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

2 Specialties Geriatric medicineDay hospitalsA high-turnover day hospital might expect to see 600new patients a year in a 30-place unit. Each consultantshould expect to have responsibility for around 12–15patients at any one time. The consultant should holdinterdisciplinary case conferences every one to twoweeks.Services beyond the base hospitalThese may include clinics at other hospitals, outreachclinics, domiciliary work and hospice work.Work to maintain and improve the quality of careThis work encompasses duties in clinical governance,professional self-regulation, continuing professionaldevelopment (CPD) and education, and the training ofothers. For many consultants at various times in theircareers, it may include an educational role, research,clinical management and provision of specialist adviceat local, regional and national levels.The BGS has produced detailed guidance on clinicalgovernance and the amount of time that is required tofulfil these requirements. Generally, a lead clinician inclinical governance needs one session of PA, whileparticipation in clinical governance would needabout 0.25 PA. This does not include any timerequired for revalidation, CPD or participation inappraisal, which are mandatory activities for allconsultants.Leadership roles and development of the serviceDepartments of geriatric medicine are expected to takean active role in the development of services for olderpeople in primary and secondary care. Such work fordesignated individuals should be recognised in thejob-planning process, alongside other managementduties such as running the department and takingresponsibility for the delivery of teaching, clinicalgovernance and the research agenda for a group ofgeriatricians.Academic geriatric medicineAcademic geriatricians usually make a significantcontribution to the NHS service for older people buthave fewer clinical PAs to allow for universitycommitments, which include teaching and research.Their job plans should reflect this mix of university andNHS work. Consultant geriatricians teach not onlyundergraduate medical students but also otherdisciplines. Many NHS geriatricians teach andundertake research when there is no academicdepartment. All academic and NHS geriatricians have aresponsibility for the postgraduate training of higherspecialist trainees in geriatric medicine, whichculminates in the award of a Certificate of Completionof Training (CCT).7 Opportunities for integrated careThere is a growing awareness of the scope for geriatricmedicine to integrate throughout healthcare services.As referred to in other sections, the importance ofgeriatrician involvement in other areas of communitycare, such as care homes rather than just the traditionalcommunity hospitals, is becoming apparent. The newterm ‘interface geriatrics’ describes the ability toperform a comprehensive geriatric assessment at thefront door of the general hospital to ensure that an olderperson is placed appropriately in order to receive thecare they need. This might be in an acute medical bed,accommodation within a community facility, or care athome with either domiciliary or early outpatient careand therapy.Geriatrician involvement with older orthopaedicpatients has been shown to improve both mortality andmorbidity, and there is clear scope for similarinvolvement to be extended throughout any surgeryfor older people, whether elective or emergencyprocedures.8 Workforce requirements for the specialtyIn 2009, there were 1,205 consultant geriatricians; anincrease of 8.5% on 2008. Half of the workforce aged50 years and under was female compared to 20% forconsultants aged 55 years and over. In the next fiveyears, it is expected that 12.4% of all consultants willreach 65 years and are likely to retire. The majority ofconsultants (86.2%) work full time. The averagenumber of PAs per week was 11.5, with the actualnumber of PAs worked being 12.4.The number of trainee posts stood at 508 in 2009,a drop of 15 from 2008. Just under half (49.6%) oftrainees were women and 34% of all trainees hadchildren. The impact of the European Working TimeDirective has been mixed, with 63.7% of traineesreporting a reduction in the quality of training but37.4% saying it has improved their work balance. Theaverage frequency of on-call work was one in 10 forweekdays and one in 11 on weekends.C○ Royal College of Physicians 2013 123