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

Consultant physicians working with patientsTable 3 Recommended maximum clinical workload for consultant haematologists according to the Royal Collegeof Physicians (RCP) and data from 2005–6 survey 8Annual numbers of patientsActivity RCP recommendation 2005–6 survey Difference (%)Inpatients 250OutpatientsNew 250 211 –15.6Return 1,500 1,920 +28Day cases/ward attendees 1,500 1,180 –21 ∗Ward consults 100∗ Increasing by 10% per annum.Patients receiving OACs as outpatients not included.Published figures from a haematology workforce document show that haematologists meet or exceed the RCP’s recommended outpatient numbers. 9Other specialist activity, including activitiesbeyond the local servicesReference laboratoriesSome highly specialised laboratories provide a regionalor even national service.Blood transfusionAppropriate time should be designated for theconsultant haematologist with responsibility for thehospital transfusion service to guarantee the safedelivery of this service. The team should include amember of the hospital transfusion team, together witha SPOT and the senior BMS of the hospital blood bank.This team is responsible for meeting the standardsoutlined in Better blood transfusion: safe and appropriateuse of blood 10 and Blood safety and quality regulations2005. 11 The team is also responsible for ensuring thatappropriate policies and guidelines are in place,including maximum blood ordering schedules (MBOS),emergency blood contingency and major incidentplanning, and that all blood components can be tracedfrom donor to recipient, with a 30-year audit trial keptas per the European directive on haemovigilance 2005. 12Hospital and primary care liaison activityConsultant haematologists are consulted regularly aboutthe management of patients in all specialties, particularlyabout problems related to anticoagulation. Many of theseconsultations may be dealt with on the telephone, butthe consultant frequently needs to see the patient. GPsappreciate close contact with haematology consultants:30–50% of laboratory work typically comes fromprimary care and telephone consultations are frequent.Roles in the laboratoryAbnormal blood films from general practice andhospitals and authorisation of all results are revieweddaily, and the workload is shared between members ofthe consultant haematology team. This frequently leadsto urgent primary care or intrahospital referrals.Clinical and laboratory networksMeetings of the MDT and other specialist meetings areheld in order to maintain clinical networking for themanagement of patients. The MDT meeting and regular‘handovers’ ensure safe continuity of care. Thedevelopment of pathology laboratory networks mayalso mean that the consultant haematologist isresponsible for an area of laboratory work acrossdifferent locations. The impact of the Carter report 13 onthe modernisation of pathology services will emerge inthenextfewyears,butitislikelythattheindependentsector will play an increasing role. Although this mayreduce the technical laboratory workload, it will have alimited effect on specialist laboratory tests or theadvisory role of consultants.7 Opportunities for integrated careThere are a number of opportunities for integratedworking with both primary care and palliative care.Patients who require monitoring of low-gradehaematological conditions such as early chroniclymphocytic leukaemia, monoclonal gammopathy andminor abnormalities of the blood count such asthrombocytopenia or neutropenia, can be managed in ajoint way between primary and secondary care.132 C○ Royal College of Physicians 2013