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

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2 Specialties Genitourinary medicineTable 1 Specimen job plan for a consultant in genitourinary medicineActivity Workload Programmed activities (PAs)Direct clinical careOutpatient clinics/clinical supervision 10–12 patients per session 4–6Ward work including day care 0.5–2On call 0.5Patient-related administration 1.0Total number of direct clinical care PAs7.5 on averageSupporting professional activities (SPAs)Work to maintain and improve the quality ofhealthcareOther NHS responsibilitiesExternal dutiesEducation and training, appraisal,departmental management and servicedevelopment, audit and clinical governance,CPD and revalidation, researcheg medical director/clinical director/leadconsultant in specialty/clinical tutoreg work for deaneries/royal colleges/specialistsocieties/Department of Health or othergovernment bodies, etc2.5 on averageLocal agreement with trustLocal agreement with trustdoctors and nurse practitioners, but require consultantsupervision: 15,000 new and follow-up consultations per 250,000population per year 42 consultant weeks per year (8 weeks annualleave/bank holidays, 2 weeks study leave) 7.5 PAs for direct clinical care 4–6 clinics 20 minutes per appointment for routine GUM(more time for HIV patients). 10–12 patients seen per clinic 2,500–3,000 consultations per year per consultant.National consultant workforce requirementsWith modernistation of service delivery and the needto contain costs, robust arguments willbe needed for expansion. Increased consultant numbersare needed where there is insufficient service provision,eg in rural areas where providing prompt access isnot possible. Ideally, consultants should not be workingsingle-handedly and they should work within definednetworks. Trusts may resist replacing retiring consultantslike for like. However, particularly with GUMand HIV services, there are additional factors that mustbe considered where greater consultant numbers maybe required: demographic mix, numerical population,HIV cohort, deprived areas, risk groups such asasylum seekers, ethnic minority groups, young people,towns and cities with a university or other trainingestablishments. The role of consultants encompassesthe provision of supervision of other healthcareprofessionals, providing the clinical governanceframework and providing medical leadership acrossa locality that may involve primary and secondarycare, and private providers. These needs, along withthe additional expectations of revalidation, teaching andtraining, will require maintaining consultant numbersdespite the specialty being commited to modernisationof practice and other ways of delivering the service.With present uncertainties, a reduction in proposednumber of consultants from the previous 1 WTE per84,000 to 2 WTE per 250,000 is suggested. In the UK(61 million population), this would equate to 480 WTE.The Centre for Workforce Intelligence 7 predicts that, by2018, 439 WTE will be reached. It suggests noadjustment to the number of training posts, taking intoaccount population growth, demographics andhistorical supply. The rate of retirement will have asignificant influence on potential vacancies.Additonally, a proportion of trainees enrolled in higherspecialist training is training part time and thereforetaking longer to reach CCT.C○ Royal College of Physicians 2013 117
Consultant physicians working with patients9 Consultant work programme/specimenjob planDirect clinical careDepending on the profile of their workload andspecialist interests, consultants will undertake 7.5 directpatient care PAs divided between outpatient andinpatient work (see Table 1). Many consultants haveoutpatient clinics on more than one site.10 Key points for commissioners1 Sexual health services should be open access,confidential and free to users irrespective of theirplace of residence.2 Services should be commissioned within aframework of local clinical networks supported byconsultant-led specialist services to ensuremaintenance of high standards, consistency of careand clinical governance.3 Commissioners should require all providers toproduce evidence of participation in national audit.4 Commissioners should require all providers toensure that staff delivering services have beenappropriately trained and are competent to carryout their roles. Providers should be required todemonstrate the use of validated competencyassessment for all clinical staff.5 BASHH standards for the management of STI andkey performance indicators listed in this documentshould be incorporated into the localcommissioning process for all levels of service toensure consistency of care and to enable meaningfulperformance management of services.References1 Department of Health. National strategy for sexual healthand HIV. London: DH, 2001.2 British HIV Association. Standards for HIV clinical care2013. www.bhiva.org/documents/Standards-of-care/BHIVAStandardsA4.pdf3 British Association for Sexual Health and HIV. Standardsfor the management of sexually transmitted infections(STIs). London: BASHH, January 2010. www.bashh.org/documents/25134 Department of Health. Health Services Building Note(HBN) 12, supplement 1 – sexual health clinics.London:DH, 2005.5 British Association for Sexual Health and HIV. BASHHClinical effectiveness group guidelines. www.bashh.org/guidelines6 Federation of the Royal Colleges of Physicians of theUnited Kingdom. Census of consultant physicians andmedical registrars in the UK, 2011 data and commentary.London: RCP, 2013.7 Centre for Workforce Intelligence. Recommendation forgenitorinary medicine training 2011. www.cfwi.org.uk/intelligence/cfwi-medical-summary-sheets/recommendation-for-genitourinary-medicinetraining-2011118 C○ Royal College of Physicians 2013
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The Royal College of PhysiciansThe
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AcknowledgementsWe would like to th
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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1 Physicians in the NHS todaycan be
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2 Specialties Clinical geneticsClin
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2 Specialties Clinical genetics6 Cl
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2 Specialties Palliative medicinePa
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2 Specialties Renal medicineRenal m
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2 Specialties Renal medicineLocal a
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2 Specialties Renal medicineInvolve
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2 Specialties Renal medicineTable 1
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2 Specialties Renal medicinekidney
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