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2 Specialties Medical oncologyTable 2 Sample job plan for academic medical oncologist with a major laboratory interestActivityProgrammed activities (PAs)Direct clinical careInpatient care (ward rounds and ward consultations) 1.0MDTs/MDT meetings 0.75Outpatient clinics 1.5Patient administration and clinical follow-up (letters, referrals, telephone calls) 1.75On call (supporting junior doctor on-call arrangements) 0.5Total number of direct clinical care PAs 5.5Supporting professional activities (SPAs)Medical education 0.25CPD 0.25Research (clinical trials, translational research in drug development, supervision of MD and PhDstudents)Other NHS duties (local trust committees, eg research and development, clinical governance andaudit)3.250.25External duties (international boards, lectures on behalf of employing institution) 0.5Total number of supporting professional activities 4.5Total programmed activities 10Note: medical oncologists, particularly in academic centres, may work with other consultant medical oncologists as part of a team sharing theoutpatient and inpatient care of a group of patients. In this case, responsibilities may vary weekly or monthly, for which an annualised job planis required.CPD = continuing professional development; MDT = multidisciplinary meeting.7 Workforce requirements for the specialtyThe number of medical oncologists has risen from 138in November 2000 to 408 in September 2012. WithMDT working, an ageing population, additional lines oftreatment available, ongoing drug development andsubsequent personalisation of cancer treatment, as wellas the generation of acute oncology services, thenumber of medical oncologists required has inevitablyincreased. To adequately provide an acute oncologyservice, approximately 100 new posts will be requiredacross the UK. The provision of acute oncology isrecognised with new posts as follows: 9 of a total of 36new appointments in 2009–10, 12 of 26 posts in2010–11 and 20 of 39 posts in 2011–12, with potentiallya further 100 posts for the provision of personalisedmedicine. Therefore, the predicted workforcerequirement in the UK is a minimum of 550 posts,representing 2.75 whole-time equivalent (WTE) postsper 200,000–250,000 population.8 Consultant work programme/specimenjob planThe workload of a medical oncologist, measured by thenumber of new patients seen annually, should beapproximately 200 (100–150 for academic medicaloncologists). Due to the lack of specialist oncologists inmuch of the UK, the workload of the majority ofmedical oncologists exceeds this.An on-call rota of oncology specialists should provide24-hour emergency cover, if necessary together with colleaguesfrom haematology or clinical oncology to ensuresufficient numbers for a rota (maximum one in five).9 Key points for commissioners1 Medical oncology is a specialty that should berepresented in every cancer centre and most cancerMDTs.C○ Royal College of Physicians 2013 159
Consultant physicians working with patients2 The requirement for systemic cancer therapy isincreasing through new therapies, the ageingpopulation, personalised complex therapies andprolonged survival with cancer.3 Patients surviving cancer require increasingspecialist intervention and monitoring to maintainremission and to deal with late effects of cancer andtherapies.4 Acute oncology is a new multidisciplinary serviceoffering significant gains in quality of patient careand clinical efficiency.5 Acute oncology requires an invest-to-save approachby commissioners and providers.6 Clinical trials are a prerequisite of high-qualitycancer care and are an expected component ofmedical oncologists’ direct clinical care.7 Translational research supports new treatmentsand subsequently better outcomes for patients withcancer. Medical oncologists are key drivers of theconcept of bench to bedside.8 Medical oncologists lead the development andintegration of new treatments safely into routinepractice.9 Training and education in systemic therapy forjunior medical staff and other healthcareprofessionals are a vital part of the role of themedical oncologist.10 The SACT dataset and database will provide aunique resource for benchmarking and audit ofchemotherapy activity and outcomes. New qualityindicators will need to be developed to supportcommissioning and management of advanceddisease, which in many areas is becoming along-term condition. Particular attention isrequired in relation to supervision of new andadditional therapeutic options, as well as survivalissues, complications and patient self-managementinitiatives.References1 Department of Health. Chemotherapy services in England:ensuring quality and safety. A report by the NationalChemotherapy Advisory Group. London: DH, 2009.http://ncat.nhs.uk/sites/default/files/NCAG%20Report.pdf2 Department of Health. The NHS cancer plan: a planfor investment, a plan for reform. London: DH,2000.3 Department of Health. Cancer reform strategy. London:DH, 2007. www.cancerscreening.nhs.uk/breastscreen/dh-081007.pdf4 Department of Health. Improving outcomes: a strategy forcancer. London: DH, 2011. www.gov.uk/government/uploads/system/uploads/attachment data/file/135516/dh 123394.pdf.pdf5 National Institute for Health and Care Excellence.Improving outcomes guidance. London: NICE. www.nice.org.uk/Search.do?x=12&y=15&searchText=Improving+outcomes+guidance&newsearch=true#/search/?reload[Accessed 21 March 2013].6 National Confidential Enquiry into Patient Outcome andDeath. For better, for worse? A review of the care of patientswho died within 30 days of receiving systemic anticancertherapy. London: NCEPOD, November 2008. www.ncepod.org.uk/2008report3/Downloads/SACT report.pdf7 Royal College of Radiologists. Interactions between cancertreatment and herbal and nutritional supplements andmedicines: information for doctors. BFCO (06)3. London:RCR, 2006. www.rcr.ac.uk/index.asp?PageID=149&PublicationID=239 [Accessed 21 March 2013].8 Royal College of Physicians and Royal College ofRadiologists. Cancer patients in crisis: responding to urgentneeds. Report of a working party. London: RCP, 2012.www.rcplondon.ac.uk/sites/default/files/documents/cancer-patients-in-crisis-report.pdf [Accessed 21 March2013].9 Federation of the Royal Colleges of Physicians of the UK.Census of consultant physicians and medical registrars inthe UK, 2011: data and commentary. London: RCP, 2013.www.rcplondon.ac.uk/sites/default/files/census ofconsultant physicians and medical registrars in the uk2011 1.pdf [Accessed 21 March 2013].10 Medical Research Council. Guidelines for good clinicalpractice in clinical trials. London: MRC, 1998.www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC002416 [Accessed 21 March 2013].11 Directive 2001/20/EC of the European Parliament and ofthe council of 4 April 2001. Official Journal of theEuropean Communities 2001;L121;34–44. http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2001:121:0034:0044:en:PDF [Accessed 21 March 2013].160 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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