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

More documents

Recommendations

Info

2 Specialties Medical ophthalmologyWorking with other specialtiesOphthalmic physicians work closely with otherspecialties, although the specialties vary depending onthe areas covered. The following list is not exhaustivebut shows the variety of specialties that interact withmedical ophthalmology: ocular and orbital inflammation – rheumatology,renal medicine, respiratory medicine,endocrinology, dermatology, infectious diseases,microbiology, haematology and radiology neuro-ophthalmology – neurology, neurosurgery,endocrinology, stroke, rehabilitation medicine andradiology diabetic eye disease – diabetes, renal medicine andobstetrics medical retina – clinical genetics and stroke.Working with community servicesThe traditional organisational boundaries of primaryand secondary care are becoming blurred 7 and this isparticularly true for ophthalmic practice with thegrowing role of community-based optometry services.Chronic disease management (eg diabetes) andprevention of disease (eg smoking cessation) arecommonly organised through general practice.Increasingly, optometrists are taking on extended rolesand being trained to diagnose and manage specificanterior segment eye conditions and glaucoma.Effective communication between different communityservices and between hospital and community servicesis vital to ensure that patients are referred in a timelyand appropriate fashion.Ophthalmology departments work with local socialwork departments and societies for the visuallyimpaired to ensure that patients with sight loss are ableto live as independently as possible. Eye clinic liaisonofficers exist in some centres to provide information,emotional support and advice to patients and cruciallyact as a link between the eye clinic, rehabilitationservices (such as low vision aid assessments) andsupport services in the community for patients withvisual impairment.5 Delivering a high-quality serviceWhat is a high-quality service?A high-quality medical ophthalmology service is onethat bridges the gap between hospital ophthalmicservices, medical care and community-based care, usingresources efficiently and effectively to provide acoordinated, patient-centred service for those withmedical ophthalmic problems.Effective communication with patients and theirfamilies and between ophthalmic physicians and otherhealth professionals involved, including those incommunity services, is essential.Quality of services should be monitored andophthalmic physicians should audit the performance oftheir services regularly, eg recording complication ratesfrom intravitreal injections and visual outcomes fortreated AMD.Ophthalmic physicians have a responsibility to train notonly doctors and trainee doctors but also members ofthe wider team, which may include nurses, optometristsand orthoptists. They have a leadership role within thehospital eye service and may choose to take on othermanagement responsibilities or roles within theNational Health Service (NHS), deanery, university orcollege.Ophthalmic physicians should manage their owncontinuing professional development (CPD) and have aresponsibility to maintain their knowledge and skills, topractise safety and to keep up to date with newdevelopments. They should recognise their limitationsand work within their capabilities, referring patients onor seeking advice where appropriate.Societies and collegesThe Medical Ophthamological Society UK is theprofessional society for ophthalmic physicians(www.mosuk.co.uk). The Royal College ofOphthalmologists (www.rcophth.ac.uk)istheprofessional body for ophthalmologists, which includesophthalmic physicians, and has a role in trainingdelivery, manpower planning and other professionalissues. The Joint Royal Colleges of Physicians TrainingBoard (JRCPTB) runs the medical ophthalmologytraining programme, 8 with input from the RoyalCollege of Ophthalmologists. Trainees in medicalophthalmology enter specialty training (ST) at ST3 levelfrom either core medical training or ophthalmologytraining.GuidelinesThe following guidelines are relevant to medicalophthalmology:C○ Royal College of Physicians 2013 163
Consultant physicians working with patientsDiabetic eye disease Royal College of Ophthalmologists. Diabeticretinopathy preferred practice screening guidance. 9 NHS Quality Improvement, Scotland. Diabeticretinopathy screening clinical standards. 10 Royal College of Ophthalmologists. Guidelines fordiabetic retinopathy. 9Age-related macular degeneration Royal College of Ophthalmologists. Maximisingcapacity in AMD services. 9 Royal College of Ophthalmologists. Guidelines formanagement of AMD. 9 Royal College of Ophthalmologists. Guidelines forintravitreal injections procedure. 9Retinal vein occlusion Royal College of Ophthalmologists. Interimguidelines for the management of retinal veinocclusion. 96 Clinical work of consultantsMedical ophthalmology is an outpatient-based specialtyalthough there are usually facilities for day-case andinpatient admission for a minority of patients.Most ophthalmic physicians do not participate inout-of-hours work, but it would be feasible foran ophthalmic physician to be on an ophthalmologyon-call rota if there was cover provided by anophthalmic surgeon for the small proportion of casesthat require urgent surgery.Specialist clinics such as ocular inflammation andneuro-ophthalmology require direct consultantinvolvement and close supervision of trainees. With thehigh-demand services like AMD and diabeticretinopathy, there is often a more supervisory role.Ophthalmic physicians need to facilitate rapid referraland diagnosis of patients with macular degenerationand are responsible for the quality of the service. Otherhealth professionals such as nurses and optometristsmay be trained to assess and manage patients withmacular degeneration according to protocols. ‘Virtualclinics’, where clinical decisions are made on the basis ofocular images and visual acuity, are used in somecentres for diabetic maculopathy to determine whichpatients need to be seen in the diabetes eye clinic.Clinical administration work can be time consumingdue to the large numbers of referrals and outpatientreviews. Ocular inflammation and neuroophthalmologyclinics are particularly demanding asadditional investigations are often required and apatient may be under the care of a number of specialists.7 Opportunities for integrated careMedical ophthalmology is complex. Hospital services,general practice, community eye services and socialservices need to be coordinated. Optometrists servelocal communities and have the ability to perform amore complete ophthalmic examination than can beachieved in general practice but until recently this hasbeen underused by the NHS. The role of theoptometrist has been reviewed in the Generalophthalmic services review (2007) 11 and the Review ofcommunity eyecare services in Scotland (2006). 12Optometrists are now taking on extended roles, in someareas taking referrals from general practice, managinganterior segment eye conditions and glaucoma in thecommunity with extended prescribing rights, andworking up more complex cases to a higher level beforethey are referred to the hospital eye service. 12 Linkingcommunity optometrists with social services andhospital eye services allows optometrists to identifythose with failing sight and to refer on for treatmentand social-work assessments where appropriate.Cost-effective evidence-based treatments are lacking ina number of areas of medical ophthalmology butparticularly in the field of ocular inflammation wherethere are no licensed immunosuppressive medications.Clinical research should be encouraged and integratedwith routine clinical care.8 Workforce requirements for the specialtyThere are currently 10 consultant medicalophthalmologists and eight trainees in the UK. Thereare no academic medical ophthalmologists or academictraining posts at present.More than half of new referrals to ophthalmology arefor medical rather than surgical ophthalmic problems. 13It is recognised that there is a lack of trained medicalspecialists and that a substantial expansion in numbersof consultants is required to deliver services in the UK.It is estimated that a ratio of one ophthalmic physicianto eight ophthalmic surgeons in a unit is required, and itis predicted that in the future there will be one164 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:
Page 114 and 115:
Page 116:
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 162 and 163: 2 Specialties Medical oncologyaroun
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 172 and 173: 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 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?