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

More documents

Recommendations

Info

2 Specialties Medical oncologyaround standardised ‘prescriptions’ of information andthe process and documentation of consent. The NCIGceased to exist in 2013 but medical oncologists now leadand participate in the Chemotherapy Clinical ReferenceGroup, which has taken on many of the roles of NCIG.Over the next 2 years, in collaboration with Macmillan,standardised national consent forms will be introducedto ensure higher standards of consent for systemiccancer treatment. This work, including patient nursingand pharmacy staff, has been led by medical oncology,initially through the NCIG and now through the JointCollegiate Council for Oncology (JCCO). Medicaloncologists are key members and often leaders of MDTsin which the patient is at the centre of any managementdecision. Adherence to national guidelines, the IOG, 5ensures high-quality services. All patients should beoffered participation in appropriate clinical trials, whichmay facilitate access to drugs that are not otherwiseprovided by the NHS. Medical oncologists arerepresented(oftenaschairpeople)onallrelevantNCRIclinical studies groups on which patient representativesensure that patients’ voices are heard as early as possibleduring the planning stages of clinical trials.Increasing importance is paid to provision ofpsychological support and to access to informationabout financial support. With more patients survivingthrough cure or prolonged control of cancer, survival isbecoming an important issue for many. Medicaloncologists are increasingly involved in identifying,monitoring and treating late effects, both of cancer andof its treatment.Patient support groupsLocal self-help groups within hospitals and thecommunity can improve patient education andsupport. Medical oncologists provide staff educationwithin the specialist oncology team, the general hospitaland the community services that provide much of thepatient care. The expert patients’ programme provideslay-led, group-based support for patients, empoweringthem to improve their quality of life despite living witha long-term condition. The National Awareness andEarly Diagnosis Initiative (NAEDI) is coordinating aprogramme of activity to raise public awareness of signsand symptoms of early cancer to encourage people toseek help sooner.Patients may wish to explore complementary therapytogether with standard treatment. This need has beenrecognised in a paper published by the JCCO. 74 Interspecialty and interdisciplinary liaisonand opportunities for integrated careMedical oncology is by design, and by national guidance,an integrated specialty through MDT working.Multidisciplinary team workingAll newly diagnosed patients are discussed in a relevantMDT meeting and a recommended treatment plan isagreed in accordance with tumour site-specificguidelines and protocols. Often medical oncologists arethe coordinators of these treatment plans, working withother specialties to create defined care pathways bothfor elective care and within acute oncology.Working with other specialtiesWithin the MDT, medical oncologists work closely withsurgeons, physicians, clinical oncologists, radiologists,pathologists, specialist nurses and the palliativecare team. The MDTs are required to communicateeffectively with those in primary care who, in turn, havetargets to ensure prompt referral of new patients. 2,3An RCP/RCR working party has recently published adocument, Cancer patients in crisis – responding to urgentneeds, which was produced by specialists in medicaloncology, clinical oncology, palliative care, emergencymedicine, intensive care, acute medicine, together withpatient representatives in recognition of the complexitiesof acute cancer management in emergency situations. 8Working with GPs and GPs with a special interest(GPwSIs)Communication with GPs is vital to provide seamlesscare at all stages of a patient’s illness. Patients in remissionrequire a coordinated follow-up strategy. Palliativetreatments require excellent communication andcoordination between oncologists and the community.Medical oncologists are frequently the non-surgicaloncology leads for trusts, providing input into themanagement and planning of services and workingclosely with trust management and primary care trusts(PCTs) on commissioning issues.Other specialty activity beyond local servicesMost medical oncologists will be based in a cancercentre and provide a number of direct clinical care(DCC)-programmed activities (PAs) in a peripheralcancer unit within their network. For some, theprincipal site of activity is within a cancer unit and theywill visit their cancer centre for audit, research andcontinuing professional development (CPD).C○ Royal College of Physicians 2013 155
Consultant physicians working with patientsWith the introduction of acute oncology, every trustthat cares for elective and non-elective admissions withcancer must establish an MDT that ensures that thereare pathways for the care of patients presenting for thefirst time with cancer, or at later stages within theircancer journey with complications due to disease ortreatment. Addressing this neglected area of cancer carerepresents new activity for medical oncologists where akey requirement is availability at an early stage. Thisrequires investment through strong partnerships ofcommissioners, cancer service providers and cancernetworks. New medical oncology posts are beingestablished to support this additional workload,recognised as sessions of DCC within job plans.Joint Collegiate Council for OncologyOn a national level medical oncologists work withcolleagues from clinical oncology and haematologythrough the JCCO to provide a nationally coordinatedforum for guidance and advice to government andcommissioners. The JCCO includes patient/userrepresentation and has participation from theDepartment of Health through the membership of thenational cancer director.5 Delivering a high-quality serviceWhat is a high-quality service?A high-quality service can be judged by the criteria ofpatient satisfaction, adherence to national and networkguidelines and accreditation standards, and theachievement of outcomes which, when audited andcompared with national cancer care standards andpublished reports, are deemed to be excellent.The NCIG (directed through the NCAT) developed keyperformance indicators that provide benchmarks forthe assessment of the quality of oncology services.Cancer is increasingly a long-term condition and manycancer survivors receive complex and toxic ongoingdisease-modifying treatments. It is imperative thatreductions in new:follow-up ratios are not used as aquality indicator in this setting.Maintaining and improving the standard of careThe system of cancer peer review ensures adherence toguidelines such as the IOG and cancer strategypublications. 