Innovation in treatment for people with rarer or less well-recognised long-term conditions Collins, Ben, author. Chronic Disease -- therapy Conservative Treatment -- adverse effects Failure to Rescue, Health Care Rare Diseases -- therapy Specialization Time-to-Treatment Inflammatory Bowel Diseases -- therapy Osteoporosis -- therapy Psoriasis -- therapy Spondylitis, Ankylosing Key messages. (1) Hundreds of thousands of people in the UK have severe psoriasis, inflammatory bowel disease (IBD), axial spondyloarthritis or osteoporosis--four rarer or less well-recognised long-term conditions. (2) While these diseases are far from uncommon, they inevitably receive less attention from policy-makers and health services leaders than the most prevalent long-term conditions. (3) There are huge costs for individuals and families when services fail to diagnose these diseases quickly and provide rapid access to appropriate treatment. While people wait for diagnosis and treatment, they often suffer irreversible damage to skin, joints or organs and lasting damage to their mental health. (4) Alongside primary care, specialist teams in hospitals can play a major role in speeding up diagnosis by creating rapid-access clinics and proactive case finding. Innovative services can also do a huge amount to speed up access to appropriate treatment in hospitals. (5) In this report, we describe a traditional approach to treatment and support that gives people limited support at an early stage in their disease and drip feeds support over many years. There are strong arguments for inverting this 'pyramid' and providing intensive support at an earlier stage, when it is possible to slow the progression of the disease. (6) We also describe a traditional phased model of treatment where GPs and hospital specialists start with the least aggressive therapies before incrementally trying more aggressive therapies. There are benefits in accelerating this process or moving directly to more aggressive therapies for some patients, getting people on to the most appropriate therapy as quickly as possible. (7) While this is a complex subject, the paper describes concern among leading specialists about the impact some current guidelines and protocols have on their ability to deliver the most appropriate care. In some cases, these guidelines and protocols mean professionals focus on narrow biomedical aspects of a person's condition, rather than making a holistic assessment of the severity of the person's illness. (8) Even specialist centres struggle to combine high-quality biomedical care with support for the psychosocial aspects of these conditions. There are also untapped opportunities to support patients more effectively, for example, through peer-support networks and connecting people with social prescribing services. (9) The centres in this paper are combining specialist expertise in related conditions, including through co-locating specialists, informal joint-working across related specialisms, running clinics in parallel and combining clinics. [London, England] : The King's Fund, January 2021 King's Fund (London, England), issuing body. Technical Report Text 1 online resource (1 PDF file (49 pages)) nlm:nlmuid-9918284244006676-pdf 9918284244006676 http://resource.nlm.nih.gov/9918284244006676 English United Kingdom Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. http://creativecommons.org/licenses/by/4.0