Consultant physicians working with patients - Royal College of ...

2 Specialties Diabetes and endocrinology8 Workforce requirements for the specialtyCurrent workforce numbersThe 2011 annual Diabetes UK RCP manpower surveyidentified 723 whole-time equivalent (WTE)consultants in the UK. These numbers give WTEconsultants per 100,000: England 1.1, Scotland 1.51,Wales 1.4 and Northern Ireland 1.67. This represents asmall overall increase in WTEs in the UK, from 1.04 in2009 to 1.16 in 2011. The number of consultantsworking single-handedly in hospitals is very small.There has been a rise in the numbers of postscombining acute medicine and diabetes and/orendocrinology that appears to reflect a lack of vacanciesin recent years in the specialty.Estimated number of consultants needed toprovide a specialist service for a population of250,000There has been a considerable increase in type 2diabetes prevalence and the prospect of formalscreening for diabetes is likely to result in a steep rise indemand for diabetes care; epidemiological studiessuggest that screening may double the number of thoseidentified as having diabetes. The latest DiabetesPrevalence Model (2010) from the Association of PublicHealth Observatories estimates that the prevalence ofdiabetes will be 8% in England by 2015.Current healthcare policy is to encourage thedevelopment of ongoing primary and intermediate carefor diabetes services. These services will, however,require support and supervision from specialists. Thecombination of these factors makes it difficult toaccurately calculate the need for specialist andsecondary diabetes care. The best current estimate isthat the increased prevalence and longevity of peoplewith diabetes and the increased complexity of care, plusthe provision of new care models, will mean an increasein the workload of diabetes specialists. The work of thespecialist is likely to change over time, with moreemphasis on work outside secondary care but also anincrease in work focused on inpatients with diabetes.For endocrinology, it is also expected that thedevolution of more routine care will be balanced by theincreased complexity of treatment options for rareconditions. Table 1 shows a recommendation of whatcould be regarded as the minimum involvement indiabetes and endocrinology to provide a service for a250,000 population. It is expressed as time divided intoprogrammed activities (PAs) (4-hour sessions). Thisanalysis is for a consultant-provided service and doesnot accurately take outpatient activity by other gradesinto account. The demands of acute medicine onspecialty registrars (StRs) and the need to supervisejuniors mean that most consultants feel that it is notpossible to quantify the input from them. Some centresrun parallel nurse-led clinics, which are not included.Table 1 shows that for the specialty commitment alonefor a 250,000 population there is a need for at least 4consultants in endocrinology and diabetes, with a10-PA contract allowing for a GIM/acute medicinecomponent and for supporting professional activities.No allowance has been made for managerial, regional ornational roles. This would require 877 WTEs atconsultant level for England and Wales (609 in 2011).9 Consultant work programme/specimenjob planThe programme in Table 2 assumes the above estimatednumber of physicians sharing a general medicalcommitment and working a 10-PA contract. This wouldfit a typical district general hospital in diabetes andendocrinology and would be different for morespecialised or academic posts. Many of the activities aregiven as a range because individual posts will varywidely even in a single department.10 Key points for commissioners1 Diabetes is rapidly increasing in prevalence,consumes about 10% of NHS resources and usesabout 17% of NHS beds.2 Many diabetic patients (eg those withuncomplicated type 2 diabetes) can be cared for inprimary care.3 Nevertheless, many will need secondary carespecialty teams. These include most type 1 andcomplex type 2 patients.4 Mandatory areas for secondary care includediabetic pregnancy, transitional (adolescent) careand diabetic foot ulceration.5 Secondary care will also lead complex newtreatments, eg insulin pumps, GLP1 agonists.6 Educational systems (eg DAFNE, DESMOND andXPERT) need support in both primary andsecondary care.7 A smooth interface for diabetes care betweenprimary and secondary care is vital and will behelped by community diabetologists and GPwSIs.C○ Royal College of Physicians 2013 95