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

More documents

Recommendations

Info

2 Specialties Neurologyworked . . . we identified an absence of leadership atboth national and local level and poor integration ofservices as key weaknesses that must be addressed. It istherefore extremely disappointing that the Departmenthas rejected our recommendations in relation to theseissues . . . the Department has got to do better and wewill be taking this up with them in due course.Neurologists are often part of the team providing carefor patients who are at the end of their lives. Patients,carers and families need to be kept fully informed aboutprognosis and the range of services available. It isessential to coordinate pain control and emotional andpsychological care.Patient support groupsPatients and carers should have access to high-qualityinformation about their neurological condition,investigations and treatment, and to local branches ofneurological charities, together with a wide range ofhealthcare workers. Increasingly, neurological patientsare experts in their condition and may be part of themultidisciplinary team (MDT) as expert patients.Availability of clinical records and resultsAll patients should be offered copies of clinic letters andthe results of investigations. Patient records should beavailable at all times to all treating agencies. This is nowincreasingly possible by electronic means.4 Interspecialty and interdisciplinary liaisonMultidisciplinary team workingNeurologists frequently work as part of MDTs whencaring for acutely ill patients and especially for patientswith LTNCs. Clinical nurse specialists and therapistswith knowledge of neurological conditions are key teammembers and some should be based in the community.Links with care of elderly people and social servicesneed to be better developed, so that patients receive theappropriate care and support required.Transition careThe ABN fully supports the RCP’s young adult andadolescent initiative to improve healthcare outcomes forthose aged 16–24 years. Some neurologists alreadyundertake transition clinics with paediatric colleagues(in specialties such as epilepsy and neuromusculardiseases) but there is a need to increase the profile ofthis type of specialist service and to ensure that it isappropriately supported by trusts and health boardsacross the UK.Working with other specialistsManaging acute neurological conditions involvesworking with acute and other medical specialists in themedical admissions unit (MAU) and during wardliaison to improve appropriateness of investigations,obtain early diagnosis and speed up discharge fromhospital by facilitating appropriate follow-up. There hasto be a close liaison with radiologists, intensivists andneurophysiologists, and the involvement ofneurosurgery and neurorehabilitation. Neurologistshave an increasing role in stroke care together withstroke physicians and geriatricians. Neurologists alsowork with psychiatrists in dementia services.Long-term condition services need neurologists,neurorehabilitationists, geriatricians and palliative carephysicians.Close liaison also exists between neurology and otherspecialties in the following areas: Parkinson’s disease(geriatrics), dementia (psychogeriatrics), higherfunction disorders (neuropsychiatry andneuropsychology), double vision and visual loss(ophthalmology), dizziness (ear, nose and throat,audiovestibular physicians), peripheral nerve and nerveroot disease (orthopaedics), inherited neurologicaldisease (clinical genetics), functional disorders(psychiatrists), pain teams and obstetric services.Working with GPs and GPwSIsCare for patients with LTNCs has traditionally beenbased in DGH or RNC outpatient clinics that are mainlyconsultant delivered, and more recently have had nursespecialist input. Newer networks of care are developingwith the involvement of primary care, and neurologistsare key members of these networks. Better use needs tobe made of combined meetings, educational seminarsand clinical guidelines to underpin this network.5 Delivering a high-quality serviceWhat is a high-quality service?The ABN and the Neurological Alliance(www.neural.org.uk) are currently assessing whatoutcomes can be measured to reflect high-quality care.These have to be meaningful and applicable to allneurology units in England, Wales and NorthernIreland. Scotland has published clinical standards forC○ Royal College of Physicians 2013 175
Consultant physicians working with patientsthe neurological health services, 4 with implementationof these standards from 2010. The National Institute forHealth and Care Excellence (NICE) has already setquality standards for stroke and dementia.The framework is in part set out in ABN 3 and RCP 5documents and the main criteria would include: a patient-centred service timely referral (according to the waiting-time targetset out by individual home nations) and adherenceto existing NICE guidance involvement of a neurologist in assessing acuteneurological emergencies provision of appropriate follow-up access to clinical nurse specialists and therapists access to rehabilitation access to palliative care clear and up-to-date information available topatients.Maintaining and improving the quality of careExcellence should be maintained and deficienciesidentified and corrected through: service developments to deliver improved care leadership role for consultant neurologists inintroducing service change education and training constructive appraisal continuing professional development clinical governance research regional and national work for the royal colleges,ABN, deaneries, Department of Health and BritishMedical Association, and as advisers to variouspatient support groups, as examples.Specialty and national guidelinesAssociation of British Neurologists’ guidelinesThe following are available at www.abn.org.uk:Neurology in the United Kingdom: numbers of clinicalneurologists and trainees (1996)Neurology in the United Kingdom: towards 2000 andbeyond (1997)Acute neurological emergencies in adults (2002)Levelling up (Neurological Alliance, 2002)The medical management of motor neurone disease – aUK perspective of current practice (2002)Academic neurology in the United Kingdom: threats,opportunities and recommendations (2003)Standards of care for people with neurological disorders(2004)Intravenous immunoglobulin in neurological diseases(2005)ABN guidelines for treatment of multiple sclerosis withB-interferon and glatiramer acetate (2009).NICE guidanceThe following are available at www.nice.org.uk:Alzheimer’s disease: donepezil, rivastigmine andgalantamine (replaced by TA111) (2001)Guidance on the use of riluzole (Rilutek) for thetreatment of motor neurone disease (2001)Beta interferon and glatiramer acetate for thetreatment of multiple sclerosis (2002)Multiple sclerosis: management of multiple sclerosis inprimary and secondary care (2003)Head injury: triage, assessment, investigation and earlymanagement of head injury in infants, children andadults (2007)The epilepsies: the diagnosis and management of theepilepsies in adults and children in primary andsecondary care (2004)Parkinson’s disease: diagnosis and management inprimary and secondary care (2006)Dementia: supporting people with dementia and theircarers in health and social care (2006)Natalizumab for the treatment of adults with highlyactive relapsing–remitting multiple sclerosis (2007)Neuropathic pain: the pharmacological management ofneuropathic pain in adults in non-specialist settings(2010)Management of transient loss of consciousness in adultsand young people (2010)Headache: diagnosis and management of headaches inyoung people and adults (2012)The epilepsies: the diagnosis and management of theepilepsies in adults and children in primary andsecondary care (2012)Urinary incontinence in neurological disease (2012)Spasticity in children and young adults (2012).NICE quality standardsQuality standards for epilepsy and headache are underdevelopmentRCP guidelines and reportsThe following are available at www.rcplondon.ac.uk:Chronic spinal cord injury: management of patients inacute hospital settings (2008)176 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:
Page 131 and 132: 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 181: Consultant physicians working with
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?