A new GIRFT study looking at rheumatology-related litigation claims over five years in England has been published in a national journal, highlighting key trends and opportunities for learning. 

A team* led by GIRFT Fellow Robert Sandler (registrar in rheumatology and general internal medicine at Sheffield Teaching Hospitals NHS Foundation Trust) and Peter Lanyon (GIRFT joint clinical lead for rheumatology) developed the research paper entitled Litigation trends within rheumatology: a retrospective analysis of claims data from England for the Getting It Right First Time programme, which has now been published in the Rheumatology Advances in Practice journal. 

NHS Resolution data for all rheumatology claims, claims referencing ‘giant cell arteritis (GCA)’ in any specialty and claims referencing or ‘vasculitis’ in any specialty was examined for the time period between the financial years from 2018/19 to 2022/23 inclusive. 

The team identified 152 rheumatology claims, with a total cost of £28.2m, with the most frequent causes cited as unnecessary pain (46%), fatality (9%) and psychiatric/psychological damage (9%). The research found only 23 of the 152 claims were closed by the end of the study period, with four of the closed claims paying damages to the claimant. 

Forty-four GCA-related claims (costing £13.1m) were identified, mostly in ophthalmology or emergency medicine rather than rheumatology – double the number from the previous five-year period. 16 vasculitis-related claims (costing £3.4m) were identified. 

The study concludes that: 

• High-cost, high-harm claims persist in rheumatology, with most remaining open for several years. 

• GCA-related claims are increasing and occur mostly outside rheumatology, highlighting the need for greater awareness across specialties and agreed care pathways, such as GIRFT’s best practice standardised pathway for GCA and suspected GCA. 

• Rare auto-immune rheumatic disease (RAIRD)-related claims seem overrepresented in cases of fatality, highlighting the importance of timely suspicion, close monitoring and careful management. 

GIRFT will soon be sharing key learning from GCA-related litigation cases, with a six-point checklist for NHS teams to review, helping them to benefit from learning at other trusts. 

*The full GIRFT team involved in the paper were: 

• Robert Sandler: GIRFT Fellow and registrar in rheumatology and general internal medicine at Sheffield Teaching Hospitals NHS Foundation Trust. 

• Peter Lanyon: GIRFT joint clinical lead for rheumatology. 

• William Gray: Academic content lead for the GIRFT Academy. 

• Nick Dunkley: former NHS England senior analytical manager. 

• John Machin: GIRFT clinical lead for litigation. 

• Luke Martin: senior operational manager for the GIRFT MSK team. 

• Flora McErlane: GIRFT joint clinical lead for paediatric rheumatology. 

• Lesley Kay: GIRFT joint clinical lead for rheumatology and NHS England’s national clinical director for MSK. 

• Tim Briggs: GIRFT programme lead and NHS England National Director for Clinical Improvement, Elective Recovery and UEC.