increase in the workload of existing con-sultants rather than the investment of new resources‘following the patient’ w3x. Furthermore, there was a clearincrease in the time patients had to wait between referralto a specialist and their rst consultation w2x. Referralhad increased, the opposite of what might have beenexpected w5x, and contrary to the intentions of provi-ding a more accessible service w1x. In order to monitorthe continuing trend, to verify the assumptions aboutchanges in working practices and to test the hypothesisthat variations in clinical practice might indicateopportunities for improving patient throughput, afurther survey was undertaken in November 2000.

Changes in rheumatology out-patient workload over 12 years in the South West of England