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

2 Specialties Genitourinary medicineClinical governance is overseen by BASHH’s clinicalgovernance committee.ResearchThe establishment of special interest groups in GUM byBASHH has promoted the research agenda of thespecialty. In HIV medicine, academic posts have beencritical to clinical and basic research. Continued clinicaland scientific research into STIs and HIV is essentialand many clinics work closely with the MedicalResearch Council (MRC), industry and other partners.Local management dutiesEach GUM service providing diagnostic and therapeuticservices for STI and HIV should be led by those holdinga Certificate of Completion of Training (CCT), orequivalent, in GUM. As a multidisciplinary team, theday-to-day management leadership should devolve to alead GUM consultant; he or she would have amanagerial relationship to the general managementstructure of the provider trust.Regional and national workMany GUM specialists participate in regional andnational work, for the RCP, BASHH and local deaneries,in addition to working closely with agencies such as theHPA on public health matters.Specialty and national guidelinesSpecialist guidelines for STIs were first published in1999. The updated guidelines include other areas ofpractice and are available at www.bashh.org. 5Guidelines for HIV management and treatment arepublished by the British HIV Association (BHIVA).The National Institute for Health and Care Excellence(NICE) guidelines include: public health intervention guidance on theprevention of sexually transmitted infections andreduction of under-18 conceptions generic and specific interventions to supportattitude and behaviour change at population andcommunity levels increasing the uptake of HIV testing to reduceundiagnosed infection and prevent transmissionamong black African communities living in England(NICE 2011) increasing the uptake of HIV testing among menwho have sex with men (NICE 2011).Specialty and national auditConsultants review the notes of patients to monitorquality of care and ensure that accurate diagnoses areentered on workload and epidemiological returns madeto trusts and the HPA on behalf of the DH.In 2003, BASHH established a national audit groupwhich undertakes an annual national audit. Specialtyspecificstandards have been developed and arerecommended as an integral part of the revalidationprocess. There are national HIV audits through BASHHand BHIVA programmes.The British Co-operative Clinical Group, a specialinterest group of BASHH, conducts regular nationalsurveys and publishes the results of clinic practices.6 Clinical work of consultantsHow a consultant works in this specialtyInpatient workThe GUM service may require inpatient accessfor the management of complex infections (such asHIV-related complications). A range of inpatientspecialties may require access to clinical opinion fromGUM consultants, who should be available to giveopinion to colleagues on request. GUM physicians whoact as sole consultant for inpatients should have currentknowledge of HIV/AIDS medicine to an acceptablelevel. Levels of junior medical staffing should besufficient to support GUM admissions.Ward rounds vary according to the numbers of patients.Many district general hospitals (DGHs) have only oneor two GUM/HIV inpatients at any one time.Consultants in DGHs may be single-handed withminimal supporting staff and manage most/all of thecare themselves. Alternatively, inpatient care may beshared with colleagues in other disciplines such asinfection or thoracic medicine. Larger units have severalGUM consultants, some of whom specialise in themanagement of HIV/AIDS, with either dedicated orshared junior staff.Outpatient workMost work in the specialty is outpatient based.STI clinics. In a 4-hour session, consultants shouldallow 3.5 hours for their own patients and 0.5 hour forconsultation, teaching and training. Clinical teachingforms a major part of the workload in teaching andnon-teaching hospitals. Fewer patients will be seenwhile teaching but numbers vary according to casemixand supporting staff. Adequate time must be allowed toC○ Royal College of Physicians 2013 115