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

Consultant physicians working with patientsTable 1 Work undertaken by consultant gastroenterologists (total PAs per week) serving a population of 250,000Activity Workload Programmed activities (PAs)Direct patient careWard rounds (except on-take and post-take) 3Outpatient clinicsNew patients 6–8 patients per clinic 9Follow-up patients 12–15 patients per clinic 13Diagnostic and therapeutic endoscopyDiagnostic and therapeutic upper GI endoscopy (10–12 patients per PA) 3Diagnostic flexible sigmoidoscopy (10–12 patients per clinic) 3Diagnostic and therapeutic colonoscopy (6 patients per clinic) 6EUS and ERCP (5 patients per clinic) 4Nutrition service 2On-take, and mandatory post-take rounds Rota 1:10 for this example 1MDT meetings 3Additional direct clinical care 6On call for emergency endoscopy(assuming some registrar input to the rota) 1Total direct patient care 54Work to maintain and improve the quality of care (6 consultants) 15Total 6910 Key points for commissionersA good-quality service for gastroenterology andhepatology should include: 91 an endoscopy service that participates in the GlobalRating System, is accredited by the JAG, participatesin national audit, provides/participates in a networkthat provides 24-hour/7-day endoscopy service forgastrointestinal bleeding and ensures that allpatients over 40 with recent onset rectal bleedingand/or persistent diarrhoea >3 weeks have access toflexible sigmoidoscopy or colonoscopy within 4weeks. Efficient use of facilities should usuallyinclude evening and weekend lists. Commissionersshould negotiate with trusts to achieve a transparentshift of activity from unnecessary endoscopy inyoung patients with dyspepsia towards appropriatelyincreased resources to meet appropriately increaseddemand for lower-GI endoscopy2 an inflammatory bowel disease service that isseparately commissioned, conforms to the IBDStandards (www.ibdstandards.org.uk)andparticipates in national clinical audit3 a hepatology service that is separately commissionedand that ensures appropriate monitoring of patientswith chronic liver disease for prophylactic treatmentof varices and early diagnosis of hepatocellularcarcinoma, and that includes 7 days/weekavailability of appropriately trained specialist carefor patients with acute jaundice and liver failure. Theservice should be provided by an appropriate MDTas defined in the National Liver Plan(www.bsg.org.uk/attachments/1004 National%20Liver%20Plan%202009.pdf)4 provision of a consultant gastroenterology/hepatology ward round on each day includingweekends and public holidays5 a multidisciplinary alcohol care team, integratedacross primary and secondary care but with ahospital base, providing a 7 days/weekservice to support patients with alcohol-relatedproblems, improve abstinence, and reducere-admission rates6 efficient use of outpatient services with lowfollow-up to new ratios, eg 1:1 for patients excludingthose with chronic disease (IBD and liver disease)and appropriate use of nurse-led clinics, telephone106 C○ Royal College of Physicians 2013