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

2 Specialties NeurologyCare after stroke or transient ischaemic attack:information for patients and their carers (2008)Measuring clinical outcome in stroke: acute care (2008)Stroke: national clinical guideline for diagnosis andinitial management of acute stroke and transientischaemic attack (TIA) (2008)Spasticity in adults: management using botulinumtoxin: national guidelines (2009)Long-term neurological conditions: management at theinterface between neurology, rehabilitation andpalliative care (2008)Oral feeding difficulties and dilemmas: a guide topractical care, particularly towards the end of life(2010)Local adult neurology services for the next decade:report of a working party (2011).Scottish Intercollegiate Guidelines Network(SIGN) guidelinesThe following SIGN guidelines are available atwww.sign.ac.uk: Diagnosis and management of epilepsy in adults(2005) Management of patients with dementia (2006) Management of patients with stroke or TIA:assessment, investigation, immediate managementand secondary prevention (2008) Diagnosis and management of headache in adults(2008) Early management of head injury (2009) Management of patients with stroke: identificationand management of dysphagia (2010) Management of patients with stroke: prevention andmanagement of complications, and discharge planning(2010) Diagnosis and pharmacological management ofParkinson’s disease (2010).Departments of HealthThe Department of Health (England) published theNSF for long-term conditions in 2005 but this wasstopped after a damning mid-point review (see NationalAudit office and Public Accounts Committee reports);the Department of Health in England will now be underappropriate scrutiny to ensure that there are measurableimprovements in services for patients with LTNCs.The Scottish Government Health Department hasproduced its report 9 on Neurological health services inScotland and its findings show enormous variabilityacross its health boards. It now has a baseline fromwhich to monitor progress.Neurology service guidelines have not been produced bythe governments of Wales and Northern Ireland andthis needs to be rectified urgently.Specialty and national auditIndividually, neurologists participate in national auditprojects (stroke and epilepsy) and the ABN is workingthrough the RCP Clinical Effectiveness Forum toestablish a system for collecting local and regional auditsand to implement a strategy for UK-wide projects.6 Clinical work of consultantsNeurologists should be involved in the acute care ofpeople with neurological disorders 2,6 andshouldhavesufficient sessions to provide this through ward liaisonand attending the MAU and the accident andemergency department.How a consultant works in this specialtyInpatient workThis may take the form of ward rounds, ward liaisonand care of emergency admissions. Time may be spentworking with MDTs, discharge planning, writingdischarge summaries and other patient-relatedadministration.Outpatient workThe number of outpatient clinics will depend on otherduties, in particular the amount of inpatient andemergency work. A 10-session job plan could have 3–4outpatient sessions. When consultants are expected tovisit more than one site, appropriate travel time must beallocated, included as working time, within aprogrammed day-care centre activity.Clinics should be reduced by 25% if they are dedicatedtraining or teaching clinics.The recommended time allocated for each neurologicaloutpatient in a general neurology clinic is: 30 minutes per new patient for a consultant, 45minutes for a specialty registrar (StR) (years 1–3) 15 minutes per follow-up patient for a consultant or30 minutes for an StR (years 1–3).C○ Royal College of Physicians 2013 177