Reflections from a GP
Dr Louise Warburton
I began working as a GP in 1990 and we moved to Shropshire shortly after that. I began working as a clinical assistant in rheumatology at the Robert Jones and Agnes Hunt Hospital in Oswestry, and also at the Princess Royal Hospital in Telford.
Back then, the patients with ankylosing spondylitis (AS) were mostly in the chronic stage, with established spinal deformities, and we couldn’t do a lot to help. Most of my work involved writing prescriptions for phenylbutazone, as it wasn’t prescribable by GPs as it had a lot of side effects. My patients swore by it and were very upset if they couldn’t get it.
In 2007, I was asked to join the National Institute of Health and Care Excellence (NICE) Guideline for Spondyloarthritis as a GP member. I felt that I was contributing to real improvements in the care of people with spondyloarthritis.
Shortly after this, NICE approved the use of biologic medications for the condition, initially anti-TNF medication. At that time, I had a patient in my GP practice who was struggling with his axial SpA and could not work. He was desperate to try the new anti-TNF medication. In Telford, where I was a GP, the Clinical Commissioning group (CCG) had not approved the prescription of anti TNF, but they had approved them in Cannock, where I was working as a Rheumatology Clinical Assistant. He moved his care to Cannock, but we still couldn’t get him an anti TNF because he still lived in Telford. It was so frustrating, and he was in the surgery every week asking for updates.
Eventually after much campaigning, the CCG in Telford approved the prescription and he was able to start treatment. He was so happy and was so much better. He was able to return to work, but he had a lot of joint and spinal changes which still impacted his life. If only he had been able to start biologics ten years earlier.
The introduction of anti-TNF medication and other biologic medications has been a real game-changer for people with inflammatory arthritis. I have been fortunate to work through such a rapidly developing time in rheumatology, and the choice of biologic medications has now increased hugely, so rheumatologists can tailor medications to each individual.
