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

More documents

Recommendations

Info

2 Specialties Nuclear medicine imaging equipment appropriate for the casemix,which should be maintained to publishedspecifications radiation protection measures to comply with allrelevant legislation office space for other staff information technology, access to electronicpatient record (EPR), results reporting andprescription analysis, and cost tabulation, PACSfacilities.If the department uses PET-CT, single-photon emissiontomography–computed tomography (SPET-CT) andpositron emission tomography–magnetic resonance(PET-MR), additional facilities may be required for staffand patients. Paediatric services may require areas forrecovery after general anaesthesia.Inpatient radionuclide treatment must take place in adedicated facility with appropriate monitoringequipment and shielding for radiation protection, andbe performed by correctly trained medical andnon-medical staff. This may involve a dedicated areawithin the nuclear medicine department, interventionalradiology and dedicated ward areas.Maintaining and improving the qualityof careAll procedures are undertaken in accordance withwritten departmental standard operating procedures(SOPs); where possible these procedures andprotocols should be derived from the BNMS orEuropean guidelines. 3–10 The expected expansion ofnuclear medicine services within cancer centres willsupport cross-specialty liaison and shared access topurpose-built, shielded facilities for radionuclidetherapy. Improving access to radionuclide therapythroughout the UK will require close MDT cooperationand mentorship of individuals working in small centres.Nuclear medicine specialists provide expert advice toMDTs and tumour working groups within cancernetworks about radionuclide treatment options forpatients with malignant disease.Service developments to deliver improvedpatient careThe 2003 intercollegiate report recommendedprioritising nuclear medicine specialist support for allUK cancer networks in a ‘hub-and-spoke’ model. 2Central (hub) functions include protocol development,provision of comprehensive diagnostic services andradionuclide therapy. Smaller (spoke) departmentsundertake a limited range of radionuclide imaging andtherapy for benign disease. Access to PET-CT hasimproved following implementation of keyrecommendations for the development of PET servicesin England. 5 Mobile service provision continues as aninterim measure probably until 2015. Planning of howto replace this mobile provision should commence 2years before any transfer of work from a mobile to astatic site.A recent review published by the British Institute ofRadiology 11 hasshownamassivevariationinprovisionof radionuclide therapy in cancer with patients in thenorth west and London being well served whileprovision in the rest of the country is oftenlimited.Education and trainingThe small number of UK consultants results insubstantial education commitments to nuclearmedicine trainees, specialty registrars in otherdisciplines and non-medical staff. Training curricula,standards and competency assessment measures havebeen developed to allow non-medical healthcare staff toundertake extended roles, thereby improving localaccess to nuclear medicine. A long-term issue has beenthe need for the modern nuclear medicine trainee toreceive adequate training in cross-sectional imaging.Although there have been examples of good localinitiatives, further work is needed to ensure thatdelivery of such high-quality relevant training is seennationwide. It is hoped that such a programme will berolled out in 2013–14.Consultants are expected to undertake at least 50 hoursof continuing professional development (CPD) perannum and may take a leading role in clinicalgovernance. Work plans should include protected timefor clinical audit, which will often be undertaken atregional or national level.Research – clinical duties and basic scienceNuclear medicine techniques are used extensively inmedical research. The 2003 college censusindicated that 40% of consultants held at leastpart-time academic contracts. 12 The pressing need todevelop academic molecular imaging is addressedwithin current proposals for curriculum and trainingreview.C○ Royal College of Physicians 2013 183
Consultant physicians working with patientsLocal management dutiesMany nuclear medicine consultants have managerialduties as heads of departments and statutoryresponsibilities with respect to the Administration ofRadioactive Substances Advisory Committee (ARSAC)and the Medical Application of Radioactive Substances(MARS) regulations. Many also contribute to the workof radiation protection and research ethics committees.Regional and national workThe small number of nuclear medicine consultantsnationally results in strong commitments to externaleducational and professional leadership. They will oftentake a leadership role with their region. It would beexpected that most consultants in nuclear medicinewould be involved in national committees at some pointin their professional life.Specialty and national guidelinesSpecialty guidance for nuclear medicine is summarisedin Table 1.6 Clinical work of consultantsHow a consultant works in this specialtyNuclear medicine is a consultant-delivered service.Specialists are responsible for justifying, supervisingand reporting diagnostic investigations and foradministering unsealed source therapy. At present, fewnuclear medicine departments provide on-call nuclearmedicine diagnostic services but pressure for extendedhours working is anticipated. The supply ofradiopharmaceuticals outside normal working hoursmay be problematic. Centres that undertake inpatienttherapy provision must ensure consultant on-callavailability.Typical time requirements for completion of differentprocedures are suggested in Table 1. These allow forreferral vetting, patient assessment, manipulation ofdrug therapy where appropriate, procedure supervision,discussion with patients and colleagues, review of otherimaging/case notes and authorisation of final reports.Also reporting of imaging should not be in isolation butreference made to previous imaging of the patientavailable on PACS.7 Opportunities for integrated careNuclear medicine consultants work closely withreferring clinicians to ensure timely access to diagnosticinvestigations, in particular to ensure that studies areperformed within the required guidelines. However,recent problems with the production of theradio-isotopes themselves have meant prolonged waitsfor some specialised studies. This shortage situation isexpected to continue till 2018. The specialty hasresponded quickly to meet the requirements of‘one-stop’ outpatient and acute medical assessmentunits. Integrated care within the hospital setting is wellestablished for patients undergoing targetedradionuclide therapy, with close cross-specialtycollaboration being reinforced by MDT working.Shared care with palliative care and community teams isincreasing to ensure supervision close to home afterradionuclide treatment. The use of hybrid imaging(PET-CT, PET-MR and SPRCT-CT) often means asingle set of images is all that is needed for diagnosis, sooffering a ‘one-stop’ diagnostic service. This has oftenmeant close working with specialist nurses in bothoncology and non-oncological specialties. Specialarrangements allow specialist nurses to requestnuclear medicine studies and remain IR(ME)Rcompliant8 Workforce requirements for the specialtyThere are approximately 230 individuals on the GeneralMedical Council’s (GMC’s) specialist register fornuclear medicine. The 2011 RCP census listed nuclearmedicine as the main specialty of 72 college members(64 in England and 2 in Scotland), a fall of 2 since 2009.However, not all of these people work full time in thespecialty. 12 The picture is complicated by thecontribution of specialists in other disciplines,particularly radionuclide radiology, to nuclear medicineservice delivery, many of whom spend only a fewsessions per week in the specialty. The 2000Intercollegiate Standing Committee in NuclearMedicine survey identified about 190 trusts thatprovided nuclear medicine services, with an average of2.2 consultants per trust, 2 equating to approximately400 consultants. The survey did not indicate the timeallocation to nuclear medicine, however, and sometrusts failed to identify any medical time at all for theservice. The RCR census of 2011 13 identified 140radiologists as providing a radionuclide service. Thismay include some double counting with the RCPcensus. Also those who report radionuclide studies butdo not have any dedicated sessions may not havemarked radionuclide radiology as a main area ofsubspecialty interest.184 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:
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 145 and 146: Consultant physicians working with
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 189: 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 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?