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

More documents

Recommendations

Info

2 Specialties NeurologyNeurologyDr J Gareth Llewelyn BSc(Hons) MD FRCP Consultant neurologist1 Description of the specialtyNeurology is the branch of medicine dealing withdisorders of the nervous system, including the brain,spinal cord, peripheral nerves and muscle. Specialistcare is provided by consultant neurologists workingwithin a network of specialist nurses,neurophysiotherapists, occupational therapists, speechand language therapists, neuropsychologists,psychotherapists, neuropsychiatrists,neurophysiologists, physicians and surgeons, includingGPs with a special interest (GPwSIs) in conditions suchas epilepsy, Parkinson’s disease or headache.The patient with a neurological illness should easily beable to access a neurology network that includes servicesat a district general hospital (DGH), neurology centre(NC) and a regional neurosciences centre (RNC).Neurologists provide a clinical lead for teams within thenetwork, coordinating the patient’s clinical pathway andpromoting the cause of patients.Who are the patients?Sixteen common diseases (including epilepsy, headacheand migraine) account for 75% of all new outpatientreferrals, the investigation and management of whichhave become more complex in the light of new medicaland surgical treatments. The remaining 25% of patientshave unusual disorders or complex symptomatologythat requires expert assessment, sophisticatedinvestigation and management (eg spinocerebellardegeneration). All patients need prompt and carefulassessment with an appropriate and safe managementplan.Disease patternsOne in six people has a neurological condition thatmakes a significant impact on their lives. 1Every year 0.6–1% of the population is diagnosed with aneurological condition and 2% of the UK population isdisabled by a neurological illness.Long-term neurological conditions (LTNCs) are verycommon – taken together there are about a 1,000patients with epilepsy, multiple sclerosis (MS) andParkinson’s disease per 100,000 of the population.2 Organisation of the service and patternsof referralThe components of the network – community settingssuch as small DGHs, NCs based in larger DGHs andRNCs – should share common protocols andguidelines. Some specialist services will be based only inparts of the network or even in some parts of the UK.Community clinicsWhere appropriate, some outpatient clinic activity willbe in community settings providing a service close tothe patient’s home.District general hospital neurology centresNeurologists increasingly work together in a neurologycentre based at a DGH. They provide a general andspecial interest neurological service with clinicalneurophysiology, neuroradiology andneurorehabilitation services but without inpatientneurosurgery facilities. These centres may haveinpatient beds for the care of acute emergencies and theinvestigation of patients with complex neurologicaldisease. The Royal College of Physicians (RCP) and theAssociation of British Neurologists (ABN) recommendthe development of these DGH neurology centres acrossthe UK. 2Regional neurosciences centresThese are crucial to the provision of high-quality care.They provide access to all relevant modern investigativeequipment and an appropriate environment for themanagement of both the more common disorders andtherarercomplexconditionsthatoftenrequireinputfrom more than one professional. All neurologistsshould have links and be attached to a neurosciencescentre.Acute neurological services (unscheduled care)Close to 20% of acute medical admissions (includingstroke) results from neurological problems. SomeC○ Royal College of Physicians 2013 173
Consultant physicians working with patientsare life threatening and require early specialistintervention.At the moment early access to neurological specialistadvice is not available in many DGHs in the UK. 2There needs to be an increase in neurology sessions inlarger DGHs to provide timely access to specialistopinion for patients admitted with neurologicaldisorders, with appropriate local access to relevantneurological investigations, eg neuroradiology andneurophysiology at the DGH.Patients with neurological disorders need to bemanaged on one ward of the hospital with suitablytrained nursing staff. Therapists and neurologicalrehabilitation can then be linked to this specialist team.Stroke servicesAcross the UK, neurologists have steadily but variablyincreased their involvement in acute stroke care,working in collaboration with care of elderly people,and stroke and acute internal medicine physicians, butthis needs to become more uniform, fully supportingand training junior staff.Neurology outpatient services (scheduled care)Patients with neurological problems should, wherefeasible, be seen for consultation as close to their homeas possible. Many patients with LTNCs can bemonitored by specialist nurses and/or GPwSIs, providedthat they are supported by the consultant neurologist.The principles of community care are as follows: local access for all patients with chronic neurologicaldisorders patient-centred care patients seen by an appropriately skilled clinician (egphysiotherapist, specialist nurse or consultantneurologist) identifying a key worker (nurse specialist,consultant, etc) designated consultant neurologist in charge better integration with social services improving clinical skills locally.Care pathways are required for patients with LTNCs andthe responsibilities of team members must be identified.Neurological care in the community is fully endorsed bythe RCP and ABN. 2Complementary servicesNeurologists support the use of complementarytherapies for their patients where there is an evidencebase.3 Working with patients: patient-centredcareWhat you do with patientsInvolving patients in decisions about theirtreatmentFollowing the initial outpatient consultation andinvestigation a diagnosis can usually be made andtreatment plans discussed with the patient, the familyand the GP. Some will require ongoing care, involvingrehabilitation and other local community services.Patients should have the name and contact details of akey worker and be able to access the most appropriatepart of the network at all times. For certain patientgroups, education, support and counselling are alsoundertaken by specialist nurses.In England, the national service framework (NSF) forlong-term conditions was launched in 2005, providing11 quality requirements to improve the care of patientswith LTNCs. In response, the ABN produced its owndocument setting out generic and specific guidance forimplementation with appropriate performancestandards. 3In 2011 the National Audit Office report 7 highlightedbasic problems with the NSF at its half-way stage.Services for people with long-term neurologicalconditions are not as good as they ought to be, despite alarge increase in spending. Progress in implementingthe Department’s strategy has been poor and localorganisations lack incentives to improve the quality ofservices.It is not clear how lessons will be learnt and there areriskstoserviceswhichtheDepartmentmustaddresstoensure that care improves.This was followed last year by a critical Public AccountsCommittee report 8 which concluded that:. . . services for people with neurological conditions aresimply not up to scratch, and the implementation of theFramework for improving neurology services has not174 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:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130: 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 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 ...

Create successful ePaper yourself

Delete template?

Save as template?