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

Consultant physicians working with patientsEducation and training, clinical governance andmanagement dutiesImmunologists are actively involved in a range of dutiesthat are essential to the maintenance of high standardsof clinical practice. These include: education andtraining of StRs, laboratory scientists and nurses;continuing professional development (CPD); clinicalgovernance; General Medical Council (GMC)revalidation; local management and national work forthe RCP and RCPath and specialist immunologicalsocieties – the British Society for Immunology (BSI),the British Society for Allergy and Clinical Immunology(BSACI) and UKPIN. With the development of acompetency-based curriculum in immunology, it isenvisaged that a consultant with responsibilities as aneducational supervisor will need to devote one weeklyprogrammed activity (PA) to teaching and trainingactivities.Research – clinical studies and basic scienceThe direct relevance of immunology to much of clinicalmedicine and its strong scientific foundations provideample opportunities for clinical studies of newimmunomodulatory therapies, the recognition of newdiseases (as shown by recent descriptions of new formsof severe combined immunodeficiency and type 1cytokine deficiency) and translational research. Despitetheir heavy NHS commitments, many immunologistsare actively involved in national and internationalclinical and laboratory studies.The few full-time academic immunologists make aproportionately greater contribution to research whileshouldering a significant clinical workload for the NHS.With the disappearance of many university immunologydepartments and recent medical school expansion,consultant immunologists have major undergraduateand postgraduate teaching commitments.6 Clinical work of consultantsHow a consultant works in this specialtyThe clinical work of consultant immunologists is largelyoutpatient based, with the following broad workpatterns: Immunologists are solely responsible for patientswith primary immunodeficiencies (antibodydeficiency, combined T- and B-cell deficiency,complement deficiency and phagocytic defects). In many centres, consultant immunologists areresponsible for patients with complex, severe allergicdisease (food allergy, drug allergy, venom allergy andanaphylaxis). In most centres, consultant immunologists performjoint clinics with paediatricians to care for childrenwith immunodeficiencies and allergy. Many immunologists have an interest in connectivetissue disease and perform joint clinics withrheumatologists for patients with autoimmunerheumatic disease and systemic vasculitis. Theincreasing recognition of autoinflammatorydisorders and its inclusion in the nationalcommissioning specification for immunodeficiency,reflects the key role played by immunologists ininvestigating and managing these patients, eithersingly or jointly with rheumatologists. Day-case immunoglobulin infusion clinics forpatients with antibody deficiency form an integralpart of the clinical workload of consultantimmunologists. With increasing recognition of IVIgas a therapeutic immunomodulator, these infusionclinics have expanded in some centres to includenon-antibody-deficient patients, eg those withinflammatory neuropathies. Immunologists are increasingly involved in thesupervision of patients receiving therapeuticbiologics for systemic autoimmune disease. Theimmunology laboratory plays a key role inmonitoring the response to certain biologics asexemplified by B-cell quantification in patientsreceiving rituximab (an anti-CD20 monoclonalantibody). Many laboratories have led theintroduction of interferon-γ assays to detect latenttuberculosis as part of the pretreatment assessmentof patients receiving anti-tumour necrosis factor(TNF)-based therapies.Outpatient workOutpatient work includes the following: primary immunodeficiency clinics severe allergic disease clinics day-case desensitisation immunotherapy challenge clinics for drug and food allergy combined clinics with paediatricians for childrenwith immunodeficiency and allergy combined clinics with rheumatologists supervision of day-case immunoglobulin infusionclinics for antibody replacement and therapeuticimmunomodulation140 C○ Royal College of Physicians 2013