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

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2 Specialties HaematologyTable 4 Specimen consultant job planActivity Workload Programmed activities (PAs)Direct clinical careDiagnostic laboratory work 2–3Ward rounds, ward referrals, MDT meetings 2–3Outpatient clinics 2–3Marrows and other specialist procedures 0–0.5Lead haematologist laboratory 0–1Lead haematologist transfusionLead haematologist venousthromboembolismOn-call and weekend workTotal direct clinical care (PAs)Supporting professional activities (SPAs)Work to maintain and improve the qualityof healthcareOther NHS responsibilitiesExternal dutiesOne haematologist would have this recognised injob planOne haematologist would have this recognised injob planThis should not exceed a 1:3 rota and carry an8% supplement; PAs for predictable orunpredictable on-call work should be recognisedin job plan – eg one PA on average per weekEducation and training, appraisal, departmentalmanagement and service development, auditand clinical governance, CPD and revalidation,researcheg medical director, clinical director, leadconsultant in specialty, clinical tutoreg work for deaneries, royal colleges, specialistsocieties, DH or other government bodies0–10–17.5 on average2.5 on averageLocal agreement with trustLocal agreement with trustNote: consultants with a significant academic workload will have separate PAs identified for NHS and/or university components. Consultant job plansmust take into account the European Working Time Directive (EWTD).Outreach haematology clinics have been established incommunity hospitals in conjunction with palliativecare. This allows for care to be delivered closer to thepatient’s home and can include simple palliativeinterventions such as supportive blood transfusions innon-haematology patients with advanced cancer whereappropriate.8 Workforce requirements for the specialtyCurrent workforce numbersAccording to the Information Centre’s 2009 census,there are 647 WTE consultants (700 headcount) whilethe Electronic Staff Record (ESR) from September 2009shows 580 WTE (605 headcount). 14The consultant workforce has increased by 11% duringthelastfiveyears. 15 The RCP’s census of consultantphysicians in the UK in 2009 showed thathaematologists are on average contracted to work 11programmed activities (PAs) with the actual number ofPAs delivered being 12.2. 15National consultant workforce requirementsThe Centre for Workforce Intelligence estimates that theexpected requirements based on changingdemographics indicate a required growth rate inconsultant haematologists of about 2%. 14,16 However,there are other factors that also need to be taken intoaccount when planning the future need for consultanthaematologists.C○ Royal College of Physicians 2013 133
Consultant physicians working with patientsAs was outlined in the 2008 report published by theBSH and the RCPath, there are a number of professionalissues that should be considered. 8 These include theincreasing complexity of treatment andsubspecialisation in haematology and other disciplines,the increasing impact of regulatory initiatives (egimproving outcome guidance and waiting-time targets)and legislation, as well as multidisciplinary working andinterhospital networking. Implementation of thedemands of Better blood transfusion: safe andappropriate use of blood 10 and the European directive onhaemovigilance 12 will require an additional 30–40consultants. An increasing laboratory workload (>5%increase per annum) generates increasing numbers ofpatient referrals and the need for clinical guidance onthe use of the laboratory and the interpretation ofresults. The specialty has supported improvements intraining programmes, but these too place greaterdemands on consultants’ and trainees’ time.The RCP report on the impact on medicine of theincreasing proportion of women entering the professionidentified that haematology is one of the specialties thathas attracted a higher proportion of women. 17 As aresult, the current male:female ratio for consultantsover the age of 55 of 7:3 changes to 1:1 for youngerconsultants and for trainees it is 4:6. Since the male tofemale ratio of consultants that work less than full timein haematology is 1:4, an increasing number ofconsultant haematologists would be expected to workless than full time. In addition, the report also notedthat women who take career breaks are taking themlater in their medical careers as consultants, which isanother factor that will impact on the ability of aconsultant-delivered service to be maintained.Therefore, the professional bodies recommend that thetotal number of consultant haematologists that will berequired is estimated to be 1250 (headcount).9 Consultant work programme/specimenjob planTable 4 outlines the typical work programme of aconsultant haematologist.10 Key points for commissioners1 Haematology is an integrated clinical and laboratoryspecialty; commissioning for one aspect of thespecialty without consideration for the other mayimpact on the viability of a local service.2 Haematologists have a key role in providing adviceto other specialties within a hospital as well as GPson both clinical and laboratory issues.3 Many aspects of a haematology service are nowprovided across a network that covers more than oneNHS provider and commissioners need to bear thisin mind when commissioning haematology services.4 Postgraduate training is closely linked to the currentorganisation of haematology services, another factorthat commissioners should bear in mind whencommissioning clinical and laboratory services.References1 Keele University. National Pathology Alliancebenchmarking review 2009–10. Keele: Keele University,2010.2 British Committee for Standards in Haematology.Facilities for the care of adult patients with haematologicalmalignancies – ‘levels of care’. BCSH Haemato-oncologyTask Force 2009. www.bcshguidelines.com/documents/levelsofcare 042010.pdf3 National Institute for Health and Care Excellence.Guidance on cancer services. Improving outcomes inhaematological cancers. The manual. London: NICE,2003.4 Fellows C. Analysis of frequent users, by local authority,April 2002–March 2003. London: London HealthObservatory, 2005. www.lho.org.uk/viewResource.aspx?id=97365 HofmanD. Analysis of frequent hospital users, by PCT,April 2003–March 2004. London: London HealthObservatory, 2006. www.lho.org.uk/viewResource.aspx?id=102866 Department of Health. Updated national guidance on thesafe administration of intrathecal chemotherapy (HSC2008/001). London: DH, 2008.7 National Institute for Health and Care Excellence.Guidance on cancer services. Improving outcomes inchildren and young people with cancer. The manual.London: NICE, 2005.8 The British Society for Haematology and the RoyalCollege of Pathologists. Haematology consultantworkforce: the next 10 years. London: RCPath, 2008.9 Department of Health. The NHS cancer plan:aplanforinvestment,aplanforreform. London: DH, 2000.www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH 409813910 Department of Health. Better blood transfusion: safe andappropriate use of blood (HSC 2007/001). London: DH,2007.134 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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