1–5 Medical oncologists lead and supportthese processes and are key members on other nationalbodies, such as the National Institute for Health andCare Excellence (NICE) and NCIG, tasked withimproving standards and outcome.Service developments to deliver improvedpatient careMedical oncologists are at the centre of nationalplanning of cancer services, research and therapiesthrough the Association of Cancer Physicians (ACP),NICE, the Royal College of Physicians (RCP), the JCCO,Cancer Research UK, the Department of Health (DH)and, previously, the office of the national cancerdirector.Systemic anti-cancer therapy dataset (SACT)In the last 3 years NCIG, through a working party led bymedical and clinical oncologists, established a nationalchemotherapy database (which is now coordinatedthrough the National Cancer Information Network). Atpresent all chemotherapy activity in England, wherethere is electronic prescribing of chemotherapy, is beingcharacterised within a standard dataset (SACT) and sentmonthly to the database. Within the next year, allchemotherapy activity will be required to be uploadedto the database. These data will provide aninternationally unique resource that will be used foraudit, and benchmarking of both activity andmeaningful outcomes such as survival.Education and trainingMedical oncology is a thriving specialty. The lastworkforce census reported an annual increase ofconsultants by 6.3% (compared with 5.3% for medicalspecialties as a whole). 9The training and supervision of specialty registrars(StRs) is becoming more detailed and time-consuming.There are currently 248 trainees within 25 trainingprogrammes across the UK. The minimum time forhigher specialist training in oncology is 4 years, but, as itis a research-based specialty, many undertake extraout-of-programme research.A competency-based curriculum has been developedwhich incorporates the 17 Postgraduate MedicalEducation and Training Board (PMETB) standards.Formal assessment of competence in procedures,knowledge, understanding of clinical trials, clinicalskills and attitudes of the aspiring medical oncologistfall to the existing consultant body through the use ofassessment tools, including mini-clinical examination(mini-CEX) and multisource feedback appraisal. SinceNovember 2010, trainees sit the specialty examination156 C○ Royal College of Physicians 2013
Page 1 and 2:
Consultant physiciansworking with p
Page 3 and 4:
The Royal College of PhysiciansThe
Page 5 and 6:
AcknowledgementsWe would like to th
Page 7:
AbbreviationsA&EAACsAMUsARCPCCGsCCS
Page 12 and 13:
1 Physicians in the NHS todaycan be
Page 15 and 16:
Consultant physicians working with
Page 17 and 18:
Page 19 and 20:
Page 22 and 23:
2 The work of the specialties2 The
Page 24 and 25:
2 Specialties Acute internal medici
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32:
Page 35 and 36:
Page 37 and 38:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 54 and 55:
2 Specialties Cardiovascular medici
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
2 Specialties Clinical geneticsClin
Page 68 and 69:
2 Specialties Clinical geneticsPati
Page 70 and 71:
2 Specialties Clinical genetics6 Cl
Page 72:
2 Specialties Clinical geneticswork
Page 75 and 76:
Page 77 and 78:
Page 80 and 81:
2 Specialties Clinical pharmacology
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
2 Specialties DermatologyDermatolog
Page 90 and 91:
2 Specialties Dermatology run monit
Page 92 and 93:
2 Specialties DermatologyDermatolog
Page 94 and 95:
2 Specialties DermatologyTable 1 Ex
Page 96:
2 Specialties Dermatology4 Parkin D
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 106 and 107:
2 Specialties Gastroenterology and
Page 108 and 109:
Page 110 and 111:
Page 112 and 113: 2 Specialties Gastroenterology and
Page 114 and 115: 2 Specialties Gastroenterology and
Page 116: 2 Specialties Gastroenterology and
Page 119 and 120: Consultant physicians working with
Page 134 and 135: 2 Specialties HaematologyHaematolog
Page 136 and 137: 2 Specialties HaematologyTable 2 A
Page 138 and 139: 2 Specialties Haematologythey have
Page 140 and 141: 2 Specialties HaematologyTable 4 Sp
Page 142: 2 Specialties Haematology11 Departm
Page 160 and 161: 2 Specialties Medical oncologyMedic
Page 164 and 165: 2 Specialties Medical oncologyset b
Page 166 and 167: 2 Specialties Medical oncologyTable
Page 168 and 169: 2 Specialties Medical ophthalmology
Page 174 and 175: 2 Specialties Metabolic medicineMet
Page 176 and 177: 2 Specialties Metabolic medicineof
Page 178: 2 Specialties Metabolic medicinemet
Page 196 and 197: 2 Specialties Palliative medicinePa
Page 198 and 199: 2 Specialties Palliative medicine-
Page 200 and 201: 2 Specialties Palliative medicineA
Page 202 and 203: 2 Specialties Palliative medicineTa
Page 204: 2 Specialties Palliative medicine24
Page 212 and 213:
2 Specialties Rehabilitation medici
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
2 Specialties Renal medicineRenal m
Page 222 and 223:
2 Specialties Renal medicineLocal a
Page 224 and 225:
2 Specialties Renal medicineInvolve
Page 226 and 227:
2 Specialties Renal medicineAcademi
Page 228 and 229:
2 Specialties Renal medicineTable 1
Page 230:
2 Specialties Renal medicinekidney
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 270 and 271:
3 Supporting the delivery of high-q
Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
Page 278 and 279:
Page 280:
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?