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

2 Specialties Gastroenterology and hepatologyprocedure annually. Half of these are likely to beperformed by GI physicians. Nine PAs per week arerequired for these procedures, allowing for trainingrequirements. Endoscopic ultrasound scanning (EUS) and ERCP:these are currently performed at an annual incidenceof 0.2%, with little change anticipated. Four PAs areneeded for ERCP and EUS, assuming that 80% ofthese are performed by GI physicians. Cancer screening and surveillance programmes:there is a national bowel cancer screeningprogramme needing approximately two lists perweek of colonoscopy, rising to three lists per weekwith full age and regional roll-out, and anincreasing surveillance burden generated frominvestigating and treating these patients.Approximately 2 (rising to 3) PAs are required forthis activity.Out-of-hours GI serviceAn out-of-hours (OOH) GI service may include anemergency therapeutic endoscopy service alone or7-day cover for patients with acute GI emergencies. Thecost implications of the OOH endoscopy service willdepend on the nature of the service (24 hours ordaytime cover only) and the number of consultants onthe rota but is likely to cost at least one consultant PAper week. Weekend and bank holiday cover forinpatients would cost about 1 PA (3 hours of premiumtime) for each day covered.Nutrition serviceThis service requires up to two consultant PAs perweek.Consultant programmed activities required toprovide a service in gastroenterology and generalinternal medicine in a DGHDirect patient careWhere members of the junior medical staff providesupport for the inpatient service and consultantsprovide the outpatient and endoscopic service, about54PAsperweekarerequiredtoprovideaserviceinaDGH with an average workload. The number of PAsrequired to run the service is reduced if part of the workis undertaken by consultant colleagues – eg those inradiology or surgery might share the endoscopicworkload over and above that assumed in thecalculations above. It has been assumed that half of allupper and lower GI endoscopic procedures will beperformed by non-GI physicians – either otherconsultants or nurse specialists. Regular help inoutpatients may come from junior medical staff – eachof whom might contribute to the work done by around50% of that recommended for a consultant PA. Itshould be noted that the delivery of an endoscopytraining list is counted as a direct clinical caresession.Work to maintain and improve the qualityof careAdditional PAs for each consultant are required for thiswork. This has been estimated at up to 2.5 PAs perconsultant, using the RCP’s guidelines, and includes:continuing professional development (CPD); teachingof junior medical staff, nursing staff and medicalstudents; administration and management; clinicalresearch; and clinical governance.On the basis of these conditions and recommendations,the number of PAs needed to provide a clinical servicein gastroenterology and general medicine for a DGHserving a 250,000 population can be calculated.Allowing 2.5 PAs for each consultant for thesupporting activities (SPAs) given above, the total is 69PAs (this assumes 6 consultants all working 11.5 PAs perweek).Table 1 summarises the work programme of consultantgastroenterologists providing a service for a 250,000population, giving the recommended workload andallocation of PAs (see page 106).National consultant workforce requirementThe calculation allows an estimate of the nationalconsultant requirement to be made. Assuming thepopulation of England and Wales is 53,861,800 (DHfigures for 2008), the total need in England and Wales is1,753 head count consultants in gastroenterology (withgeneral medicine), using the Centre for WorkforceIntelligence calculations.9 Consultant work programme/specimenjob planTable 2 summarises an example of the work programmeof consultant physicians undertaking gastroenterologyand acute general medicine, giving the recommendedworkload and allocation of PAs.C○ Royal College of Physicians 2013 105