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

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