Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
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2 Specialties Immunologyexpansion <strong>of</strong> 75%. In addition to replacing retiringconsultants, numbers will need to expand by 7.5% perannum over the next 10 years to achieve this figure.9 <strong>Consultant</strong> work programme/specimenjob planTable 1 shows a consultant work programme/specimenjob plan.10 Key points for commissioners1 Immunology and allergy services for <strong>patients</strong> <strong>with</strong>primary immunodeficiency, complex allergy andC1 inhibitor deficiency have been designated asnationally commissioned services.2 The specialty deals <strong>with</strong> many rareimmunodeficiency disorders that have designated‘orphan status’ <strong>with</strong>in the European Union.3 Specialist management for <strong>patients</strong> <strong>with</strong> primaryantibody deficiency is highlighted by theimprovements in actuarial survival and reductionsin morbidity that have accrued as a direct result <strong>of</strong><strong>patients</strong> receiving dedicated care fromimmunologists. 16,174 Evidence-based guidelines for the management <strong>of</strong><strong>patients</strong> <strong>with</strong> primary antibody deficiency havebeen developed by UKPIN (including guidance forcommissioners) and, as major users,immunologists have played a key role in thedevelopment and implementation <strong>of</strong> the DH’simmunoglobulin demand management plan.5 The use <strong>of</strong> therapeutic immunoglobulin forantibody deficiency and immunomodulation isunderpinned by a number <strong>of</strong> key performanceindicators (KPIs), which will be monitored as part<strong>of</strong> a national dashboard.6 Patients <strong>with</strong> C1 inhibitor deficiency (hereditaryand acquired) are dependent on emergencytreatment <strong>with</strong> C1 inhibitor and/or bradykininreceptor antagonists (Icatibant) for crises, <strong>with</strong> aminority requiring prophylactic treatment. As <strong>with</strong>antibody deficiency, these <strong>patients</strong> should bemanaged in centres <strong>with</strong> appropriate specialistimmunological expertise.7 Immunologists have led the development <strong>of</strong> hometherapy for <strong>patients</strong> <strong>with</strong> antibody deficiency(immunoglobulin), autoimmune neuropathies andhereditary angioedema (C1 inhibitor).8 Immunologists are major providers <strong>of</strong>comprehensive allergy services and are closelyinvolved in the development <strong>of</strong> accreditationstandards for allergy centres.9 The need for, and evidence supporting, growth inthe capacity <strong>of</strong> specialised allergy services has beenmade repeatedly in recommendations (2003–2010)from the medical royal colleges, the House <strong>of</strong>Commons Health Select Committee and the House<strong>of</strong> Lords Science and Technology Committee.10 Specialised immunology diagnostic laboratoryservices should only be commissioned fromaccredited laboratories.References1 Lambert PH, Metzger H, Miyamoto T, et al. Clinicalimmunology: guidelines for its organization, trainingand certification. Relationships <strong>with</strong> allergology andother medical disciplines. A WHO/IUIS/IAACI report.Clin Exp Immunol 1993;93:484–91.2 Wood P, Stanworth S, Burton J, et al. UK PrimaryImmunodeficiency Network. Recognition, clinicaldiagnosis and management <strong>of</strong> <strong>patients</strong> <strong>with</strong> primaryantibody deficiencies: a systematic review. Clin ExpImmunol 2007;149:410–23.3 El-Shanawany TM, Arnold H, Carne E, et al. Survey <strong>of</strong>clinical allergy services provided by clinicalimmunologists in the UK. J Clin Pathol 2005;58:1283–90.4 Longhurst HJ, Carr S, Khair K. C1-inhibitor concentratehome therapy for hereditary angioedema: a viable,effective treatment option. Clin Exp Immunol2007;147:11–17.5 Gompels MM, Lock RJ, Abinun M, et al. C1 inhibitordeficiency: consensus document. Clin Exp Immunol2005;139:379–94.6 Provan D, Chapel HM, Sewell WAC, O’Shaughnessy D.Prescribing intravenous immunoglobulin: summary <strong>of</strong>Department <strong>of</strong> Health guidelines (on behalf <strong>of</strong> the UKImmunoglobulin Expert Working Group). BMJ2008;337:990–2.7 Department <strong>of</strong> Health. Specialised services nationaldefinitions set: 3rd edn. Specialised immunology services(all ages). Definition no 16. London: DH, 2008.8 Department <strong>of</strong> Health. Specialised services nationaldefinition set, 2nd edn. Specialised pathology services (allages). Definition no. 25. London: DH, 2002.9 Arnold DF, Timms A, Luqmani R, Misbah SA. Does agating policy for ANCA overlook <strong>patients</strong> <strong>with</strong> ANCAassociated vasculitis? An audit <strong>of</strong> 263 <strong>patients</strong>. JClinPathol 2010;63:678–80.10 Harper NJ, Dixon T, DuguéP,et al. Suspectedanaphylactic reactions associated <strong>with</strong> anaesthesia.Anaesthesia 2009;64:199–211.11 Spickett GP, Askew T, Chapel HM. Management <strong>of</strong>primary antibody deficiency by consultantC○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013 143