Table 2.

Summary of Key Themes

Barriers	Non-Professional		Professional
	Patients	Carers	Secondary Care Specialists	General Practitioners
Specialist Referral	• Delay in referral from primary care	• Delay in referral from primary care	• Delay in referral from primary care • Quality of referral influences prioritisation	• Role as gatekeepers to specialist care • Need for positive blood tests • Referral linked to personal confidence and role perception
Routine follow up and DMARD monitoring	• Lack of time with rheumatologist • Cancellation and postponement of appointments • Perceived lack of knowledge of GPs • Poor primary/secondary care interaction	• Waiting times in clinic • Transport difficulties • Perceived lack of knowledge of GPs • Poor primary/secondary care interaction	• Time pressures • Paucity of follow up appointments • Lack of monitoring by GPs	• Lack of regular review • Lack of clarity of role in monitoring
Access to care in times of need	• Difficulty of access during a flare	• No specific comments	• Seeing patients urgently impeded by time pressures and paucity of appointments. • GPs not providing emergency care	• Lack of knowledge of RA treatment • Preference for personal knowledge of rheumatologist to access secondary care urgently