A13. Specialised Rheumatology

Scope and service

Rheumatology is a multi-disciplinary branch of medicine that deals with the investigation, diagnosis and management of patients with arthritis and other musculoskeletal conditions. This incorporates over 200 disorders affecting joints, bones, muscles and soft tissues, including inflammatory arthritis and other systemic autoimmune disorders, vasculitis, soft tissue conditions, spinal pain and metabolic bone disease.

The services encompassed by this Clinical Reference Group (CRG) relate to the treatment of patients with rare diseases or patients with specific common diseases who have complex needs.

Chair and Membership

A voluntary Chair is appointed for a three-year term. Please see the Clinical Guide for CRGs for further information. Clinical members are drawn from the 12 Senate areas in England and are voluntary appointments. Up to four patient and carer members and up to four professional/training organisations are eligible to join the CRG membership. The accountable commissioner holds the managerial accountability for the work of the CRG; collaborating commissioners hold an interest in the work of the CRG.

Chair Peter Lanyon graduated from the University of Birmingham in 1986, and initially worked in Primary Care prior to training in Rheumatology. Since 1999 he has been a Consultant Rheumatologist at Queens Medical Centre, Nottingham University Hospital, where he provides a specialised service for patients with Vasculitis and Connective Tissue Diseases, including tertiary referrals from across the East Midlands. He has experience in medical management, service leadership and clinical redesign, and has initiated the development of a regional audit and peer review network within his region. He is actively involved in clinical research, participating in clinical studies of Systemic Lupus Erythematosus, Vasculitis, Sjogren’s Syndrome, Myositis, and Systemic Sclerosis. He is a Council Member of the British Society for Rheumatology and Royal College of Physicians Regional Specialty Advisor (Service).
National Clinical Director Co Chair Peter Kay

Clinical Members

N1 North East Bridget Griffiths
N2 Greater Manchester, Lancashire and S Cumbria Ian Bruce
N3 Cheshire and Mersey Marina Anderson
N4 Yorkshire and The Humber Tim Tait
M1 West Midlands Simon Bowman
M2 East Midlands Marian Regan
M3 East of England Gavin Clunie
L1 London NW Richard Keen
L2 London NE Michael Ehrenstein
L3 London S David D’Cruz
S1 South West Nick Viner
S2 Wessex Brian Davidson
S3 Thames Valley Raashid Luqmani
S4 South East Coast Sian Griffith

The CRG is currently in the process of recruitment to the membership places below; as appointments are confirmed this webpage will be updated.

Patient and Carer Member

Jane Dunnage
John Mills
Nicola Whitehill
Lara Bloom

Affiliate Organisation

British Health Professional in Rheumatology (BHPR) Janice Mooney
British Society for Rheumatology Chris Denton
Royal College of General Practitioners Graham Davenport
Royal College of Physicians Richard Watt
Lead Commissioner Sarah Watson London
Pharmacy Lead Andrew Pothecary
Public Health Lead Dr Ayesha Ali


A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 specialised services Area Teams to contract services on an annual basis.


The service specifications are important in clearly defining what NHS England expects to be in place for providers to offer evidence-based, safe and effective services. They have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe core and developmental service standards. Core standards are those that any reasonable provider of safe and effective services should be able to demonstrate, with developmental standards being those that really stretch services over time to provide excellence in the field. The following service specifications have been prepared by the CRG:

Policy Statements

A policy statement is a brief document that defines the current commissioning position to support service contracting. They are interim documents for use whilst a full commissioning policy is being developed or until a formal NICE Technology Appraisal Guideline has been published.


A commissioning policy is a document that defines access to a particular service for a cohort of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into a commissioning policy, as appropriate. These are important documents that are developed to define national consistency.

A13/P/a Clinical Commissioning Policy: Rituximab and Anti-Neutrophic Cytoplasmic Antibody Associated Vasculitis

Quality Measures

Quality measures aim to find the most appropriate and deliverable measures that can be used nationally to help organisations improve the quality of care in their services. These are prioritised to form a ‘dashboard’.

View the quality dashboards

Innovation Portfolio

The innovation portfolio is an opportunity to collate information on innovative approaches that may have been developed in one or more areas, and to consider whether these might be rolled out more consistently in the future. An innovation might, for example, become a core requirement of all providers, enshrined in the core national service specification.

Tell us about a new innovation which is already developed and available to the NHS that you would like us to know about. Click here to create a personal account or here if you have registered previously and so already have a personal account to use the CIMIT CoLab® specialised services web platform.


Commissioning for Quality and Innovation (CQUIN) is a framework that was first established as part of the 2009/10 NHS Operating Framework as an incentive scheme which forms part of the contract between a commissioner and a provider. CQUIN schemes link successful delivery of specific outcomes and actions with the release of an additional payment to the provider, which for 2013/14 is a payment of an amount up to 2.5% of contract value.

A CQUIN scheme is made up of a number of separate indicators (“CQUINs”) which address a range of clinical areas and issues. The purpose of a CQUIN scheme is to drive quality improvements across a range of areas. In 2013/14 there are no national CQUIN schemes for specialised rheumatology. CQUINs, once developed, for the 2014/15 contracting round will be published here in 2014/15.


Spending on the NHS will increase each year between 2011 and 2015. However, demand for health services is rising, and what is expected of the NHS changes as society changes. This means that the NHS will need to make up to £20 billion worth of efficiency savings by 2015, so that there are more funds available for treating patients and to allow the NHS to respond to changing demands and new technologies.

Productivity is one of the work streams to deliver those efficiency savings. Productivity is about the redesign and streamlining of healthcare services by examining the way the NHS commissions, manages, works and delivers healthcare services to reduce inefficiencies and maximise efficiencies; ensuring value for money; and reducing unnecessary poor design in its processes and delivery of care that are not cost effective, and have little impact on improved outcomes or improved quality of care for patients.

CRGs have a key role in providing advice about potential opportunities to improve productivity and efficiency, for example by removing any inefficiencies in care pathways or by identifying opportunities where a national procurement of drugs or devices might reduce costs.


Other important publications that relate to this CRG include:

Documents will be published online shortly