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

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1 Physicians in the NHS todayrelationships between specialists and GPs, will probablyrequire more and not fewer specialists coupled with newcontractual arrangements.There is also an increased need to be aware of the healthof a local population and the incidence and prevalenceof particular diseases to best plan patient pathwaysinvolving primary care and specialist care, as well aspublic health medicine.Changing delivery of medical careThe delivery of acute medical care has graduallychanged. The new specialty of acute medicine isproviding more of this service. The traditional role ofthe consultant general physician in acute medicine hasreduced in recent years. However, the rising number ofmedical admissions and the increasing number of frailolder people with a number of different conditionsmeans that we have to think seriously about the bestway to care for the acutely ill medical patient and thebest balance between specialists and general physicianswith an interest in a specialty.There is also a need for more specialist centres to givehighly specialised care to a population, eg thrombolysisin stroke, because every hospital dealing with acutemedical admissions may not give this treatment. Astechnology advances, there are merits in groupingexpertise together in specialised centres that cover abigger population than a local hospital. Thesedevelopments may drive the need for reconfigurationof hospitals.Working with patientsPatients, relatives and carers are knowledgeable. Theyask questions, and expect and require answers. Theywant to be more involved in making decisions about thepattern of their care. Many now communicate withtheir doctors by text and email, asking questions derivedfrom internet searches. The doctor–patient relationshipis evolving towards a more open, honest and equalpartnership from which we all benefit. Physiciansincreasingly involve patients and their carers instrategic plans and developments as well as decisionsabout their individual treatment and care. There isincreased emphasis on shared decision-making betweenpatients and their health professional – the RCP istaking this work forward in partnership with others,including patient groups and the departmentsof health.The RCP has appointed a clinical fellow in SharedDecision Making and supportive self-management totake this agenda forward.Many physicians also work with patient groups toinform the development of services and there is muchevidence of that in the specialty sections of Chapter 2.As revalidation becomes a reality, individual patientfeedback to clinicians will become routine. The nextstep, where this does not already happen, will be to gainunderstanding and feedback from patients and carersabout the totality of the clinical service and to use thisinformation to guide further developments.There is a need for future work on how best to workwith patients and the public, to involve them as truepartners in service development and to learn from theirperspectives to improve clinical care and services.The RCP has a well-established Patient InvolvementUnit. The role of this unit is to encourage and promotepatient, carer and public involvement in RCP activities,and to ensure that all plans and decisions made withinthe RCP have been considered in collaboration withpatients, carers and the public before implementation.In addition to employed staff the unit has a lay patientandcarerchairaswellasanRCPofficer.Over60patients and carers are members of the Patient andCarer Network. Network members are recruitedthrough open advertisement in a variety of media,including the Big Issue. They complete an applicationand interview, and references are taken up beforeconfirmation of appointment for a 3-year tenure, withthe option to extend by a further year.The lay chair is responsible for chairing the Patient andCarer Steering Group where the strategic aims of theunit are discussed and developed. The lay chair is also afull member of Council.The RCP has worked hard to ensure that patient andcarer involvement is integrated into all areas of itsbusiness. Every specialty medical committee/board hastwo patient/carer members. This involvement has beena key tool in ensuring that the RCP has considered andacted upon first-hand patient expertise and experience.All patient care pathways and chapters of this book havebeen considered and contributed to by the members ofC○ Royal College of Physicians 2013 11
Consultant physicians working with patientsthe RCP Patient and Carer Network members via thesework streams.Patients and carers with long-term conditions havemany opportunities to observe what systems work andwhat systems could be improved within healthcareservice delivery. The RCP document, Teams withoutwalls, 24 highlighted the need to break down barriers(both physical and virtual) to improve healthcareservices resulting in improved care. Patients and carerssupported the production of this report, and areworking hard to ensure that the content is embeddedinto working practice.Members of the Patient and Carer Network have beenable to inform the RCP on both where they feel areas ofgood practice exist and where there could beimprovement to patient care.The content of this book is a testament to theimprovements that have been made in approaches topatient and carer services and healthcare delivery. Thewidespread introduction of multidisciplinary teams,and work to remove barriers between different parts ofthe health service and different agencies have improvedpatient care. The future development of new approachesto education development and training, patient andcarer involvement, advanced patient care pathways, andpatient and carer feedback will continue to informfuture developments and improved patient care.It is essential that there is strong patient and carerinvolvement in future commissioning and servicedevelopment arrangements, if the needs of patients andcarersaretobemetappropriately.Themechanismforthis in England is unclear at present, with the changes ofthe new health Act, but it is essential that there is astrong patient and public voice in the development offuture services.Academic medicineThe Cooksey report, published in 2006, introducedchanges to the way in which UK research was structuredand funded. 25,26 In the NHS the value of research isjudged increasingly on perceived health and societalneeds rather than scientific expertise alone. TheNational Institute for Health Research (NIHR) hasdeveloped an infrastructure through which theresearch-active physician should be able to contribute tothis vision. Despite this, challenges remain. Culturalchanges in the NHS place an increasing emphasis onclinical service over teaching and research.The potentially conflicting demands of employers (egNHS, universities, industry and grant-awarding bodies),those who fund research (eg national awarding bodiesand charities), and training and regulatory institutions(eg royal colleges and the GMC) need to be reconciled.The move towards a consultant-delivered clinicalservice and the workload relating to clinical governance,revalidation and CPD may mandate new ways ofworking, and achieving a balance between clinical andacademic training, and geographical mobility will beneeded.Through a series of working parties and associatedpublications, the Academic Medicine Committee(AMC) of the RCP has attempted to address these issues.First, it has held workshops and published positionpapers concerning routes of entry and training systemsin academic medicine. 27 The need for a transparentcareer structure up to and including properly structuredand supported consultant posts has also been debated. 28Second, the AMC has been an integral part of the RCP’sMedicines Forum, leading the workstream relating totranslational research. Specifically it has identified waysin which the RCP can act as a link between nationalagencies and the research-active physician, therebyfacilitating the UK research agenda. Finally, the AMChas provided evidence to a number of investigations,consultations and reports, the most significant of whichhas been the 2011 report of the Academy of MedicalSciences into the burden of regulation impacting on UKresearch and clinical trials. 29SummaryThe context of clinical practice has changed rapidlysince the millennium and is set to change further.Revalidation, changes in medical education andresearch, and the expansion of the potential portfolio ofthe consultant coupled with a move towards aconsultant-delivered service and servicereconfiguration, pose challenges and unrivalledopportunities. There is a need for clinical leadership inmanagement, quality improvement, andcommissioning and planning of services.Better planning, support, education and training of theconsultant workforce are now needed to ensure that we12 C○ Royal College of Physicians 2013
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