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

Consultant physicians working with patientsThe duration of consultation appointments in tertiarysubspecialist clinics will vary according to theconsultant/team involved and is likely to be longer thanfor general neurology clinics.Clinically related administrationA minimum of an additional 50% of time per clinic isincluded in direct clinical care for responses to referralsand administration relating to consultations.Balance of clinics, wards, acute andsubspecialty careThis will vary between neurologists, depending on theproportion of the working week spent in the RNC,DGH/NCs, or doing community clinics or at a regionalcentre. Most will have at least one specialist clinic perweek. Neurology beds are mainly located in RNCs, butlarger DGHs designated as NCs should be encouragedto have some dedicated neurology beds withappropriately skilled nursing and junior medical staff.Proportion of direct supervision/teamworkThe proportion of consultant-delivered activity hasincreased. Trainees should have regular meetings withtheir educational and clinical supervisors and the moredemanding delivery and monitoring of traineeeducation require timetabling through the job-planningprocess. All neurologists should be within a team, butthe team structure will vary depending on the site(DGH/NC/RNC) of greatest clinical activity.Community-based workOver the last decade, clinical nurse specialists (CNSs)and GPwSIs have played an increasing role in themanagement of patients with a range of neurologicalconditions both in hospital and in the community.Average ratios of new:follow-up patients are on thewhole meaningless, particularly when caring forpatients with LTNCs, and do not reflect quality of care.Specialist investigative and therapeuticproceduresThese are limited, with the exception of a botulinumtoxin injection. It may become more common forneurologists to have a role in the running ofelectroencephalography (EEG) and electromyography(EMG) clinics.Specialist on callThis may be a regional rota from the neurosciencescentre, or based more locally if this can be achieved.Other specialist activityMany neurologists will have regional or supra-regionalclinical responsibilities.7 Opportunities for integrated carePathways for a number of neurological conditionsalready exist (stroke, epilepsy, Parkinson’s disease,motor neuron disease and acquired brain injury) butthis is an area that requires further expansion.Neurologists should be given the flexibility in jobplanning to be able to develop integrated pathwaysthat extend outside secondary care, so that quality ofcare improves and clinic/hospital admissions arereduced.8 Workforce requirements for neurologyAt present there are 684 consultant neurologists inNHS practice in the UK, with 274 national trainingnumbers.To provide a comprehensive DGH neurology servicethat includes scheduled and unscheduled neurologicalcare, at least 3.6 whole-time equivalent (WTE)neurologists per 250,000 population are required – atotal of around 880 consultants in the UK. 2There is a need and increasing demand for 7-day24-hour expert services. This will be difficult to providefor neurology with the current consultant numbers –particularly at DGH level. It is unrealistic that allexisting DGHs will provide such a specialist neurologyservice; this should happen in larger DGHs with NCsand RNCs, with an absolute minimum number of 1neurologist per 70,000 population to cover one siteevery day of the week. If there aren’t enoughneurologists to allow that level of staffing, then therewill need to be a rationalisation of the number ofhospitals that are able to admit, investigate and managepatients with neurological illness.The projected greater liaison with community servicesis also likely to be demanding on time. Time needs to bemade available through job planning to allow aneurologist to teach and supervise GPwSIs andcommunity nurses in a range of topics includingParkinson’s disease, multiple sclerosis and motorneuron disease, brain injury, headache and epilepsy.178 C○ Royal College of Physicians 2013