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

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2 Specialties Gastroenterology and hepatologyTable 2 Example work programme of consultant physicians undertaking gastroenterologyActivity Workload Programmed activities (PAs)Direct clinical careOn-take and mandatory post-take rounds (According to numbers of admissions, rota and 1–4non-consultant support)It is recommended that all other activities arecancelled for a large proportion of the time when aconsultant is on-take for acute medicine, which willclearly have an impact on the routine clinicalworkload that can be undertaken by a consultant.Oncall for emergency endoscopy 0–1Ward rounds and other inpatient work2(except post-take rounds – see above)Referrals and specialist services (eg1nutrition rounds, monitoring service)Diagnostic and therapeutic endoscopy ∗ Diagnostic upper GI endoscopy: 10–12 †1–2Diagnostic and therapeutic ERCP: 4 †Therapeutic upper GI endoscopy: 5–6 †Diagnostic flexible sigmoidoscopy: 10–12 †Diagnostic and therapeutic colonoscopy: 6 †Outpatients (general medical or specialist) New: 6–8 patients per clinic1–2Follow-up: 12–15 patients per clinicClinically related administration 1.5–2.5Total number of direct clinical care PAs7.5 on averageSupporting professional activities (SPAs)Work to maintain and improve the qualityof healthcareOther NHS responsibilitiesExternal dutiesEducation and training, appraisal, departmentalmanagement and service development, audit andclinical governance, CPD and revalidation, researcheg medical director, clinical director, lead consultantin specialty, clinical tutoreg work for deaneries, royal colleges, specialistsocieties, DH or other government bodies, etc2.5 on averageLocal agreement with trustLocal agreement with trust∗ List sizes will be reduced proportionately if training is included.† Numbers = patients per 4-hour list.and email consultation. Efficient first consultationfor new patients should be facilitated by the use ofstructured referral forms containing relevant dataand pre-investigation results, agreed by localconsultation between primary and secondary care.Secondary-care trusts should provide explicitinformation that allows targeted referral ofpatients to the most appropriate subspecialtyservice7 a multidisciplinary nutrition service that providesdaily input into the care of inpatients withnutritional problems, and provides specialist dieteticsupport in all settings for patients with specialdietary requirements including patients with liverdisease, IBD, coeliac disease and patients with shortbowel. A coeliac disease service conforming to NICE(www.nice.org.uk/CG86) and European Society forPaediatric Gastroenterology, Hepatology andNutrition (www.espghan.med.up.pt) standards ondiagnosis, national guidance on management andusing cost-efficient pharmacy supply schemes tomanage prescriptions.See also Table 3.C○ Royal College of Physicians 2013 107
Consultant physicians working with patientsAudit Patient questionnairesTable 3 Commissioning gastroenterology services and measuring qualityEffectiveness Safety Patient experienceIrritable bowel syndrome NICE CG61 (2008); 10BSG guideline (2007) 11Iron-deficiency anaemia BSG guideline (2011) 12 Audit QuestionnaireNutrition NICE CG32 (2006) 8 NCEPOD report 2010 AuditCoeliac disease NICE CG86 (2009) 13 Audit Patient questionnairesDyspepsia NICE CG17 (2004) 14 AuditInflammatory bowel diseaseNational standards for IBD Care(2009); 15 BSG guideline (2011); 16NICE TA187 biologics (2010); 17NICE CG118 (2011) 18Results of National IBDAuditAssessed by auditResults of National UGIBAcute upper GI bleeding Scope for improvement (2011); 7141 (2012) 20BSG guideline (2009); 19 NICE CG auditQuestionnaireAlcohol-related diseaseBSG guideline (2010); 21 NICE CG Audit of alcohol-related115 (2011) 22 (re)admissions and deathSurvival without alcoholEndoscopy services BSG QA/Global Rating Scale 23 BSG QA/Global RatingScale; JAG approvalGlobal Rating Scale scoresA/B; patient questionnairesReferences1 Department of Health. Clinical outcomes guidelines.London: DH, 2000.2 National Confidential Enquiry into Patient Outcome andDeath. Parenteral nutrition: a mixed bag. London:NCEPOD, 2010.3 British Society of Gastroenterology. Care of patients withgastrointestinal disorders in the United Kingdom, a strategyfor the future. London: BSG, 2006.4 Barrison IG. Out of hours gastroenterology. Apositionpaper. London: BSG, 2007.5 Barrison IG, Bramble M, Wilkinson M et al. Provision ofendoscopy related services in district general hospitals.London: BSG, 2001.6 Royal College of Physicians. Consultant physiciansworking with patients, 3rd edn. London: RCP,2005.7 British Society of Gastroenterology. Scope forimprovement: a toolkit for a safer upper gastrointestinalbleeding (UGIB) service. London: BSG, 2011.8 National Institute for Health and Care Excellence.Nutritional support in adults: oral nutrition support,enteral feeding and parenteral nutrition. Clinical guidelineCG32. London: NICE, 2006.9 British Society of Gastroenterology. Commissioningevidence-based care for patients with gastrointestinal andliver disease. London: BSG, 2012.10 National Institute for Health and Care Excellence.Irritable bowel syndrome in adults: diagnosis andmanagement of irritable bowel syndrome in primary care.Clinical guideline CG61. London: NICE, 2008.11 British Society of Gastroenterology. Guidelines on theirritable bowel syndrome: mechanisms and practicalmanagement. London: BSG, 2007.12 Goddard AF, James MW, McIntyre AS, Scott BB.Guidelines for the management of iron deficiencyanaemia. Gut 2011;doi 10.1136/gut.2010. 228874.13 National Institute for Health and Care Excellence.Recognition and assessment of coeliac disease. Clinicalguideline CG86. London: NICE, 2009.14 National Institute for Health and Care Excellence.Managing dyspepsia in adults in primary care. Clinicalguideline CG17. London: NICE, 2004.15 IBD Standards Group. Quality care: service standards forthehealthcareofpeoplewhohaveinflammatoryboweldisease (IBD). Brighton: Oyster HealthcareCommunications, 2009.16 Carter MJ, Lobo AJ, Travis SPL. Guidelines for themanagement of inflammatory bowel disease in adults.Gut 2004;53(Suppl 5):v1–v16.17 National Institute for Health and Care Excellence.Crohn’s disease - infliximab (review) and adalimumab(review of TA40): guidance. Technology appraisal TA187.London: NICE, 2010.108 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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