Dr Andrew Hilson FRCP - Royal College of Physicians

Shape of TrainingresponseThe expansion of this workforce needs to go hand-in-hand with greater attractiveness of (General) InternalMedicine to all doctors, and it should not be part of a process doctors pass through to reach the next stageof their career. Greater continuity of patient care will aid this. The Commission also proposes greaterinfluence and responsibility for future physicians in this specialty. We believe that (General) InternalMedicine consultants are well-suited to leadership roles given the breadth of clinical experience that theywill have, and their broader view of care. This greater responsibility and prestige is another way in whichsuch a career could be made more attractive to trainees and doctors.In the future, a more structured approach to promoting the expert skills and knowledge needed to deliver(General) Internal Medicine in the way and at the level described here, should be considered. It may bethat a dedicated (General) Internal Medicine specialty will become possible and practical. However, this willneed further consideration and a period of transition.There is a growing need for doctors to be familiar with research, such as in genomics and informationtechnology. All doctors should value, understand and apply relevant research throughout their clinicalpractice. The best researchers should continue to be allowed into a separate stream to maximise theirresearch effectiveness, but sometimes only for the active part of their career. At the same time, thereshould be more flexibility to allow such trainees to re-enter clinical work, and to allow clinical trainees andconsultants to take time out for research.Future Hospital CommissionThe RCP is exploring all of these topics as part of its Future Hospital Commission. The Commission is lookinginto how we can improve hospital services, taking into account the current issues and drivers of future care.The Commission is chaired by Sir Michael Rawlins, with stakeholders including patients, other RoyalColleges, the Academy of Medical Sciences, the Care Quality Commission, Public Health England and theNHS Confederation. Its findings will be reported in the summer, but some themes have already becomeclear from the Commission’s work. 7One emerging theme is that healthcare professionals should provide holistic, compassionate andindividually tailored care, which considers co-morbidities and mental wellbeing. Multi professionalteamwork and leadership are vital. Overall care should be seamless between primary, secondary, and socialcare. This should be reflected in individualised care plans for patients. Having medical practitioners workingacross these interfaces will help, and this may include general practitioners (GPs) with special interests,community specialists and GPs working in hospitals. Social care and public health need to be much moreengaged with hospital care.There also needs to be greater seven day access to services, both in primary and secondary care. Patientsshould be assessed and treated more rapidly by competent, trained practitioners. Within hospitals, thereshould be greater continuity of care. This is likely to require changing work patterns to ensure continuity inacute medical rotas with fixed teams, and also reducing transfers of patients between wards. Whentransfers occur between divisions in a hospital, there should still be access to specialists and high-level carebeds.The RCP looks forward to continuing to work with the Shape of Training review as the Future HospitalCommission develops its final recommendations.11 St Andrews Place, Regent’s Park, London NW1 4LETel: +44 (0)20 3075 1649, Fax: +44 (0)20 7487 5218 www.rcplondon.ac.ukRegistered charity no. 210508