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

2 Specialties Haematologythey have responsibility through involvement inmanagement, clinical governance, professionalself-regulation, continuing professional development(CPD), education and training and the provision ofspecialist advice at local, regional and national levels.They participate in national laboratory qualityassurance schemes; national service accreditationschemes such as that organised by Clinical PathologyAccreditation (UK) Ltd and the cancer peer-reviewprocess; projects to audit clinical outcomes andprocesses; and local, regional and national educationalmeetings.Research – clinical studies and basic scienceAlthough there are many challenges in academicmedicine haematology remains one of the moreacademic specialties. Most hospitals participate inclinical trials in accordance with the trust’s researchgovernance arrangements. Between 30–40% of traineestake time out during their higher specialist training tofollow a research project, with many proceeding to ahigher degree. This research expertise is reflected in theenthusiastic support given to national studies organisedthrough the National Cancer Research Institute.Specialty and national guidelinesIn all areas of haematology, the BCSH produces robust,evidence-based guidance that meets the challenges of ahighly complex and rapidly changing field. Theguidelines are produced through a well-defined processdesigned to fully assess available evidence and involve allrelevant stakeholders. Guidelines are disseminated bypublication in peer-reviewed journals and on thewebsite of the BCSH (www.bcshguidelines.com), whichcurrently receives around 100,000 page hits per month.Other important guidelines include those forhaemophilia produced by UKHCDO, which is part ofthe Haemophilia Alliance(www.haemophiliaalliance.org.uk/docs/who.htm),those for blood transfusion produced by the NationalBlood Transfusion and Tissue Transplantation Service(www.transfusionguidelines.org.uk)andNICE(www.nice.org.uk).6 Clinical work of consultantsContributions made to acute medicalor surgical careHaematologists are consulted regularly on problemsarising as emergencies in acute medical and surgicalpatients, particularly with regard to haemostaticproblems and anticoagulant treatment.Direct clinical haematology careTable 3 outlines maximum clinical workload forconsultant haematologists according to the RoyalCollege of Physicians (RCP), and the data from 2005–6survey by the British Society for Haematology (BSH)and Royal College of Pathologists (RCPath). 8Inpatient workThe type of work carried out by a consultanthaematologist varies considerably, depending onsubspecialisation and the size of the hospital, but almostall will have patients with complex medical conditionsthat make clinical responsibilities onerous. Time mustbe designated for MDTs to direct patient care. Theincreasing inexperience of trainees makes them less ableto contribute to the clinical service, and this isinfluencing a change from a consultant-led service to aconsultant-delivered service.Day-case and outpatient workMost haematologists run two to three outpatient clinicsper week and increasingly provide care in day caserather than inpatient settings.Specialist investigative and therapeuticproceduresBone marrow aspirates and trephine biopsies are usuallyperformed by medical staff, but nurses are increasinglybeing trained in the procedure. The results are reportedby haematologists, although the results of trephinebiopsies may be reported by a specialisthaemato-oncological pathologist.Intrathecal chemotherapy is given by specificallydesignated haematologists under strictly controlledconditions. 6 Apheresis is usually performed by specialistnurses under the supervision of a consultanthaematologist with experience in this field.Specialist on-call arrangementsHaematologists provide an essentiallyconsultant-delivered on-call service for their laboratorywork and for patients under their care, and aconsultative service to other disciplines. The intensity ofon-call work varies (average on-call rota: one day inevery four days), 1 and provision of highly specialisedadvice can be onerous, particularly in transplant andhaemostasis centres.C○ Royal College of Physicians 2013 131