THE report Rheumatology in Scotland – the state of play, which was jointly produced by the British and Scottish Societies for Rheumatology ("Huge concern over rising waiting times to see rheumatologist", The Herald, November 6) and concerns expressed in Dr Durward’s letter (November 7) highlight increasing challenges faced by GPs and patients.

Detecting and suspecting more serious acute illness deserving of early specialist assessment is a key skill for GPs. In an average-sized practice of 5,000 patients and

three to five GPs, only two patients may present annually with new onset of rheumatoid arthritis, the commonest inflammatory arthritis. That is a very small percentage of those who present with joint pains. GPs in Scotland rarely refer someone with suspected osteoarthritis or mechanical back pain to rheumatogists but of course those common diagnoses will be made in clinics.

The same difficulty arises with neurological symptoms – headaches, fits, blackouts and funny turns. Again, serious diagnoses are uncommon but patients worry and GPs do too.

The waiting times standard for most specialities is 12 weeks from routine referral to first outpatient appointment, not four weeks as the rheumatology report suggests. Currently across all specialties and health boards the achievement is 75 per cent, well below the 90 per cent standard. It has been better but unfilled vacancies and a risk-averse increase in referrals is lengthening the wait. Patients with signs of new acute inflammatory joint disease will be seen sooner if marked urgent, but even “sooner” has become longer. Email and ready telephone advice for GPs are other routes put in place which favour sound risk management and provide a measure of patient assurance.

Patients themselves should ask how long they are likely to wait to be seen and their GP should be able to answer that along with advice to consult again if symptoms change. At the specialist end, many will be able to be given reassurance at their first appointment and when subsequent investigations supports that, a letter from the consultant to the patient copied to their GP should meet their needs and avoid second appointments.

Waiting times are not nearly as long as they were 20 years ago but expectations have risen and good communication between patient and GP and between GP and specialist is key to managing current stresses safely. Despite additional funding from the Scottish Government this is unlikely to change much in the next year or two.

Dr Philip Gaskell,

Woodlands Lodge, Buchanan Castle Estate, Drymen.