Background: The devolved nations have differing commissioning arrangements surrounding high-cost drugs. The 2015 NHS England Clinical Commissioning Policy on the use of sildenafil and bosentan for the management of systemic sclerosis-related digital ulcers (SSc-DU) in England aligns with guidelines by the UK Scleroderma Study Group and BSR. We undertook a multicentre service evaluation project across the South West (SW) UK and Wales to review real world management of SSc-DU, before and following the 2015 guidance.Methods: The project was conducted by rheumatology trainees within the South West Audit Network (SWAN). Anonymised data on DU burden and management before and after 2015 was collected retrospectively from case notes of SSc patients (pre-dating 2015), between September and December 2017. Patients treated with vasodilators for pulmonary arterial hypertension were excluded.