Axial Spondyloarthritis Playbook: Reducing Time to Diagnosis and Improving Patient Experience

Written by Jill Hamilton, Head of Policy & Health Services at NASS

 

Following extensive consultation, NASS developed a Route Map to Diagnosis—a framework that follows the patient journey and identifies the key points where delays commonly occur:

 

• People with back pain may not realise that their symptoms could be axial SpA.
• Primary care practitioners may not recognise the signs of axial SpA.
• People with symptoms of axial SpA may not be referred directly to rheumatology.
• Rheumatologists may not always have access to the latest knowledge, diagnostic criteria or imaging protocols for axial SpA.

These four themes shaped the Act on Axial SpA campaign, which targeted multiple audiences—members of the public, primary care teams, other secondary care specialties (including ophthalmology, dermatology and gastroenterology), and rheumatology services. The campaign included a public awareness initiative, professional education programmes, research publications, and service improvement work.

An Evidence-Based Tool: Bringing the Campaign Together

In early 2025, NASS brought together the insights and learning from the Act on Axial SpA campaign to create the Axial SpA Playbook. This best-practice guide supports healthcare professionals around the world in reducing time to diagnosis and improving the patient experience locally.

The Playbook outlines everything required for effective service improvement – from establishing the right foundations to implementing change and measuring impact. It is organised along the key stages of the patient pathway and provides practical checklists to help teams assess their current practice. It also emphasises the use of data to understand performance, identify unmet need and monitor progress over time.

Linked resources offer easy access to guidance, templates, tools and case studies. Teams can use the Playbook to review their service, set improvement priorities and collect meaningful local data.

 What the Playbook Includes

• Implementation plan on a page – quick wins and essential areas for improvement
• Service enablers – ensuring consistent, high-quality care through standard pathways and service provision
• Data and measurement frameworks – to establish baselines, set improvement targets and track progress
• Embedding the patient voice – integrating lived experience into service design and shared decision-making
• Public awareness materials – adaptable local resources, including NASS symptom checker posters and social media assets
• Primary care resources – educational materials, triage tools and referral guidance to connect primary and secondary care
• Referral guidance from other specialties – ophthalmology, dermatology and gastroenterology pathways
• Diagnosis in rheumatology – guidance on inflammatory spinal MRI protocols, collaboration with radiology, and the role of multidisciplinary services
• Post-diagnosis support – signposting to patient information, self-management resources and service developments

 

National Launch and NHS Collaboration

The Playbook was officially launched in April 2025 at the British Society for Rheumatology Annual Conference. Around 200 delegates attended a 90-minute session featuring:

In September 2025, NASS was proud to announce a major milestone: NHS England’s Getting It Right First Time (GIRFT) Rheumatology Programme agreed to co-badge and distribute the Playbook. This partnership gives the Playbook national recognition within the UK health system and paves the way for broader international collaboration in reducing diagnostic delay and improving care for people living with axial SpA.

Local Implementation

We are currently working with three teams — two based in Bristol and one in Bath — to fully implement the Playbook in their local areas through, what we are calling, a place-based intervention. In addition, we are collaborating with individual practitioners, teams, and local networks to apply specific parts of the Playbook according to their particular needs and priorities.

Staying Relevant and Up to Date

We meet regularly with health care professionals from a wide range of backgrounds and specialist areas to ensure that the examples, guidance, and references included in the Playbook remain accurate, current, and relevant for the diverse, international community of health care professionals we aim to support.

Do you want to find out more?

You can visit the Act on Axial SpA website, where you will find the Playbook and our online tutorial, with more videos to follow. If you want to discuss any elements of the Playbook, email Jill Hamilton on jill@nass.co.uk.

 

 

*ASIF uses the acronym ‘axSpA’ whereas NASS use ‘axial SpA’ – they both refer to axial spondyloarthritis, whether it is radiographic or non-radiographic.

 

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