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

Consultant physicians working with patientsfurther 3–4 hours per week (1 PA) should be consideredto allow for meeting with next of kin.Within a department there should be sufficient capacityfor consultants to provide prospective leave cover forcolleagues, including being able to do a ward round oftheir patients.RehabilitationNumbers of rehabilitation patients looked after by aconsultant geriatrician, with supporting medical staff,will vary depending on where the rehabilitation istaking place. In a traditional hospital setting with directsupervision (either acute or community), this could beexpected to be an average ward ie 24–30 patients. In a‘virtual ward’ or intermediate-care setting, this numberwould vary depending on the expertise of the leadstaff, and complexity of the patients. A consultantnormally would be expected to complete at least onerehabilitation ward round per 20 patients eachweek, and this would include a meeting of themultidisciplinary team (MDT).In addition, the consultant is likely to require onefurther PA for meeting relatives, reviewing unstablepatients, special case conferences and troubleshooting.Community workDepartments of geriatric medicine should expect to playa significant role in the community, including workingin teams to deliver intermediate care; reviewing patientsin care homes (NHS and private sector) – often inconjunction with community matrons or other expertallied health professional colleagues; assessing patientswho require long-term care; and providing homeassessments at the request of colleagues in primary care.These duties of community geriatricians may beundertaken in partnership with social services, byGPwSIs in older people and perhaps by nurse ortherapist consultants.Continuing careWhen continuing care work is undertaken, a consultantgeriatrician would be expected to have directresponsibility for around 30 continuing care beds andwould normally be expected to review the needs of thepatients at least once every two weeks.Referral work including interspecialty andinterdisciplinary liaisonA consultant would expect to deal with around five to10 referrals per week. Absolute numbers will depend onconsultant numbers and local provision of specialistliaison services within an acute hospital.Outpatient workTable 2 considers the requirements of outpatient clinicsfor general geriatric medicine and general internalmedicine (GIM).Table 2 Requirements of outpatient clinics for general geriatric medicine and GIM with indicative timings forconsultationsTime (minutes)Type of patientNewconsultation ∗Follow-upconsultationAdministration †(per patient)Training andpatient discussion(per patient)Consultant and ST4–7Complex elderly care patient ‡ 45–60 20 10 10General medical patient (young or old) § 15–25 10 5 10ST1–3Complex elderly care patient ‡ 60 30 10 10General medical patient (young or old) § 45 15 5 10ST = specialty trainee.∗ A new consultation would cover patient history, an examination, discussion of findings, reviewing or ordering investigations and a management plan.† Administration may be during clinic or at another time and includes dictation, reviewing results, phone calls, electronic correspondence, etc.‡ Complex conditions such as multiple problems, memory loss, Parkinson’s disease, falls and incontinence.§ General conditions such as transient ischaemic attacks, weight loss, anaemia, gastrointestinal problems and ischaemic heart disease.122 C○ Royal College of Physicians 2013